Iranian Journal of Kidney Diseases
Volume:13 Issue: 6, Nov 2019

Non-adherence to treatment is a common problem among hemodialysis (HD) patients and was considered as a reliable factor in patients deteriorating, increasing admission chance and inappropriate responding to HD treatment. According to multiple factors related to Non-adherence with HD treatment and its importance in patients’ quality of life, this study aims at a systematic reviewing of Non-adherence to treatment among Iranian dialysis patients. Treatment with adherence status is one of the problems that patients encounter during dialysis. This study aims at detecting the most important causes of Non-adherence in patients on dialysis according to previous studies. First, all of the studies related to our title were searched using main keywords (dialysis, hemodialysis, adherence, and non-adherence) for English and Persian databases; Iranmedex, Magi ran, SID, Iran doc, Google, Google scholar, PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic that covering the period from 2010 to 2018 was reviewing following a predefined inclusion and exclusion criteria. As a result, 40 papers related to inclusion and exclusion criteria were identified and analyzed. Data were collected according to study features, measures of Non-adherence, prevalence rates and factors related to Non-adherence. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this systematic review. According to the results of present study six main categories were found. The main reasons for Non-adherence with treatment in dialysis patients listed in the papers included: Patient related factors, socioeconomic factors, psychological factors, health care related factors, therapy related factors and disease-related factors. Trying to improve adherence is very important and can play a significant role in increaseing the health status among patients on dialysis.

 Urinary angiotensinogen (uAGT) has been described as a novel biomarker of acute kidney injury (AKI) and chronic kidney disease (CKD). Renal interstitial inflammatory cell infiltration is a common renal pathological feature of AKI and CKD. However, the correlation between uAGT and renal interstitial inflammatory cell infiltration is unknown. The aim of this study was to analyze the expression of uAGT, its relationship with interstitial inflammatory cell infiltration, and prognosis in patients with renal insufficiency.

The expression of uAGT, urinary kidney injury molecule 1 (uKIM-1), and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were examined by enzyme-linked immunosorbent assay (ELISA) at baseline and kidney pathology was evaluated at the same time.

Sixty-five patients with renal insufficiency and 12 healthy controls were enrolled. uAGT, uKIM-1, and uNGAL levels were significantly higher compared with healthy participants. uAGT showed the strongest correlation with interstitial inflammatory cell infiltration (r = 0.366, P < .05). uAGT level was able to identify interstitial inflammatory cell infiltration with greater accuracy (AUC = 0.664, P < .05) than other urinary biomarkers. After a median follow-up of 22 months, 15 patients reached the composite renal endpoint. Kaplan meier survival curves followed by multivariate cox proportional hazards regression analysis showed that uAGT (> 166.8 ng/mg creatinine) independently predicted higher risk of the endpoint.

uAGT may be used as a non-invasive biomarker of interstitial inflammatory cell infiltration and a strong predictor of renal prognosis in patients with renal insufficiency.

The mortality rate in patients with acute kidney injury (AKI) is high. The aim of this study was to evaluate the efficacy of treatment with adipose-derived mesenchymal stem cells (AD-MSC) in renal ischemia-reperfusion (I/R) model in rats.

In this study 28 male Wistar rats were divided into four groups of control, sham, I/R24h+PBS, and I/R24h+AD-MSC. Blocking the renal arteries for 45 minutes induced renal I/R and then reperfusion was conducted for 24 hours. Parameters including urine volume, osmolarity, plasma creatinine (Crp), and blood urea nitrogen (BUN) were evaluated and values of creatinine clearance (CCr), absolute sodium excretion (UNaV°), fractional excretion of sodium (FENa), absolute potassium excretion (UKV°) and fractional excretion of potassium (FEK) were calculated. The right kidney was removed to measure the malondialdehyde (MDA) and ferric reducing antioxidant power (FRAP), as well as the left kidney for histological evaluation.

I/R caused a significant increase in Crp, BUN, UNaV°, FENa, FEK, MDA, and tissue damages. In addition, the values of CCr, urine osmolarity, and FRAP level decreased significantly (P < .05). Following AD-MSC treatment, values of FENa, Crp, FEK, MDA, and tissue damages decreased significantly, while urine osmolarity increased significantly in the I/R24h + AD-MSC group compared to the I/R24h + PBS group. Furthermore, FRAP values increased significantly (P < .001). Conclusion. Treatment with AD-MSC reduced tissue damage and oxidative stress while increasing antioxidant activity. In addition, it improved kidney function after 45 min ischemia and 24 h reperfusion.

 Kidney involvement is a hallmark of systemic lupus erythematosus (SLE) and evaluation of its inflammatory response is demanding. It was the aim of the present study to evaluate the levels of CXCL10 and vitamin D in serum samples of cases with active lupus nephritis (LN).

Fifty lupus patients were enrolled in our study, 25 patients had lupus nephritis and 25 patients were without evidence of LN. Thirty-nine healthy subjects were also participated as a control group. Complete biochemical and serological parameters were measured and their correlation with serum levels of vitamin D and CXCL10 were assessed in the studied groups.

Serum levels of CXCL10 were significantly elevated (P≤ 0.020), while vitamin D were diminished in SLE group and active LN as compared with healthy controls and SLE patients without nephritis, respectively. CXCL10 correlated with SLE disease activity index (SLEDAI) and renal activity (P < .05), while vitamin D correlated with C3 and anti-dsDNA antibody (P < .05). Based on the receiver operator characteristic (ROC) curve analysis, CXCL10 and vitamin D levels were not better than conventional biomarkers for discriminating LN patients from non-nephritis SLE patients; however, they could differentiate most of SLE cases from healthy individuals with area under the curve (AUC) ≥ 0.703 (P < .05).

Results indicated the importance of elevated levels of CXCL10 and deficiency of vitamin D on the pathogenesis of active LN disease.

 The central venous catheter (CVC) has been shown to increase mortality in hemodialysis (HD) patients compared with the arteriovenous fistula (AVF). However, no study has examined the mortality of HD patients based on the time of conversion from the CVC to AVF. In this study, we investigated the association between patients’ survival and length of time of using each access.

The C5.0 algorithm was used to find rules about the relationship between duration of the different access usage and survival. The cox model was applied to assess the association of the obtained duration categories and mortality.

From 2367 adult patients who received maintenance HD from 2012 to 2014, 705 patients were eligible for the study. Using an AVF for more than 8 months and a CVC for less than 4.2 months had the highest one-year survival rate (91.8% and 87.4%). The hazard ratio (HR) for mortality of less than 2.8 months of AVF usage compared to the longest usage was 6.90 (95% CI: 4.60 - 10.30) before adjustment and 5.03 (95% CI: 3.20 - 8.00) after adjustment for all confounders. For the CVC, the ratio was 8.8 (95% CI: 6.00 - 13.00) when comparing more than 9.2 months of usage with the lowest usage duration before an adjustment and 6.00 (95% CI: 3.80 - 9.41) after adjustment.

Our results presented that regardless of the type of initial vascular access, limiting the length of the time using CVC as well as switching to AVF could significantly improve the survival of HD patients

 Hemodialysis (HD) patients are a high-risk population for acquiring blood-borne viruses such as HHV-6. HHV-6 can remain latent in the host cells after primary infection; the reactivation of virus may result complications such as seizure, respiratory failure, hepatitis, and encephalitis. There is a limited report concerning HHV-6 infection in HD patients in Iran. Thus, this study was conducted to determine the frequency of HHV-6 among HD patients.

We determined HHV-6 DNA in sera samples of 84 patients undergoing HD. The DNA was extracted from the sera samples and the presence of HHV-6 DNA variants A and B was evaluated by nested PCR.

52/84 (61.9%) of HD patients were males and 32/84 (38.1%) females. The age ranges of patients were between 18 to 85 years and the mean age was 52 ± 1.52 (± SD) years. Out of 84 sera samples, HHV-6 DNA was detected in 10 (11.9%) participants, including 6/52 (11.5%) in males and 4/32 (12.5%) in females. HHV6A was detected in 10/10 (100%) of positive cases. No HHV-6 B was found in HD patients. The distribution of HHV-6A DNA was not significant between genders (P > .05). Out of 84 HD patients, 55 (65.47%) cases were over 50 years, among them 10 (18.18%) cases were positive for HHV-6 A infection (P < .05).

The results showed that only HHV-6 DNA variant A was found in 11.9% of HD patients. Regarding the consequence of HHV-6 reactivation, to manage and improve treatment, the screening of HHV-6 DNA test should be implemented for HD patients.

Tacrolimus is the cornerstone of immunosuppressive therapy in organ transplantation with variable inter-individual pharmacokinetics. This study assessed the relationship between CYP3A5/3A4 polymorphisms and tacrolimus dose requirement as well as 6-month transplant outcomes in Iranian kidney transplant recipients.

In this prospective study, 110 adult kidney transplant recipients treated with tacrolimus were genotyped for the presence of common SNPs: rs776746: A > G (CYP3A5*3). Patients who carried at least one CYP3A5*1 allele were known as CYP3A5 expressers while those who were CYP3A5*3/*3 homozygotes were classified as CYP3A5 non-expressers.

The daily tacrolimus dose was significantly higher and tacrolimus dose adjusted trough levels (C/D ratio) was significantly lower in CYP3A5 expressers compared with non-expressers (P < .05). Although the incidence of clinically suggested acute allograft rejection was significantly higher (OR = 0.365 [95% CI: 0.14 - 0.93]; P < .05) and median time to first acute rejection was sooner among CYP3A5 expressers compared with non-expressers (12.17 vs. 26.83 days, P < .05); however, estimated glomerular filtration rate, incidence of biopsy proven acute rejection and delayed graft function and 6-month patients’ and grafts’ survival did not differ between the two groups.

CYP3A5 genetic polymorphism is significantly associated with required tacrolimus dose. After achieving desired tacrolimus blood level, although some transplant outcomes such as the incidence of clinically suggested acute rejection and time to first rejection were different between CYP3A5 expressers and non-expressers, however, other clinical outcomes did not differ between groups. Therefore, it is not the time to routinely assess kidney transplant recipients for CYP3A5 genetic polymorphism before transplantation

Sheehan syndrome (SS) is postpartum hypopituitarism resulting from pituitary gland necrosis caused by severe hypotension due to massive intra or post-partum hemorrhage. Defective NaCl transport in the distal convoluted tubule, due to mutations affecting the thiazide sensitive Na-Cl-cotransporter results in the autosomal recessive salt-losing renal tubulopathy, Gitelman syndrome (GS). These two have been rarely described together. We report the case of a middle-aged woman with both these conditions, resulting in management issues. Physicians encountering unexplained hypokalemia refractory to standard management must consider the possibility of renal tubular disorders.