Comparing the frequency of hypertension determined by peri-dialysis measurement and ABPM in hemodialysis patients.

Controlling blood pressure in hemodialysis patients is crucial but not always easy. The most common blood pressure measurement method is peri-dialysis measurement, but due to interdialytic blood pressure fluctuations, we are unsure if it is the proper way for evaluating blood pressure. Some studies have shown the superiority of 24-h ambulatory blood pressure monitoring over peri-dialysis blood pressure measurement. We aimed to compare the consistency of these methods in determining hypertension among hemodialysis patients. We studied 50 patients (mean age: 55.8 years) on regular hemodialysis in Imam Khomeini University Hospital, Tehran, Iran. Peri-dialysis blood pressure and interdialytic 24-h ambulatory blood pressure monitoring were recorded for each patient. Patients' demographic data and peri-dialysis weight were recorded too. All data were analyzed using the PASW Statistics 18.0, SPSS Inc. (Chicago, IL). There was a significant difference between pre-dialysis mean systolic blood pressure (146.1 ± 23.3 mmHg) and mean systolic blood pressure recorded by ambulatory blood pressure monitoring (135.3 ± 19.3 mmHg) (p = 0.001). There was also a significant difference between pre-dialysis mean diastolic blood pressure (83 ± 14 mmHg) and mean diastolic blood pressure recorded by ambulatory blood pressure monitoring (77.3 ± 10 mmHg) (p = 0.003). But the frequencies of hypertension measured with both methods were significantly consistent and the Kappa agreement coefficient was 0.525 (p = 0.001). Considering ambulatory blood pressure monitoring as the gold standard for blood pressure measurement, our recommendation for the best cutoff point to diagnose hypertension, with the highest sensitivity and specificity would be 135/80 mmHg for pre-dialysis blood pressure and 115/70 mmHg for post-dialysis blood pressure.

Estimated Prevalence of Venous Thromboembolism in Iran: Prophylaxis Still an Unmet Challenge.

BACKGROUND: Inappropriate thromboprophylaxis is a serious problem in Iran. Venous thromboembolism (VTE) is one of the most important causes of morbidity in patients in surgical and obstetrics departments and intensive care units (ICUs). It is a leading preventable cause of mortality among in-patients. This study was designed to determine the prevalence of VTE and its epidemiology in an Iranian population for the first time. MATERIALS AND METHODS: There is no national registry system for keeping VTE records in Iran. To statistically calculate the annual prevalence of VTE, we used the prevalence of VTE in presence of each VTE predisposing condition and the annual prevalence of each VTE predisposing condition in Iran. RESULTS: The average annual number of total adult patients with predisposing conditions of deep vein thrombosis (DVT) in Iran was 5,288,272 people. The mean annual prevalence of DVT in Iran was between 686,928 and 2,089,738 cases. The mean annual prevalence rate of DVT among the hospitalized Iranian adult patients with the risk of DVT was approximately between 129.90 and 395.16 cases per 1000 patients. CONCLUSION: The mean annual prevalence of DVT among the hospitalized Iranian adult patients not receiving prophylaxis is high. We also found that appropriate prophylaxis was provided for less than half the patients in need.

Cardiac troponins in patients with chronic kidney disease and kidney transplant recipients without acute cardiac symptoms.

INTRODUCTION: Cardiovascular diseases are the most common causes of death in chronic kidney disease (CKD) and kidney transplant patients. This study aimed to evaluate cardiac troponins in transplant recipients and CKD patients without cardiac symptoms. MATERIALS AND METHODS: Two groups of patients (CKD and kidney transplant recipients) were evaluated for troponins T and I levels. These values were associated with renal replacement therapy and demographic and clinical characteristics of the patients. RESULTS: Eighty CKD patients and 80 kidney transplant recipients were studied. There was a significant difference in Troponins T and I levels were significantly higher in the CKD group than in the transplant recipients. In the CKD group, 14 patients (17.5%) had an elevated troponin T level and 8 (10.0%) had an elevated troponin I, all of whom were in stage 4 of CKD. None of the kidney transplant patients had a positive troponin. Among CKD patients, decreased glomerular filtration rate was associated with elevated troponin I level. Elevated troponin T level was significantly associated with age and decreased glomerular filtration rate. In multivariable analysis, significant associations were found between troponin T level and age, serum creatinine, and glomerular filtration rate. A significant relationship was also found between troponin I and cholesterol and glomerular filtration rate. CONCLUSIONS: The assessment of troponin T and I in CKD and kidney transplant patients shows that in patients with CKD and without any symptoms of acute coronary syndrome, serum level of cardiac troponins increase and it is linked to serum creatinine and GFR.

Diagnosis and treatment of Sagliker syndrome: a case series from Iran.

Sagliker syndrome was introduced in 2004 in patients with end-stage renal disease and severe secondary hyperparathyroidism. This syndrome describes maxillary and mandibular deformities, dental abnormalities, benign soft tissue tumors in mouth, and various kinds of skeletal changes including short stature and fingertip abnormalities. There are a few reports from different regions of the world. The aim of this study is to report 5 cases of the Sagliker syndrome from Iran.