فهرست مطالب

  • Volume:14 Issue: 4, 2020
  • تاریخ انتشار: 1399/05/04
  • تعداد عناوین: 15
|
  • Simin Dashti-Khavidaki*, Hossein Khalili, Anahid Nourian Pages 247-255

    Treatment of coronavirus disease 2019 (COVID-19) among patients with CKD requires special pharmacotherapy considerations that are reviewed here. Literature review was done for several pharmacotherapy aspects in CKD patients including selection and modification of COVID-19 treatment, drug interactions, nephrotoxicity of drugs that are used for treatment of COVID-19 and potential risks/benefits of routine medications of CKD patients during COVID-19 pandemic. CKD patients should be treated according to local or national COVID-19 protocols as other patients. But, there is no data on using remdesivir in patients with severe CKD. Oseltamivir and ribavirin require dose modification in patients with moderate to severe CKD. Nephrolithiasis, CKD, and acute interstitial nephritis have been reported with protease inhibitors. Acute kidney injury has been reported with remdesivir in patients with severe COVID-19. Pharmacokinetic-enhanced protease inhibitors increase the concentration of some drugs such as statins, cinacalcet, steroids, calcineurin inhibitors (CNIs). Some hypothetical benefits and harms have been suggested for statins and renin-angiotensinaldosterone system inhibitors in COVID-19 patients. Continuing guideline-directed administration of these drugs is recommended. Among different immunomodulating/immunosuppressive drugs, hydroxychloroquine and CNIs are the safest ones during COVID-19. Antimetabolites are suggested to be withheld during moderate to severe COVID-19. Fluid therapy and anticoagulant prophylaxis/ treatment need special attention in CKD patients with COVID-19. CKD patients with COVID-19 are treated as other patients, with some dose modifications if needed. Be mindful for management of drug interactions as well as modification of immunosuppressive drugs in patients with moderate to severe COVID-19.

    Keywords: CKD, COVID-19, pharmacotherapy, SARS-CoV-2
  • Zhouke Tan, Guibao Ke, Junlin Huang, Die Yang, Mingjing Pi, Li Li, Xiaolin Liu, Shaohua Tao, Lvlin Chen, Guobiao Liang, Shuangxin Liu * Pages 256-266

    Carvedilol, the third generation of vasodilators; serves as the blocker of non-selective beta-adrenergic receptor and alpha1 adrenergic receptor. It could protect the cardiovascular system of patients receiving dialysis treatment. However, current clinical trials discussing the therapeutic benefit of carvedilol on patients receiving dialysis treatment remain inconsistent. Consequently, we decided to perform a meta-analysis to evaluate the clinical efficacy of carvedilol on patients receiving dialysis treatment. A search was conducted using EMBASE, Pubmed, Cochrane Central Register of Controlled Trials, Wanfang database, Chinese National Knowledge Infrastructure (CNKI), and VIP information database up to February 2020. We research publications (include English and Chinese language) that discuss the effects of carvedilol on cardiovascular events, all-cause mortality, hospitalizations or left ventricular ejection fraction (LVEF) in dialysis population. Our analysis included 4 randomized control trials and 2 observational studies. We discussed the therapeutical effects of carvedilol on all-cause mortality, cardiovascular events, hospitalizations, and LVEF of patients receiving dialysis treatment. Totally, this analysis reported 2998 hemodialysis (HD) patients. We found a significant association between carvedilol and reduced incidence of all-cause mortality, cardiovascular events and hospitalizations in HD patients. In addition, carvedilol significantly improves LVEF (n = 241; WMD = 6.95; 95% CI, 0.54 to 13.36; I2 = 90%) in HD population. Our systematic review and meta-analysis demonstrates that carvedilol is associated with a reduced incidence of cardiovascular events, all-cause mortality and hospitalizations in patients on HD. Besides; carvedilol significantly improves LVEF in HD population. Nevertheless, high-quality and well-powered evidence is still needed, so as to further confirm the impacts of carvedilol on HD patients.

    Keywords: carvedilol, cardiovascular events, mortality, hemodialysis
  • Alireza Abrishami, Nastaran Khalili, Nooshin Dalili *, Reza Khaleghnejad Tabari, Reza Farjad, Shiva Samavat, Ali Neyriz Naghadehi, Hamidreza Haghighatkhah, Mohsen Nafar, Morteza Sanei-Taheri Pages 267-277
    Introduction

    In this study, we aimed to evaluate the presentation and outcome of COVID-19 in patients with chronic kidney disease (CKD).

    Methods

    We included 43 patients with a past history of CKD and confirmed diagnosis of COVID-19. Patients were evaluated for demographic characteristics, clinical and laboratory data and findings of initial chest computed tomography (CT) and were followed until either death or discharge occurred. Then, study variables were compared based on final outcome and stage of CKD.

    Results

    Mean age ± SD of patients was 60.65 ± 14.36 years; 65.1% were male. Five of 43 patients (11.6%) died on follow-up and the rest were discharged. Disease outcome did not differ across CKD stages (P > .05). More than half of the patients (58.1%) presented with severe disease on admission. Clinical symptoms were similar to those of non-CKD individuals. Mean duration of hospitalization was higher in those who died, although not significant (16.6 ± 8.38 vs. 11 ± 6.26, P > .05). The only hematologic parameter that significantly differed between survivors and non-survivors was lactase dehydrogenase level (P < .05). Ground-glass opacification and reticular pattern were the most frequent patterns on CT and pleural effusion existed in about one-fifth of all patients. A greater lower zone score was noted in deceased patients (P < .05).

    Conclusion

    Patients with CKD are vulnerable to a more severe form of COVID-19 and experience a higher mortality rate than the general population; however, higher CKD stage is not related to worse prognosis or different imaging manifestation compared with lower stage.

    Keywords: chronic kidneydisease, COVID-19, computedtomography, mortality
  • Nasrin Esfandiar, Ghamartaj Khanbabaee *, Khadijeh Riazi Kermani Pages 278-281
    Introduction

    A few data on the prevalence of renal involvement in cystic fibrosis and its spectrum in childhood is available. In the present study, we conducted a prospective study on children who had cystic fibrosis and evaluated their renal involvement. In fact, the aim of the study was to provide data on the clinical consequences of proper identification of kidney disease in a group of children with cystic fibrosis.

    Methods

    This prospective study was conducted on 55 consecutive patients with previous diagnosis of cystic fibrosis during a threeyear period and at least 3 months to over 5 years or more follow-up. The inclusion criteria was the diagnosis of cystic fibrosis which was made by clinical presentation of cystic fibrosis and laboratory results. Initially, patients’ medical records were reviewed and relevant data were collected. A 24-hour urine collection (or a random urine sampling in very young infants) was used to assess crystalluria and renal function was evaluated by blood sampling.

    Results

    Totally, 55 patients with cystic fibrosis were admitted in two hospitals with the mean age of 8.22 ± 5.66 years. GFR totally reduced in 34.5%. The overall prevalence of hypercalciuria was estimated to be 60%, while hyperoxaluria, hypocitraturia, and hyperuricosuria in 41.8%, 24.5%, and 47.3%; respectively.

    Conclusion

    Crystalluria is a common consequence of cystic fibrosis in childhood. The prevailing crystalluric finding includes hypercalciuria followed by hyperuricosuria, and hyperoxaluria. During disease GFR may be decreased due to several reasons such as nephrotoxic drugs usage.

    Keywords: cystic fibrosis, renalinvolvement, children
  • Guanhua Guo, Yingsi Zeng, Qinkai Chen, Xiaojiang Zhan, Haibo Long, Fenfen Peng, Fengping Zhang, Xiaoran Feng, Qian Zhou, Xianfeng Wu, Xuan Peng, ET NA, Xiaochun Lai, Yujing Zhang, Zebin Wang, Yueqiang Wen*, Jianbo Liang Pages 282-289
    Introduction

    Though neutrophil/lymphocyte ratio (NLR) level appears to be related with stroke events in general population, its relationship with stroke in peritoneal dialysis (PD) patients is still uncertain. This study aims to investigate the association between NLR and the first occurrence of stroke in PD patients.

    Methods

    In this retrospective cohort study, 1507 PD patients were enrolled from four centers in China and stratified into tertiles of NLR levels. The incidence of the first occurrence of stroke was analyzed by Kaplan-Meier cumulative incidence curve among different NLR tertiles, competing risk analysis was used to calculate the incidence of the first occurrence of stroke in the presence of competing risk of other events, multivariable COX regression analysis was performed to estimate the hazard ratios (HRs) for the first occurrence of stroke, as well as forest plot was utilized to describe the relationship between NLR and the first occurrence of stroke in different subgroups.

    Results

    During follow-up, 84 new-onset stroke events were recorded. Kaplan-Meier cumulative incidence curves showed significant differences in the incidence of the first occurrence of stroke among three groups (log-rank test: P < .001). In competing risk analysis, the cumulative incidence curves for tertiles of NLR levels were highly significant for the first occurrence of stroke (P < .001), but they were not statistically different for the occurrence of other events. Compared to the lowest tertile of NLR level, the highest tertile was associated with increased risk of the first occurrence of stroke in the adjusted Cox model (HR = 2.39, 95% CI: 1.37 to 4.15; P < .05). As for forest plot, there was no interaction in all subgroups.

    Conclusion

    High NLR was an independent risk factor for the first occurrence of stroke in PD patients.

    Keywords: neutrophil-tolymphocyte ratio, peritonealdialysis, stroke
  • Rana Shafabakhsh, Zatollah Asemi, Zeljko Reiner, Alireza Soleimani, Esmat Aghadavod, Fereshteh Bahmani * Pages 290-299
    Introduction

    This study evaluated the effects of nano-curcumin intake on metabolic status in patients with diabetes on hemodialysis (HD).

    Methods

    This randomized, double-blind, placebo-controlled clinical trial was performed on 60 patients with diabetes on HD. Participants were randomly divided into two groups to take either 80 mg/d nano-curcumin (n = 30) or placebo (n = 30) for 12 weeks.

    Results

    Nano-curcumin significantly decreased fasting plasma glucose (β = -19.68 mg/dL, 95% CI: -33.48 to -5.88; P < .05) and serum insulin levels (β = -1.70 µIU/mL, 95% CI: -2.96 to -0.44; P < .05) when compared with patients who received placebo. Nanocurcumin treatment was associated with a significant reduction in triglycerides (β = -16.13 mg/dL, 95% CI: -31.51 to -0.75; P < .05), VLDL-cholesterol (β = -3.22 mg/dL, 95% CI: -6.30 to -0.15; P < .05), total cholesterol (β = -17.83 mg/dL, 95% CI: -29.22 to -6.45; P < .05), LDL-cholesterol (β = -15.20 mg/dL, 95% CI: -25.53 to -4.87; P < .05), and total-cholesterol/HDL-cholesterol ratio (β = -1.15, 95% CI: -0.2.10 to -0.21; P < .05) when compared with the placebo. Nanocurcumin also resulted in a significant reduction of serum high sensitivity CRP (β = -0.78 mg/L, 95% CI: -1.41 to -0.15; P < .05), and plasma malondialdehyde (β = -0.25 µmol/L, 95% CI: -0.45 to -0.04; P < .05); but also with a significant increase in plasma total antioxidant capacity (β = 52.43 mmol/L; 95% CI: 4.52 to 100.35; P < .05) and total nitrite levels (β = 3.62 µmol/L, 95% CI: 2.17 to 5.08; P < .001) when compared with placebo.

    Conclusion

    Nano-curcumin intake for 12 weeks had beneficial effects on metabolic profile in patients with diabetes on HD.

    Keywords: nano-curcumin, insulin resistance, LDLcholesterol, triglycerides, hemodialysis, diabetes
  • Tahereh Malakoutian, Alireza Mirzaei, Azadeh Shiroudbakhshi, Azade Amini Kadijani, Arash Tehrani-Banihashemi, Mozhdeh Zabihiyeganeh * Pages 300-307
    Introduction

    Trabecular Bone Score (TBS) is an index of bone microarchitecture independent of Bone Mineral Density (BMD). Recently, TBS data has been used to optimize the predictive value of the Fracture Risk Assessment Tool (FRAX). The aim of this study was to evaluate the clinical value of FRAX adjustment with TBS in kidney transplant recipients.

    Methods

    Seventy post-transplant Iranian kidney recipients were included in this study. After the evaluation of BMD and TBS, the risk of major osteoporotic fracture (MOF) and hip fracture (HF) was assessed once with and once without TBS adjustment. The proportion of patients who needed a therapeutic intervention was compared before and after TBS adjustment. The association between TBS and BMD data was also evaluated.

    Results

    The mean age of the patients was 54 ± 8.8 years (range: 40 to 77). The mean TBS of the patients was 1.30 ± 0.12. In multivariate analysis, the TBS was significantly associated with the age (P < .05) and dialysis period (P < .05). A strong correlation was found between the spine BMD and TBS data (r = 0.612, P < .001). A significant correlation was found between the MOF and HF of the patients before and after adjustment for TBS. The proportion of patients needed a therapeutic intervention significantly increased from 17.1% to 25.7% after TBS adjustment of FRAX.

    Conclusion

    Adjustment of FRAX with TBS will reclassify the treatment decision in a considerable number of kidney transplant recipients. This clinical value warrants the adjustment of FRAX data with TBS in future workouts.

    Keywords: bone mineraldensity, trabecular bone score, fracture risk assessment, major osteoporotic fracture, hipfracture
  • Mohsen Akhavan Sepahi, Fateme Toloii, Shahram Arsang Jang, Bibi Leila Hoseini * Pages 308-311

    Renal scarring with reflux develops renal nephropathy. The risk is higher when it is associated with urinary tract infection (UTI). Hence, we investigated the prevalence of renal scars among children under one-year-old with the first UTI in Qom, Iran. We conducted this retrospective study on 140 infants divided in two reflux (n = 70) and non-reflux (n = 70) groups. Participant’s records had been analyzed by descriptive and analytic statistics. The prevalence of renal scar was 32.12% among all 140 infants. The prevalence of renal scars among children with and without reflux, was 33 (47.1%), and 12 (17.1%) out of 70 (P < .001); respectively. The rate of renal defects increased with higher grades of reflux. We found that the rate of renal scar is high in Qom. Therefore, we recommend screening susceptible children in order to prevent renal damage.

    Keywords: urinary tractinfection, vesicoureteral reflux, pediatrica, renal damage, prevalance
  • Masoud Hassanvand Amouzadeh, Mohsen Akhavan Sepahi*, Ezatollah Abasi Pages 312-314

    We report two sisters (13- and 4-year-old) presenting with moderate intellectual disability, dysmorphic facial features, intermittent hematuria, proteinuria, and dental caries. Their parents and other family members were not affected. Whole-exome sequencing was performed to screen the underlying genetic cause. These patients have been analyzed using Next-Generation Sequencing (NGS) method and homozygote variant (c.890delC) has been detected in the THOC6 gene. Direct Sanger sequencing confirmed that they are homozygote for the pathogenic variant mutations in the THOC6 gene, which is associated with Beaulieu-Boycott-Innes syndrome (BBIS). These patients also had proteinuria and subsequently developed hematuria. This is the first report of BBIS in association with proteinuria and hematuria without renal defects. Core clinical features include low birth weight with subsequent growth failure, short stature, and intellectual disability with language delay, characteristic faces, cardiac defects, and renal anomalies. The possible pathophysiological mechanisms associated with proteinuria and transient hematuria without renal defects are discussed.

    Keywords: developmentaldelay, intellectual disability, dysmorphic facial feature
  • Zakaria Hamdan, Mahdi Tarabeih, Kamel Jebrin, Emad Khazneh, Eman Abusalameh, Hanan Nuairat, Osama Sawalmeh * Pages 315-317
    Introduction

    The incidence of ESRD is increasing dramatically and the majority of patients are commenced to hemodialysis (HD) or peritoneal dialysis (PD) due to the long waiting time for renal transplantation. PD has comparable outcomes with HD but many barriers limit its utilization. Obesity is considered among the barriers and this was attributed to its related complications.

    Case Report

    A 50-year-old male patient with ESRD presented to our hospital for PD. He was extremely obese (BMI = 44.2 kg/m2). The case was discussed between the nephrology, surgical and nursing team, and the decision was made to proceed towards PD.

    Conclusion

    Obesity should not impede the beneficial effects of PD. The obstacles of obesity, which we faced; could be overcome with the collaboration between a highly qualified multidisciplinary team.

    Keywords: peritoneal dialysis, obesity, end-stage renaldisease
  • Hasan Haci Yeter*, Nisa Yetkin, Omer Faruk Akcay, Ulver Derici, Turgay Arinsoy Pages 318-320

    Familial mediterranean fever (FMF) is an autosomal recessive auto-inflammatory disorder, which could lead to secondary (AA) amyloidosis. Anakinra is an IL-1 receptor blocker and a treatment option for patients with FMF. There is no reported rejection episode associated with the use of Anakinra in the literature. A fortynine years old woman with a history of kidney transplantation is described here. Anakinra was initiated in the patients whose FMF attacks were exacerbated, and the inflammation could not be controlled under the colchicine treatment. After eight months of follow up under Anakinra treatment, a moderate but persistent increase in serum creatinine level was observed. Allograft biopsy was compatible with acute T cell-mediated rejection with BANFF type 2A. Data on the use of Anakinra in KTRs is limited. Antidrug-antibodies or hapten induced T cell activation may facilitate late-onset acute T cell-mediated rejection in the patient who used Anakinra.

    Keywords: anakinra, antidrug-antibody, hapten, kidneytransplantation, rejection
  • Mohammad Taghi Najafi, Mohammad Reza Abbasi, Seyed Ali Dehghan Manshadi, Soraya Rahimzadeh, Mohammad Hossein Shojamoradi * Pages 321-322
  • Muhammed Mubarak, Ramin Tolouian, Jolanta Kowalewska, Hamid Nasri * Pages 323-325
  • Page 329

    Erratum information (IJKD_V14_No3): On page 184, the name of Elahe Sanei should be added as 5th author with following affiliation “Mashhad University of Medical Sciences, Mashhad, Iran”. On Page 215, Table 2; Alpha Koloto must be changed to Alpha Klotho. On Page 215, Figure explanation must be read as “ It shows comparison of alpha klotho levels in exercise and control patients (alpha 1: before, alpha 2: after study, darman: exercise)”.