Uric acid in predicting the traumatic rhabdomyolysis induced acute kidney injury; a systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review and meta-analysis was to assess the value of uric acid in predicting acute kidney injury caused by traumatic rhabdomyolysis. METHODS: The search was conducted in MEDLINE, Scopus, Embase and Web of Science until November 1, 2023. Based on the inclusion and exclusion criteria, the articles were included by two independent researchers. Data regarding study design, patient characteristics, number of patients with and without AKI, mean and SD of uric acid and prognostic characteristics of uric acid were extracted from relevant studies. STATA version 17.0 was used to compute pooled measures of standardized mean differences, odds ratios, and diagnostic accuracy. I2 and chi-square tests were used to assess heterogeneity between studies. RESULTS: We found 689 non-redundant studies, 44 of them were potentially relevant. Six articles met the inclusion criteria and were included in the review. The results of the meta-analysis confirmed that there was a significant correlation between serum uric acid levels and the occurrence of AKI (SMD = 1.61, 95% CI = 0.69 to 2.54, I2 = 96.94%; p value = 0.001). There were no significant publication biases. CONCLUSION: According to this meta-analysis, uric acid levels could be considered as a predictor of acute kidney injury following traumatic rhabdomyolysis.

Acute kidney injury following traumatic rhabdomyolysis in Kermanshah earthquake victims; A cross-sectional study.

INTRODUCTION: Rhabdomyolysis induced acute kidney injury (AKI) develops due to leakage of the potentially nephrotoxic intracellular content into the circulation. This study aimed to evaluate the prevalence and predictive factors of AKI in Kermanshah earthquake victims. METHODS: This cross-sectional study was performed on victims of 2017 Kermanshah earthquake, Iran, who were admitted in Kermanshah and Tehran Hospitals. Data of the hospitalized patients were gathered and the prevalence of rhabdomyolysis induced AKI was studied. In addition, correlations of various clinical and laboratory variables with rhabdomyolysis induced AKI were assessed. RESULTS: 370 hospitalized patients with the mean age of 39.24 ± 20.32 years were studied (58.6% female). 10 (2.7% of all admitted) patients were diagnosed with AKI. Time under the rubble (p < .0001), serum level of creatinine phosphokinase (CPK) (p < .001), lactate dehydrogenase (LDH) (p < .0001), aspartate aminotransferase (AST) (p = .001) and uric acid (p = .003) were significantly higher in patients with AKI. Area under the ROC curves of CPK, LDH, AST, and uric acid for predicting the risk of developing AKI were 0.883 (95% CI: 0.816-0.950), 0.865 (95% CI: 0.758-0.972), 0.846 (95% CI: 0.758-0.935), and 0.947 (95% CI: 0.894-0.100), respectively. The best cutoff points for CPK, LDH, AST, and uric acid in this regard were 1656 IU/L, 839.5 U/L, 46.00 IU/L, and 5.95 mg/dL. CONCLUSION: The rate of traumatic rhabdomyolysis induced AKI development was estimated to be 2.7%. Time under the rubble and serum levels of CPK, LDH, AST, and uric acid were identified as the most important predictive factors of AKI development.

Effects of soy isoflavones on serum lipids and lipoprotein (a) in peritoneal dialysis patients.

BACKGROUND AND AIM: Lipid abnormalities are common in peritoneal dialysis (PD) patients and no effective treatment to decrease serum lipoprotein (a) [Lp(a)] in dialysis patients is known so far. Therefore, this research was designed to investigate the effects of soy isoflavone supplement on serum lipids and Lp(a) in PD patients. METHODS & RESULTS: In this randomized, double-blind, placebo-controlled trial, 40 PD patients were randomly assigned to either the isoflavone or the placebo group. The patients in the isoflavone group received 100 mg soy isoflavone daily for 8 weeks, whereas the placebo group received corresponding placebos. At baseline and the end of the 8th week, 7 mL of blood was obtained from each patient and serum triglycerides, total cholesterol, low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and Lp(a) were measured. Serum Lp(a) reduced significantly up to 10% in the isoflavone group at the end of week 8 compared to baseline (P < 0.05), and the reduction was significant in comparison with the placebo group (P < 0.05). Serum HDL-C increased significantly up to 11.5% in the isoflavone group at the end of week 8 compared to baseline (P = 0.05), and the increment was significant in comparison with the placebo group (P < 0.05). There were no significant differences between the two groups in mean changes of serum triglycerides, total cholesterol, and LDL-C. CONCLUSIONS: This study indicates that daily administration of 100 mg soy isoflavones reduces serum Lp(a) and increases HDL-C concentration which are two determinants of cardiovascular disease in PD patients. CLINICALTRIALS.GOV: NCT03773029. REGISTRATION NUMBER AND DATE: NCT03773029 - 2018.

Effects of soy isoflavones on serum systemic and vascular inflammation markers and oxidative stress in peritoneal dialysis patients: A randomized controlled trial.

Cardiovascular disease (CVD) is common in peritoneal dialysis (PD) patients. This study was designed to investigate the effects of isoflavones on systemic and vascular inflammation markers and oxidative stress in PD patients. In this randomized clinical trial, 40 PD patients were randomly assigned to either the isoflavone or the placebo group. The isoflavone group received 100 mg soy isoflavones daily for 8 weeks, whereas the placebo group received corresponding placebos. At baseline and the end of eighth week, serum high sensitive C-reactive protein (hs-CRP), intercellular adhesion molecule type 1 (ICAM-1), vascular cell adhesion molecule type 1 (VCAM-1), E-selectin, and malondialdehyde were measured. Serum VCAM-1 decreased significantly in the isoflavone group at the end of Week 8 compared to baseline (p = .01), whereas no significant change was observed in the placebo group. Serum ICAM-1 decreased significantly in the isoflavone (p = .01) and placebo (p = .01) group compared to baseline. However, the reduction of ICAM-1 was significantly higher in the isoflavone group than in the placebo group (p = .02). There were no significant differences between the two groups in mean changes of serum E-selectin, malondialdehyde, and hs-CRP. This study indicates that isoflavones reduce serum VCAM-1 and ICAM-1, which are two CVD risk factors, in PD patients.

Risk factors of severe peritoneal sclerosis in chronic peritoneal dialysis patients.

Peritoneal dialysis (PD) offers the healthiest way for starting renal replacement therapy (RRT) in End Stage Renal Disease patients, however exposes long-term PD patients to a dangerous complication named encapsulating peritoneal sclerosis (EPS). In this study, we searched for possible risk factors of EPS. Data were collected from two PD centers covering period 1995-2012 and comprised 464 patients. Control group defined as PD patients stayed on PD >42 month (n = 122), and case group was 12 confirmed EPS patients. Associations were analyzed using linear regression analysis. Prevalence and incidence of EPS were 2.59% and 8.9% with an incidence of 0.7% patient-years, respectively. The age at start of PD in EPS patients (32.75 ± 10.8 year) was significantly lower compared with control group (49.61 ± 16.18 year, p = .0001). The mean duration of PD in EPS and control group were 2494.4 ± 940.9 and 1890.2 ± 598.8 days (p = .002). Control group had 145 episodes of peritonitis during total duration of 7686 patient months (peritonitis rate of 1/53). This was 1/26 with a total 38 episodes of peritonitis during the total duration of 997 patient months (p = .01) for EPS group. In regression analysis, PD duration, age at PD start and duration of Ultrafiltration failure (UFF) were associated with EPS. Longer time being on PD, younger age, and higher UFF duration were the risk factors for EPS development.

The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis.

INTRODUCTION: Identifying the potential effective factors of rhabdomyolysis-induced acute kidney injury (AKI) is of major importance for both treatment and logistic concerns. The present study aimed to evaluate the value of creatine kinase (CK) in predicting the risk of rhabdomyolysis-induced AKI through meta-analysis. METHODS: Two reviewers searched the electronic databases of Medline, EMBASE, Cochrane library, Scopus, and Google Scholar. Data regarding study design, patient characteristics, number of cases, mean and screening characteristics of CK, and final patient outcome were extracted from relevant studies. Pooled measures of standardized mean difference, OR, and diagnostic accuracy were calculated using STATA version 11.0. RESULT: 5997 non-redundant studies were found (143 potentially relevant). 27 articles met the inclusion criteria but 9 were excluded due to lack of data. The correlation between serum CK and AKI occurrence was stronger in traumatic cases (SMD = 1.34, 95 % CI = 1.25-1.42, I(2) = 94 %; p < 0.001). This correlation was more prominent in crush-induced AKI (adjusted OR = 14.7, 95 % CI = 7.63-28.52, I(2) = 0.0 %; p = 0.001). Area under the ROC curve of CK in predicting AKI occurrence was 0.75 (95 % CI = 0.71-0.79). CONCLUSION: The results of this meta-analysis declared the significant role of rhabdomyolysis etiology (traumatic/non-traumatic) in predictive performance of CK. There was a significant correlation between mean CK level and risk of crush-induced AKI. The pooled OR of CK was considerable, but its screening performance characteristics were not desirable.

Non-diabetic renal disease with or without diabetic nephropathy in type 2 diabetes: clinical predictors and outcome.

BACKGROUND: Renal involvement in type 2 diabetes is mostly due to diabetic nephropathy (DN), but a subset of diabetic patients could present with pure non-diabetic renal disease (NDRD) or NDRD superimposed on DN. We conducted a prospective cohort study to identify the underline renal pathology in type 2 diabetic patients with defined clinical criteria for renal biopsy. METHODS: A total of 46 patients (27 female, mean age of 48.9 ± 11.9 years) with type 2 diabetes mellitus (DM) and atypical features of DN with unexpected proteinuria, hematuria, and/or renal impairment were enrolled in this study. RESULTS: Of 46 patients with type 2 diabetes, 16 (34.8%) had DN, 20 (43.5%) had NDRD, and 10 (21.7%) had NDRD superimposed on DN. Membranous nephropathy (34%) was the most common NDRD. Patients with NDRD had a lower frequency of diabetic retinopathy (5%), shorter duration of diabetes, higher range of proteinuria, and better kidney survival. In multiple logistic regression analysis, only lack of diabetic retinopathy was independent predictor of NDRD. Positive and negative predictive value of diabetic retinopathy (DR) for diabetic nephropathy was 94 and 68%, respectively. CONCLUSION: Kidney biopsy is strongly recommended for patients with type 2 diabetes and atypical renal presentation for DN, particularly in the absence of DR. This approach could lead to diagnosis of NDRD with better renal survival.

Potential of Autologous Adipose-Derived Mesenchymal Stem Cells in Peritoneal Fibrosis: A Pilot Study.

BACKGROUND: We aimed to determine the effects of systemic therapy with autologous adipose tissue derived mesenchymal stem cells (AD-MSCs) on different parameters of peritoneal function and inflammation in peritoneal dialysis (PD) patients. METHODS: We enrolled nine PD patients with ultrafiltration failure (UFF). Patients received 1.2±0.1×106 cell/kg of AD-MSCs via cubital vein and were then followed for six months at time points of baseline, 3, 6, 12, 16 and 24 weeks after infusion. UNI-PET was performed for assessment of peritoneal characteristics at baseline and weeks 12 and 24. Systemic and peritoneal levels of tumor necrosis factor α (TNF-α), interleukin-6(IL-6), IL-2 and CA125 (by ELISA) and gene expression levels of transforming growth factor beta (TGF-ß), smooth muscle actin (𝛼-SMA) and fibroblast-specific protein-1 (FSP-1) in PD effluent derived cells (by quantitative real-time PCR) were measured at baseline and weeks 3, 6, 12, 16 and 24. RESULTS: Slight improvement was observed in the following UF capacity indices: free water transport (FWT, 32%), ultrafiltration - small pore (UFSP, 18%), ultrafiltration total (UFT, 25%), osmotic conductance to glucose (OCG, 25%), D/P creatinine (0.75 to 0.70), and Dt/D0 glucose (0.23 to 0.26). There was a slight increase in systemic and peritoneal levels of CA125 and a slight decrease in gene expression levels of TGF-ß, α-SMA and FSP-1 that was more prominent at week 12 and vanished by the end of the study. CONCLUSION: Our results for the first time showed the potential of MSCs for treatment of peritoneal damage in a clinical trial. Our results could be regarded as hypothesis suggestion and will need confirmation in future studies.

Prevalence of Compartment Syndrome and Disseminated Intravascular Coagulation following Rhabdomyolysis; a Systematic Review and Meta-Analysis.

Abstract. Introduction: Rhabdomyolysis (RM) may cause some complications such as compartment syndrome and disseminated intravascular coagulation (DIC), which can affect its prognosis. This systematic review and meta-analysis aimed to investigate the prevalence of the mentioned complications following RM. Methods: Medline, Embase, and Scopus databases were searched using keywords related to compartment syndrome, DIC, and rhabdomyolysis with appropriate combination. Cohort and cross-sectional studies that conducted research on the prevalence of compartment syndrome and DIC in patients with RM were included in the present study. The desired data were extracted from the included studies and meta-analysis was conducted on them to calculate pooled prevalence of these complications. Results: Twenty articles were included in our systematic review. The rate of compartment syndrome reported in these studies ranged from 0 to 30.7%. Our meta-analysis revealed the pooled prevalence of 4% (95% confidence interval (CI): 2.20 to 7.40) for compartment syndrome in these studies. The pooled prevalence of this complication was 7.1% (95% CI: 2.90 to 16.00) among patients with severe RM and 4.4% (95% CI: 1.80 to 10.00) in traumatic RM. The rate of DIC reported in the included studies ranged from 0 to 40.47%. Our meta-analysis showed the pooled prevalence of 8.3% (95% CI: 03.90 to 16.50) for this complication among RM patients. Conclusion: We reported the rates of compartment syndrome and DIC in RM patients based on rhabdomyolysis etiologies through an epidemiologic systematic review and meta-analysis. The rate of compartment syndrome was slightly higher in patients with severe RM and its rate in patients with traumatic RM was close to the overall rate of compartment syndrome.

Association of overtime urine volume and ultrafiltration changes with patient survival in continuous ambulatory peritoneal dialysis patients.

BACKGROUND: Associations between patient survival and baseline urine volume (UV), ultrafiltration (UF) volume, and combined UV and UF were evaluated in Iranian continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: From 1995 to 2006, data on 1472 CAPD patients from 26 centers were collected. Demographic, clinical, and laboratory characteristics were analyzed using STATA software. Baseline UV was considered as an indicator of residual renal function and patients with an annual decrease of more than 250 cc/day were placed in decreasing UV group. The role of a new variable, net positive fluid removal, which defines as the combination of baseline UV and UF, was also evaluated. RESULTS: Patients with higher baseline UV were significantly more married and educated and candidate for CAPD based on positive selection criteria. In dichotomous categorization, mean of serum creatinine was lower and albumin was higher in patients with UV ≥ 1000 cc/day compared with UV < 250 cc/day. A significant correlation was found between baseline UV <250 cc/day and ≥1000 cc/day and patient survival. Patients with stable UV had better survival compared with patients with decreasing UV (p = 0.04). There was no correlation between UF and patient survival. Remarkable association with patient and technique survival and net positive fluid removal ≥2000 cc/day and <500 cc/day was observed. Multiple Cox regression analysis revealed significant correlation between net positive fluid removal ≥2000 cc/day and higher patient survival [p = 0.01, hazard ratio (HR) = 13.2], higher first albumin (albumin ≥ 3.5 mg/dL, p = 0.01, HR = 0.02), and lower negative selection (p = 0.0001, HR = 11.8). CONCLUSION: Loss of UV over time and lower net positive fluid removal increase mortality of PD patients.

The Epidemiological Characteristics and Outcome of COVID-19 in Patients Undergoing Peritoneal Dialysis: A Multi-center Study in Iran.

The pandemic of COVID-19 emerged in December 2019. Although numerous features of the illness have been investigated, the impact of disease on those patients with underlying diseases, is still a major problem. The aim of this multicenter, cohort study, was to determine the clinical manifestations of COVID-19 in peritoneal dialysis (PD) patients. Five hundred and five patients, receiving PD, were enrolled in this study, out of which 3.7% had coronavirus infection. Fever was the most common symptom (63.2%). The hospitalization rate was 10.5, 21.1% required admission to intensive care units (ICU) and the mortality rate was 21%. The most common cause of infection included close contact with the infected individuals and lower rates of protective equipment use. Although the incidence of COVID-19 among PD patients is low, the severity of the disease and the mortality rate are quite high. Vaccination and adherence to preventive measures are strongly recommended in PD patients.  DOI: 10.52547/ijkd.7147.

Prognostic factors and therapy assessment of IgA nephropathy: report from a single unit in iran.

BACKGROUND: Immunoglobulin A (IgA) nephropathy is the most common cause of primary glomerulonephritis with slow progression to end-stage renal disease (ESRD) in up to 40% of patients. METHODS: A retrospective cohort study of patients with biopsy-proven IgA nephropathy was performed in our center from 1998 to 2009. We tried to determine the clinical and pathological factors which affect patients progressing to ESRD. We also compared the impact of renin-angiotensin system (RAS) blockers therapy alone or in combination with prednisone on baseline proteinuria and glomerular filtration rate (GFR) after 6 months of treatment in patients with proteinuria>1 g/d and GFR>30 mL/min. RESULTS: There were 70 IgA nephropathy patients of whom 46 were men. The average age of patients at biopsy was 39 ± 12.1 years. During the median 23.5 (6-130) months of follow-up, 10 patients progressed to ESRD and no patient died. Five-year renal survival following biopsy was 88%. By multivariate analysis, age more than 50 years (p = 0.003) and baseline serum creatinine level (p = 0.012) were independent predictors of progressing to ESRD and poor prognosis. Although there was no significant difference in proteinuria reduction after 6 months of treatment, kidney function was less preserved in RAS inhibitors therapy alone than in the combination treatment with prednisone. CONCLUSION: We showed that late diagnosis of patients with IgA nephropathy might be associated with poor outcome. Our results also suggest that addition of prednisone to RAS blockers may lead to better preservation of kidney function.

Associations of Body Composition, Muscle Function, and Physical Activity with Mortality in Peritoneal Dialysis Patients.

INTRODUCTION: Loss of skeletal muscle mass and muscle strength is common in dialysis patients. Therefore, this investigation was designed to determine the association between body composition, muscle function, and physical activity with mortality in peritoneal dialysis (PD) patients. METHODS: This was a multicenter cohort study on all eligible PD patients (n = 79) in Tehran PD centers. At baseline, skeletal muscle mass and muscle strength were determined using bioelectrical impedance analysis and handgrip strength, respectively. Physical performance was assessed by a 4-meter walk gait speed test. Physical activity level was estimated by using the long-form International Physical Activity Questionnaire at baseline. The mortality of PD patients was evaluated two years after the start of this study. RESULTS: The total dialysis adequacy was significantly lower in dead patients in comparison with live patients (P < .05). In contrast, serum hs-CRP (P < .05), and the total amount of glucose absorbed daily from PD solutions (P < .05) were significantly higher in dead patients in comparison with live patients. There were no significant associations between body fat mass, skeletal muscle mass, skeletal muscle mass index, muscle strength and physical performance with mortality in PD patients. However, in PD patients with physical activity ≤ median, odds of mortality was 7.4 times higher than those with physical activity > median (OR = 7.4, 95% CI: 1.3 to 43.3; P < .05). CONCLUSION: This study indicates that low physical activity; low dialysis adequacy, high serum hs-CRP, and high amount of glucose absorbed from PD solutions are related with high mortality in PD patients.

Effects of isoflavones on bone turnover markers in peritoneal dialysis patients: a randomized controlled trial.

PURPOSE: The aim of this study was to investigate the effects of soy isoflavones on serum markers of bone formation and resorption in peritoneal dialysis (PD) patients. METHODS: In this randomized, double-blind, placebo-controlled trial, 40 PD patients were randomly assigned to either the soy isoflavone or the placebo group. The patients in the soy isoflavone group received 100 mg soy isoflavones daily for 8 weeks, whereas the placebo group received corresponding placebos. At baseline and the end of the 8th week, 7 ml of blood was obtained from each patient after a 12- to 14-h fast and serum concentrations of bone formation markers (osteocalcin and bone alkaline phosphatase), bone resorption markers [N-telopeptide and receptor activator of nuclear factor kappa B ligand (RANKL)], and osteoprotegerin as an inhibitor of bone resorption were measured. RESULTS: Serum N-telopeptide concentration decreased significantly up to 27% in the soy isoflavone group at the end of week 8 compared to baseline (P = 0.003). Also, serum RANKL concentration reduced significantly up to 17% in the soy isoflavone group at the end of week 8 compared to baseline (P = 0.03). These bone resorption markers did not significantly change in the placebo group during the study. There were no significant differences between the two groups in mean changes of serum osteocalcin, bone alkaline phosphatase, and osteoprotegerin. CONCLUSION: This study indicates that daily administration of 100 mg soy isoflavone supplement to PD patients reduces serum N-telopeptide and RANKL which are two bone resorption markers. CLINICALTRIALS.GOV: NCT03773029, 2018.

Peritoneal dialysis in iran and the middle East.

The countries of the Middle East have a cumulative population of 261.1 million and a mean gross national income per capita of US$9500. The total number of patients with end-stage renal disease (ESRD) in the Middle East is almost 100 000, the mean prevalence being 430 per million population (pmp). The first implementation of intermittent peritoneal dialysis (PD) in the Middle East occurred in Turkey in 1968; continuous ambulatory PD started in Saudi Arabia, Turkey, and Kuwait in the 1980s; and automated PD, in Turkey in 1998. The total active PD patients in the region number approximately 8170. With 5750 patients, Turkey ranks first, followed by Iran and Saudi Arabia with 1150 and 771 patients respectively. Penetration of PD with respect to the ESRD population is 7.5%, and with respect to dialysis overall is 10.2%. The dialysis rate in the region, 312 pmp, is almost half the European number of 581 pmp, with a PD prevalence of 32 pmp (range: 0 - 81 pmp). The number of active PD patients has risen dramatically in the main countries since the end of the 1990s: Turkey, to 5750 from 1030; Saudi Arabia, to 771 from 132; and Iran to 1150 from 0.

Prevalence of Protein-Energy Wasting and Its Association With Cardiovascular Disease Risk Factors in Iranian Peritoneal Dialysis Patients.

INTRODUCTION: Protein-energy wasting (PEW) is prevalent in dialysis patients, and cardiovascular disease (CVD) is the leading cause of mortality in these patients. This study aimed to determine the prevalence of PEW and its relationship with CVD risk factors in peritoneal dialysis (PD) patients in Tehran, Iran. MATERIALS AND METHODS: All eligible PD patients in Tehran peritoneal dialysis centers were included in this cross-sectional study. The diagnosis of PEW was done based on the criteria of the International Society of Renal Nutrition and Metabolism. Serum high-sensitivity C-reactive protein, soluble intercellular adhesion molecule type 1, malondialdehyde, and lipid profile were measured. RESULTS: The prevalence of PEW was 29% in the PD patients. Significant associations were found between the prevalence of PEW in PD patients and sex (P = .01), age (P = .03), type of PD dialysis solution (P = .04), and microinflammation (P = .03). Serum C-reactive protein (P = .02), soluble intercellular adhesion molecule type 1 (P = .001), and triglyceride (P = .03) were significantly higher in the PD patients without PEW as compared to those with PEW, whereas high-density lipoprotein cholesterol level was significantly lower in the PD patients without PEW as compared to those with PEW (P = .003). CONCLUSIONS: Our study shows that PEW is prevalent in Iranian PD patients. In addition, serum concentrations of CVD risk factors are dependent on the amount of glucose absorbed from PD solutions and are more impaired in PD patients without PEW as compared to those with PEW.

Dietary Intake and Its Related Factors in Peritoneal Dialysis Patients in Tehran, Iran.

INTRODUCTION: Poor nutritional status is prevalent in peritonealdialysis (PD) patients and is related to morbidity and mortality.Therefore, the aim of the present study was to assess the dietaryintake and its related factors in PD patients in Tehran, Iran. METHODS: All eligible PD patients in Tehran peritoneal dialysiscenters were included in this cross-sectional study. Dietary intakeof PD patients was determined using a 3-day dietary recall. Also,a 4 mL blood sample was obtained from each patient to measureserum biochemical parameters. RESULTS: Intake of energy, protein, and fiber were lower thanrecommended values in 81%, 92%, and 100% of PD patients;respectively. The prevalence of inadequate energy intake in PDpatients with dialysis vintage ≤ 5 years was significantly higheras compared to those with dialysis vintage > 5 years (P < .05). Asignificant association was observed between inadequate energyintake and inadequate vitamin B3 intake (P < .05). There was amarginally (not) significant association between inadequate energyintake and inadequate vitamin B1 intake (P = 0.06). Intake of thevitamins B1, B2, B3, B6, folic acid, B12, E, C, and of the minerals,calcium, and zinc from both the diet and supplements were lowerthan recommended values in 15%, 38%, 23%, 39%, 52%, 32%, 47%,29%, 54%, and 50.5% of PD patients, respectively. CONCLUSION: Insufficient intake of energy and various nutrients arecommon in PD patients in Tehran, Iran; which may contribute tomorbidity and mortality in these patients.

Strategies for Prevention and Treatment of Peritoneal Fibrosis: A Scientometric Study.

BACKGROUND: Interest in using peritoneal dialysis (PD) shows global and national increase. However, it remains a challenge to prevent the progression of PD-associated fibrosis in clinical practice. Here, we assessed the status of scientific publications in prevention and management of PD-associated fibrosis in a scientometric study. METHODS: We retrieved the bibliometric data by search terms "encapsulating peritoneal fibrosis," "treatment or prevention," and their synonyms in the Scopus databases until December 2, 2017. Data were analyzed using Scopus analysis tools, SPSS version 15 and Visualizing Scientific Landscapes viewer version 1.6.5. RESULTS: Number of publications showed a steady significant increase (P < 0.001) reaching to 390 documents. Japan had the highest share (21.3%) followed by United Kingdom. Coauthorship network assessment assigned "Ikeda M." from Japan as the top author. The top source of documents was "Peritoneal Dialysis International." Most of documents were original articles focusing on prevention and management of malignant fibrosis of peritoneum (72.6%). The documents were cited totally 5636 times with average citations per article of 14.45, and relatively high H-index of 38. CONCLUSIONS: Despite the global increasing trend in scientific output in this field, contribution of our country is very small. Perhaps more national and international collaboration is required to encourage our researchers for producing more scientific products.

Percutaneous biopsy of kidney; comparison between prone position and sitting position.

INTRODUCTION: Percutaneous kidney biopsy has been established as a safe, reliable and minimally invasive method. This study aims to describe the author's experience with biopsy of the kidney and to compare the results in sitting position versus prone in terms of the complication rate. MATERIALS AND METHODS: Patients were divided into two groups: prone and sitting position according to the clinician's and patient's preference. Followed by kidney biopsy, a questionnaire was completed. Then, data and the mean number of glomeruli in each group were compared. RESULTS: Apart from sweat, presumably due to the prone position, no significant differences were found regarding the side effects including dizziness, seizure, nausea, and vomiting between the two groups. The number of glomeruli was not significantly different between two groups. CONCLUSION: In comparison with the prone position, kidney biopsy at sitting position is more comfortable at least for patients who seems couldn't tolerate prone position. We recommend sitting position for kidney biopsy owing to the low side effects rate of this diagnostic technique.

Systemic Infusion of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells in Peritoneal Dialysis Patients: Feasibility and Safety.

OBJECTIVE: Using mesenchymal stem cells (MSCs) is regarded as a new therapeutic approach for improving fibrotic diseases. the aim of this study to evaluate the feasibility and safety of systemic infusion of autologous adipose tissue-derived MSCs (AD-MSCs) in peritoneal dialysis (PD) patients with expected peritoneal fibrosis. MATERIALS AND METHODS: This study was a prospective, open-label, non-randomized, placebo-free, phase I clinical trial. Case group consisted of nine eligible renal failure patients with more than two years of history of being on PD. Autologous AD-MSCs were obtained through lipoaspiration and expanded under good manufacturing practice conditions. Patients received 1.2 ± 0.1×106 cell/kg of AD-MSCs via cubital vein and then were followed for six months at time points of baseline, and then 3 weeks, 6 weeks, 12 weeks, 16 weeks and 24 weeks after infusion. Clinical, biochemical and peritoneal equilibration test (PET) were performed to assess the safety and probable change in peritoneal solute transport parameters. RESULTS: No serious adverse events and no catheter-related complications were found in the participants. 14 minor reported adverse events were self-limited or subsided after supportive treatment. One patient developed an episode of peritonitis and another patient experienced exit site infection, which did not appear to be related to the procedure. A significant decrease in the rate of solute transport across peritoneal membrane was detected by PET (D/P cr=0.77 vs. 0.73, P=0.02). CONCLUSION: This study, for the first time, showed the feasibility and safety of AD-MSCs in PD patients and the potentials for positive changes in solute transport. Further studies with larger samples, longer follow-up, and randomized blind control groups to elucidate the most effective route, frequency and dose of MSCs administration, are necessary (Registration Number: IRCT2015052415841N2).