Pre-hypertension and Hypertension Among University Students in Bahrain: A Study of Prevalence and Associated Risk Factors.

BACKGROUND/OBJECTIVES: In the last 20 years, hypertension has become more common among younger age groups. Based on a global meta-analysis, the combined prevalence of hypertension and prehypertension were 4.0% and 9.7%, respectively. This study aimed to evaluate the prevalence of prehypertension and hypertension among university students and their associated risk factors. METHODS: Four hundred and eleven students aged between 18 and 25 (196 males and 215 females) were randomly selected to participate from the College of Medicine and Medical Sciences (CMMS) and the College of Business Administration, Bahrain. The data was collected through a structured questionnaire, which gathered information about lifestyle habits. Trained students measured the participant's blood pressure and body mass index (BMI) according to standardized settings. All risk factors were studied according to the study field and their gender. RESULTS:  The mean age of the participants was 16.4±0.9 years. Of the total participants, 61.3% (n= 252) were normotensive, 30.7% (n= 126) were pre-hypertensive, and 8% (n= 33) were hypertensive. The prevalence of hypertension and pre-hypertension was higher in male students, 13.8% (n=27) and 44.9% (n= 88), compared to female students, 2.8% (n=6) and 17.7% (n=38), respectively. The results of the univariate analysis showed an association of hypertension with the field of study, gender, age, BMI, exercise frequency, frequency of eating junk food, and family history of hypertension (p < 0.05). Multivariate logistic regression analysis found a significant association between hypertension and pre-hypertension with gender, the field of study, and BMI. CONCLUSIONS: The findings of the study revealed that hypertension and pre-hypertension are common among university students in Bahrain. The risk factors for these conditions include studying medicine, being male, and being obese.

Quality of Life in Kidney Donors: A Single-Center Experience.

BACKGROUND: Live kidney donation is used to treat end-stage renal disease, but it poses risks and decision-making challenges for donors. This study examines kidney donors' long-term quality of life (QOL). METHODS:  We conducted a cross-sectional survey on kidney donors between 1982 and 2018. We used the Short Form-36 (SF-36) (Arabic version) to measure the donors' QOL. Out of 60 donors contacted, 44 agreed to participate and responded. Demographic information, donor-recipient relationships, and specific questions about the donation were collected and analyzed. RESULTS: The mean age of the donors was 50.1 ± 11.7 years at follow-up, and 26 (59.1%) were males. Most donors were siblings and parents, accounting for 36.4% (n=16) each. The time since the donation was 111.5 ± 97.1 months. All donors decided voluntarily to donate and all of them would do it again if given a chance. However, one donor (2.3%) complained that the donation had caused problems in his marriage, while six donors (13.4%) experienced clinically relevant distress, and two donors (4.5%) experienced financial disadvantages. Donors had high QOL scores, with a mean score of 73.1 and 96.9 (on a scale of 1-100) for the eight subscales. The highest score was for role social functioning, while the lowest was for energy/fatigue. The mean scores for the four fatigue subscales were low, ranging from 61.8 to 86.8. The lowest score was for feeling calm and reassured, while the highest was for feeling frustrated. In social functioning, the highest score was for the effect of mental health on work performance (97.2). We analyzed various demographic factors and their correlation with QOL and found no significant correlation in most domains regarding sociodemographic characteristics. CONCLUSIONS: Our research indicates that most kidney donors have had a positive experience over the past four decades. Both male and female donors of all ages reported good long-term QOL, further enhanced by recognition and support from their families and friends. These findings provide further support for our current policy on organ donation.

Quality of Life in Hemodialysis Versus Peritoneal Dialysis Patients in Bahrain.

INTRODUCTION: Chronic diseases, including chronic kidney disease, affect patients' quality of life (QOL). Hemodialysis (HD) and peritoneal dialysis (PD) are renal replacement methods in these patients. This work aimed to study the relationship between QOL scores in patients with end-stage renal disease (ESRD) on HD and PD. METHODS: This study was done at Salmaniya Medical Complex (SMC), Bahrain, from May to July 2023. A standard QOL index score instrument in Arabic form was used on 76 HD and 38 PD patients. The inclusion criteria included dialysis for at least three months and an age of more than 18 years with no severe morbidities or psychological diseases. RESULTS: The mean age of HD and PD patients was 58.7 ± 11.2 and 55.9 ± 12.1 years, respectively. Thirty-five (46.1%) of the HD patients and 17 (44.7%) of the PD patients were females. In most dimensions, the QOL score of the patients treated with PD was better than that of the HD group. The number of hospital admissions was statistically significantly higher in the HD group (p = 0.007); however, there was no significant difference in the causes of admissions (p = 0.131). In this study, we observed the highest QOL score in the family subscale (93.2 ± 9.2 and 98.6 ± 4.7), followed by the psychological/spiritual subscale (81.1 ± 16.7 and 97.6 ± 3.9) in the HD and PD groups, respectively), but it was statistically significantly higher in the PD group (p < 0.001). CONCLUSION: Our findings show that patients starting PD had better QOL scores in all domains than patients starting HD. Moreover, patients on PD maintained more active social support and ultimately felt better emotional well-being and physical health than those undergoing HD.

Quality of Life among Hemodialysis Patients: Role of the Dialysis Shift.

This study examined the effects of the time of hemodialysis (HD) on patients' quality of life (QOL). This study included 175 HD patients (116 males, 59 females), aged 18-80 years (mean = 58.1 ± 11.3 years). Shift 1 was 7:00-11:00 AM, Shift 2 was 12:00-4:00 PM, Shift 3 was 5:00-9:00 PM, and Shift 4 was 10:00-2:00 AM (38, 38, 43, and 56 patients, respectively). Those on Shift 4 had a higher mean age compared with the other shifts, with a higher number of widowed people (8.6%). The proportions of males and females showed no significant differences among the shifts. The mean duration on dialysis was 42.1 ± 39.3 months, with a shorter duration for Shift 4. We observed the highest QOL score for the psychological and spiritual subscale, followed by the family subscale. Half the patients were dissatisfied with their jobs and had less satisfaction with their sexual life, their education, and getting a kidney transplant. We found a significant difference in overall QOL among shifts, with the greatest difference between Shifts 3 and 4. Health and functioning, psychological and spiritual, and social and economic scores were lowest in Shift 4, which was significantly different from Shift 1 and Shift 3. We found significant associations between overall QOL and general health, and the scores from different domains. Satisfaction was moderate in all groups. The study revealed poor QOL among Shift 4 patients; hence, they need more support in clinical practice guidelines.

Adaptations of Clinical Teaching During the COVID-19 Pandemic: Perspectives of Medical Students and Faculty Members.

Background: The COVID-19 pandemic had serious implications on medical schools' programs that necessitated lots of adaptations of teaching, learning, and assessment to guarantee continuity of education in medical schools. Our study aimed to evaluate perspectives of clerkship students and faculty members regarding clinical teaching adaptations implemented during the COVID-19 pandemic. Methods: A descriptive, cross-sectional, survey-based study was conducted and targeted 5th and 6th year clerkship students and full- and part-time clinical faculty. The survey explored (1) perception of the degree of contribution of implemented adaptations to student achievement of expected clinical competencies, (2) degree of confidence regarding students' achievement of expected clinical competencies through such adaptations, and (3) perception of the effect of implemented educational adaptations on students' learning. Descriptive statistics were used, and statistical significance level was set at p < 0.05. Results: The survey exhibited high internal consistency. Both students and faculty members felt that most of the adaptations had moderate to high contribution to student achievement of expected clinical competencies. On a 5-point scale, the highest score was given by faculty members to "Interpretation of investigations" (3.93±0.84) while the lowest scores were given by faculty members (3.10±1.21) and students (2.57±1.36) to "Performing clinical procedures". Students and faculty members agreed that the adaptations had positive effect on students' learning except for the statement "Students were able to easily monitor their academic progress" where students gave less scores than faculty members, with a statistically significance difference (p=0.029). Conclusion: Students and faculty members had similar perspectives regarding the implemented adaptations and their impact and contribution to student learning and achievement of the basic clinical competencies. Both of them agreed on the need for and importance of the implemented adaptations. Our findings recommend such adaptations during the times of crises, which can be conducted through integrating online teaching with face-to-face teaching.

Evaluation of the Utility of Online Objective Structured Clinical Examination Conducted During the COVID-19 Pandemic.

Background: The COVID-19 pandemic led to profound restrictions on the face-to-face learning and assessment in all educational institutions, particularly the medical schools. The College of Medicine and Medical Sciences of the Arabian Gulf University (CMMS-AGU) conducted the final exams, both theoretical and clinical components, for its MD students online. This study was conducted to evaluate the utility of online clinical exams held at CMMS-AGU. Methods: This is a cross-sectional, mixed method study that included samples from final year medical students, examiners, and heads of clinical departments. Data were collected through surveys, structured interviews, documents' review, and calculation of online examination's psychometrics. Descriptive statistics were used. Quantitative data were presented in the form of means and standard deviations. Responses of heads of clinical departments in the structured interview were transcribed and analyzed thematically based on three pre-established themes. Results: Quantitative and qualitative data on the utility (validity, reliability, acceptability, educational impact, and cost and feasibility) of online objective structured clinical examination (OSCE) were collected. Content validity of the online clinical examination was established through high mean scores of content representativeness, which was confirmed by the heads of clinical departments regarding the proper coverage of clinical skills. Criterion validity was established through a high correlation between clinical and theoretical exam results (r = 0.75). Reliability of the exam was established through an acceptable Cronbach's alpha value (0.70 to 0.78) over the four days of the examinations. The examinations were perceived as highly acceptable by both students and examiners. High educational impact was inferred from students' responses and review of documents. The examination was found to be feasible and of reasonable cost. Conclusion: Online OSCE might be a good alternative of conventional clinical assessments in times of crises and impossibility of having in-person contact between students, examiners, and patients. An important major drawback is still present in such initiatives, which is the inability to assess students' physical examination skills.

Inflammatory markers in chronic kidney disease and end stage renal disease patients.

BACKGROUND: Chronic kidney disease (CKD) is condition characterized by a gradual loss of kidney function, patient with CKD suffering from a variety of immune system defects. METHODS: This study looked at Fas, T cell, BCl2, and P53 activity in people with CKD, end stage renal disease (ESRD), and stable controls. RESULTS: The CD4+ and CD8+ levels in ESRD patients' peripheral blood were slightly lower than those in CKD patients. The CKD and ESRD groups had slightly higher Fas and FasL mRNA expression and slightly lower BCl2 mRNA gene expression than the normal control group (P < 0.05). P53 mRNA gene expression was shown to be higher in the patients than in the controls (P < 0.01). CONCLUSIONS: ESRD patients have a significantly lower number of T-cell subsets than CKD patients this is related to a higher degree of apoptosis in these cells.

Prevalence of Musculoskeletal Manifestations in Adult Kidney Transplant's Recipients: A Systematic Review.

Background and Objectives: The musculoskeletal (MSK) manifestations in the kidney transplant recipient (KTxR) could lead to decreased quality of life and increased morbidity and mortality. However, the prevalence of these MSK manifestations is still not well-recognized. This review aimed to investigate the prevalence and outcomes of MSK manifestations in KTxR in the last two decades. Materials and Methods: Research was performed in EBSCO, EMBASE, CINAHL, PubMed/MEDLINE, Cochrane, Google Scholar, PsycINFO, Scopus, Science Direct, and Web of Science electronic databases were searched during the years 2000-2020. Results: The PRISMA flow diagram revealed the search procedure and that 502 articles were retrieved from the initial search and a total of 26 articles were included for the final report in this review. Twelve studies reported bone loss, seven studies reported a bone pain syndrome (BPS) or cyclosporine-induced pain syndrome (CIPS), and seven studies reported hyperuricemia (HU) and gout. The prevalence of MSK manifestations in this review reported as follow: BPS/CIPS ranged from 0.82% to 20.7%, while bone loss ranged from 14% to 88%, and the prevalence of gout reported in three studies as 7.6%, 8.0%, and 22.37%, while HU ranged from 38% to 44.2%. Conclusions: The post-transplantation period is associated with profound MSK abnormalities of mineral metabolism and bone loss mainly caused by corticosteroid therapy, which confer an increased fracture risk. Cyclosporine (CyA) and tacrolimus were responsible for CIPS, while HU or gout was attributable to CyA. Late diagnosis or treatment of post-transplant bone disease is associated with lower quality of life among recipients.

Quality of Life among Renal Transplant Recipients in Bahrain: A Single-Center Experience.

Although a positive effect of renal transplantation on quality of life (QOL) scores was demonstrated in numerous international studies, there are a few studies in renal transplant recipients in Arabic countries. The purpose of this study was to assess the QOL in renal transplant recipients in Bahrain. We used the standard QOL Index (QOLI) score instrument in Arabic languages. This study included 58 patients, aged 26-71 years, and 63.8% of them were males. We excluded patients below 18 years old and failed renal transplant at the time of the study. The highest QOL score was in the psychological/spiritual domain (87.4 ± 12.2), followed by the family domain (85.5 ± 13.1), the health and functioning domain (82.7 ± 13.3), and the social and economic domain (80.5 ± 13.9). There was a highly significant high positive correlation between the QOLI and each of the tested domains (P <0.001). Married participants had a significantly higher QOL score in the family domain, compared to unmarried participants (P = 0.025). The QOL scores in the health and functioning domain were significantly affected by the patient's social status, residence, and coexisting diabetes mellitus. In addition, the QOLI scores were significantly greater among patients who did their transplants in Bahrain (P = 0.045). Most of the renal transplant patients in Bahrain are satisfied with their QOL. Their QOL was also variably impacted by the different sociodemographic and clinical factors.

Public survey of financial incentives for kidney donation in Bahrain.

With the increasing prevalence of end-stage kidney disease in Bahrain, kidney donation is of vital importance. In this study, we want to assess how financial incentives will influence peoples' views and decisions regarding kidney donation. The aim is to establish strategies to increase the number of kidneys for transplantation in Bahrain. We adapted a previously established questionnaire on financial incentives for living kidney donations. The questionnaire assessed the public opinion in Bahrain on how kidney donation can be influenced by two different financial incentives, namely 10,000 Bahraini Dinars and life-long health insurance. We collected a convenient sample of 446 participants by distributing an electronic version of the questionnaire. IBM SPSS Statistics version 23 software was used for data entry and analysis. Of the total participants, 39% were male and 61% were female. Eighty percent of the participants believed that their chances for kidney donation will not increase in turn of receiving a financial compensation, while 20% of them believed that it will increase. Our study found that generally married participants (70%) find it a preferable development for health insurance companies to offer financial compensation for kidney donation, while nonmarried participants (30%) found it not a preferable but also not an adverse development (P = 0.038). Furthermore, there is a positive correlation between age and preferable views toward financial incentives to increase kidney donation (P <0.001). Although financial incentives for kidney donation might encourage a minority of the population, the majority will not be influenced by implanting a financial incentives' system for kidney donation.

Quality of life and its determinants among hemodialysis patients: A single-center study.

The purpose of this study was to investigate the relation between selected demographic and clinical characteristics and quality of life (QOL) scores in patients with end-stage renal disease who receive dialysis. We conducted the study at one hemodialysis (HD) unit in Bahrain from May 2018 to July 2018. We used standard QOL Index (QOLI) score instrument in Arabic form. This study included 100 patients (66 men and 34 women), aged 22 to 80 years on treatment with maintenance HD for four to 190 months. Inclusion criteria were as follows: those aged >18 years with no severe morbidities or psychological diseases and were on dialysis for at least three months. The following QOL scores were recorded: the health and functioning domain (64.8 ± 15.3), the social and economic domain (65.6 ± 14.1), the psychological/spiritual domain (74.9 ± 14.3), and the family subscale domain (75.9 ± 14.5). Male patients had reduced QOL though not statistically significant and younger patients had better QOL scores. The QOL scores revealed a decreasing trend with decreasing level of education, and they were higher among those who were not working and stayed at home. In addition, the family subclass scores were significantly higher among the married patients. Correlations between the demographic characteristics and QOL scores showed that there was a significant negative correlation between family domain and educational level and marital status, while there was a significant positive correlation between residence and psychological domain. Age, gender, marital status, residence, ethnicity, education level, employment status, income, and duration on HD nonsignificantly affected one or more domains of QOLI scores in such patients. Adequate management of these factors could influence patient outcomes.

Long-term renal outcome and survival of kidney transplant recipients admitted to the intensive care unit.

The goal of this study was to evaluate the course and outcome of kidney transplant (KT) recipients admitted to the intensive care unit (ICU). We reviewed the data of all adult renal transplant recipients who are admitted to the ICU at our center, between 1997 and 2017. Data reviewed included the demographic features, causes of end-stage renal disease, causes of admission, time between transplantation and admission, and ICU course and outcome. Among 379 KT recipients followed up in our center, 60 patients were admitted to the ICU and were categorized to early (during first 90 days; n = 28); intermediate (3-12 months; n = 7); and late (12 months and later, n = 25). The rate of ICU admission was 15.9%, and the mean age was 48.3 ± 12.6 years. The main reason for ICU admission was surgical complications (71%) in early group and infection (57% and 80%) in the intermediate and late groups, respectively. Mortality was significantly higher in late admission (52%) (P = 0.0001) and the leading cause of death in all groups was sepsis (89%). Twenty patients required ventilator that was an independent risk factor for mortality (P < 0.05). There was statistically significant decrease in the overall 5-year and 10-year patient survival (P = 0.031) in KT patients admitted to the ICU. The study shows that the main reason for ICU admissions was infections, especially in late admission. Mortality rate was relatively high and was linked to need for ventilator. Admission to the ICU is usually associated with decrease in the graft and patient survival.

Survey of medical students to assess their knowledge and attitudes toward organ transplantation and donation.

Kidney transplantation is the most preferred treatment modality for patients with end-stage renal disease (ESRD). This study aims at understanding the awareness, attitudes, and beliefs among the medical and nonmedical students. The study population consisted of 500 medical students and 39 nonmedical controls, who were surveyed using a reliable questionnaire that examined their knowledge and attitudes. A 24-item self-administered questionnaire, which assessed the levels of knowledge, attitude regarding organ donation with dichotomous scale and demographic data were used. Of the 500 medical students who received the questionnaire, 376 (75.2%) with a mean age of 22.1 ± 2.5 years responded; 39% were male, 43.6% were Bahraini, and 32.2% were from Saudi Arabia, 51.3% were in Grades-5 and 6 and 58.8% resided in big cities. The medical students had a highly positive attitude and great willingness toward organ donation. Majority of them (75.3%) knew the treatment of ESRD, and 70.7% recognized correctly that kidney transplantation is the optimal treatment for ESRD. However, only 10.4% knew that it is performed in Bahrain since 1995. A total of 241 participants (64.3%) reported positive attitude toward living kidney donation and 71.8% expressed their agreement to donation after death. More than half (66.8%) believed that their religion permits organ donation, although 56.6% of the participants believed that there is a danger after donating a kidney. When compared to nonmedical students, there was no statistically significant difference in the attitudes toward living kidney donation (P = 0.823) or organ donation after death (P = 0.066).

Human leukocyte antigen G and renal allograft transplant.

OBJECTIVES: Studying immune tolerance induced by HLA-G in kidney allograft acceptance may help understanding of its mechanisms, hoping in the future to boaster it and decrease the immunosuppressive drugs given that are well known to have serious adverse effects. MATERIALS AND METHODS: The current study sought to evaluate soluble HLA-G in 3 groups: kidney transplanted patients with no rejection episodes, transplanted patients with biopsy-proven renal rejection, and healthy age-matched non transplanted individuals. Three groups were studied: kidney transplanted patients with no rejection episodes (n = 43); transplanted patients with biopsy-proven renal rejection (n = 27); healthy, age-matched, nontransplanted individuals as controls (n = 42). Soluble HLA-G level was measured in the serum by a quantitative sandwich enzyme linked immunosorbent assay. RESULTS: sHLAG level was significantly higher in the transplanted patients compared with the control. Prograf and not cyclosporine or Rapamune had positive effects on sHLAG levels. Patients with chronic rejection had a significant lower level of sHLAG compared with a graft stable group. No effect of donor type, infection or duration posttransplant, on sHLAG levels was found. CONCLUSIONS: The results of the current study are consistent with previous studies addressing the role of sHLAG in inducing immunotolerance postkidney transplant. The findings from the current study on the chronic rejection group, supports the on-going research of having a treatment with HLA-G/or derivate, which may constitute in the future a novel efficient antigraft rejection therapy.

T-regulatory cells in chronic rejection versus stable grafts.

OBJECTIVES: Studying regulatory T cells in kidney allograft acceptance versus chronic rejection may help in the understanding of more mechanisms of immune tolerance and, in the future, may enable clinicians to induce immune tolerance and decrease the use of immunosuppressive drugs. The aim of the current study was to evaluate regulatory T cells in kidney transplant patients with stable graft versus transplant with biopsy-proven chronic rejection. MATERIALS AND METHODS: The 3 groups that were studied included: kidney transplanted patients with no rejection episodes (n = 43); transplanted patients with biopsy-proven renal rejection (n = 27); and healthy age-matched nontransplanted individuals as controls (n = 42).The percentage of regulatory T cells (CD4+CD25+Foxp3+) in blood was determined by flow cytometry. RESULTS: The regulatory T cell percentage was significantly lower in chronic rejection patients than control or stable graft groups. No significant difference was observed in regulatory T cell percentage between the stable graft and control groups. In the stable graft group, patients on rapamycin had a significantly higher regulatory T cell percentage than patients on cyclosporine. No effect of donor type, infection, or duration after transplant was observed on regulatory T cell percentage. CONCLUSIONS: The results of the current study are consistent with previous studies addressing the function of regulatory T cells in inducing immunotolerance after kidney transplant. Considering the established role of regulatory T cells in graft maintenance and our observation of high regulatory T cell percentage in patients receiving rapamycin than cyclosporine, we recommend including rapamycin when possible in immunosuppressive protocols. The findings from the current study on the chronic rejection group support ongoing research of having treatment with regulatory T cells, which may constitute a novel, efficient antirejection therapy in the future.

Immunological aspects of biopsy-proven lupus nephritis in Bahraini patients with systemic lupus erythematosus.

Lupus nephritis (LN) is a frequent and potentially serious complication of systemic lupus erythematosus (SLE) that may influence morbidity and mortality. Immunological investigations are aiding tools to the kidney biopsy findings in early diagnosis, in addition to monitoring the effect of therapy. The aim of the present study is to highlight the role of these investigations in a group of Bahraini patients and to determine whether there is any positive association between these findings and the outcome of LN. The current study is a retrospective case-control study of randomly selected 88 SLE patients, 44 with biopsy-proven LN and 44 without, acting as controls. All renal biopsies performed during the period from 1996 to 2012 were classified according to the World Health Organization classification. Immunological investigations analyzed are: Antinuclear antibodies (ANA), anti-ds DNA, anti-ENA, anti-cardiolipin antibodies (abs) and complement components C3, C4. Human leukocyte antigen (HLA) typing class II was performed on selected cases. All patients had positive ANA (100%). A significantly high frequency of anti-Smith abs among the non-LN group (43.18%) compared with the LN group (18.18%) was found (P <0.001). On the other hand, the anti-Ro/SSA abs in the non-LN group was also found at a statistically higher frequency (20.45%) compared with that in the LN group (4.54%) (P <0.01). Anti-ds-DNA abs were found to be higher in the LN group (84.09%) compared with the non-LN group (70.45%), but the difference was not statistically significant (P = 0.082). There was a positive association of ANA positivity and low C3 and or C4 in the studied group. In our study, 88.2% of the HLA typed patients had HLADR2, DR3 or both. In conclusion, in our Arabic Bahraini SLE patients, the presence of anti-Smith, anti-Ro/SSA and anti-RNP antibodies and the absence of anti-dsDNA antibodies are independent predictive markers for renal involvement. However, more prospective studies with a larger number of patients are essential to ascertain those findings.

Risk factors and outcomes of new-onset diabetes after transplant: single-centre experience.

OBJECTIVES: We sought to study the prevalence, risk factors, and long-term prognosis of posttransplant diabetes mellitus. MATERIALS AND METHODS: We studied all patients with end-stage renal disease without diabetic nephropathy who received a kidney transplant and were followed-up at our center since 1983 (n=218; age, 44.3 ± 13.1 y). Patients with new-onset diabetes after transplant were compared to kidney transplant recipients without risk factors for diabetes mellitus. Patients with new-onset diabetes after transplant were divided into subgroups according to time of onset (early; < 90 d vs late, ≥ 90 d). RESULTS: In total, 73/218 patients (33%) developed new-onset diabetes after transplant. Patients with new-onset diabetes after transplant were significantly older (51.2 ± 11.4 vs 40.7 ± 12.5 y; P < .001) and had a tendency to have a higher body mass index (29.6 ± 8.7 vs 21.6 ± 7.8 kg/m2; P =.05) than those that did not have new-onset diabetes after transplant. In multivariate analysis, age (P < .001), hepatitis C virus infection (P < .05), family history of diabetes mellitus (P < .03), and tacrolimus use (P < .001) were independent risk factors. Five- and 10-year death censored patient survival rates were worse in those that had new-onset diabetes after transplant compared with controls (log rank, 0.04), whereas there was no difference in outcomes between the early and late subgroups. CONCLUSIONS: The prevalence of new-onset diabetes after transplant was 33%. Age, body weight at time of transplant, tacrolimus use, family history of diabetes mellitus, and hepatitis C virus infection are independent risk factors for new-onset diabetes after transplant. New-onset diabetes after transplant has a negative effect on patient survival, irrespective of the time of onset and duration of diabetes.

Why does kidney allograft fail? A long-term single-center experience.

We studied the characteristics and the predictors of survival in Bahraini renal transplant recipients with an allograft that functioned for more than 10 years. Seventy-eight patients underwent renal transplantation between 1982 and 1999. Among them, 56 patients maintained functioning allografts for more than 10 years (range 10-30 years). Characteristics of the surviving patients, data on graft survival, and determinants of outcome were obtained by reviewing all medical records. The mean age at time of renal transplantation was 33.6 ± 15.3 years. The source of the graft in 42 (75%) recipients was from living related donors with a mean age of 31.4 ± 7.7 years, and it was the first graft in 48 recipients. The primary immunosuppression regimen consisted of cyclosporine (CsA) and prednisolone. Azathioprine (AZA) was given to 52 (92.9%) recipients, while four patients received steroids and AZA only. Induction therapy was administered to 30 patients in the CsA group. Acute rejection episodes occurred in eight (14.3%) patients, of whom two experienced two episodes. During the last follow-up in January 2010, the mean serum creatinine was 118.3 ± 46.5 µmol/L. A history of cancer was noted in one patient, whereas hypertension was encountered in 54% and diabetes mellitus in 20.5%. We compared the graft functioning group with the graft failure group and found that the independent determinants of long-term graft survival included time of late acute rejection episodes and histopathologic findings of chronic allograft damage, post-transplant hypertension and serum creatinine at one year. We conclude that renal transplantation even in its earliest years and despite the associated numerous complications has provided a ten-year or more of near-normal life to patients with end-stage renal disease.

Sirolimus-based calcineurin inhibitor withdrawal immunosuppressive regimen in kidney transplantation: a single center experience.

BACKGROUND/AIM: This observational study was conducted to evaluate the safety and efficacy of the conversion from calcineurin inhibitors (CNIs) to sirolimus (SRL)-based immunosuppressive therapy in kidney transplantation. MATERIALS AND METHODS: Sixty-four kidney recipients of mean age 38.3 +/- 14.6 years were converted to SRL. The main reasons for conversion were elective in 45 (70.3%) and biopsy-proven chronic allograft nephropathy in 11 (17.2%). The primary CNI used was cyclosporine A in 51 patients. Mean time to conversion was 50.5 months. After conversion, 61 patients received mycophenolate mofetil. We evaluated the impact of conversion on renal function for 5 years post-conversion. The overall mean follow-up time was 72.8 months. RESULTS: The analysis showed significant improvement in renal function at month 3 post-conversion (P < 0.05) with stabilization thereafter. Lipid parameters and blood sugar levels were similar pre- and post-conversion. Abnormal liver function test was transient in 12.8%. Reasons for SRL discontinuation were nephrotic range proteinuria in two patients and mouth ulceration in one. We compared patients with serum creatinine <140 micromol/l and those with serum creatinine > or = 140 micromol/l, and found that serum creatinine was an independent risk factor for chronic allograft dysfunction (P = 0.02). Graft loss occurred in three patients because of cardiovascular death in two and an acute rejection episode in one. CONCLUSIONS: We concluded that conversion from CNIs to SRL is an option and of benefit without significant acute rejection episodes or chronic allograft dysfunction especially in well-selected kidney transplant recipients with good graft function.

Soluble Fas: a useful marker of inflammation and cardiovascular diseases in uremic patients.

BACKGROUND: Inflammation has been associated with atherosclerotic cardiovascular disease (CVD) and anemia in patients with end-stage renal disease (ESRD) which may lead to left ventricular impairment via myocardial hypertrophy and/or ischemia. We therefore sought to investigate serum levels of sFas in uremic patients and its correlation with known markers of inflammation and CVD. METHODS: The study included 30 patients on hemodialysis, 30 patients with chronic kidney disease (CKD), and 30 normal control subjects. We measured serum levels of sFas, C-reactive protein (CRP), and albumin. We also investigated the association of serum sFas levels with the presence of CVD by echocardiographic assessment before and after 1 year. RESULTS: Levels of sFas were elevated in CKD and ESRD patients compared to controls. sFas levels correlated positively with serum creatinine and negatively with serum albumin. In the dialysis patients, we observed that sFas levels were higher among those with CVD. Compared with baseline, after 1 year of follow-up there was a significant decrease in left ventricular (LV) ejection fraction, increases in LV end-diastolic dimension and LV end-systolic dimension, and myocardial ischemic changes. CONCLUSIONS: These results suggest that sFas may be a marker of inflammation in CKD and ESRD patients.