Relationship between donated kidney volume determined by ultrasound adjusted for clinical factors and 1-month and 1-year creatinine clearance: A retrospective study.

BACKGROUND: Graft volume as a surrogate of nephron numbers correlates with allograft function. The primary aim of this study was to correlate renal volume determined by ultrasound, adjusted to recipient clinical parameters in order to determine post-transplant renal function at the end of the first year. MATERIALS AND METHODS: A total of 140 patients were enrolled in this study, including 75 males, with a total mean age of 41.2 ± 13.5 years. Clinical data of all donors and recipients undergoing kidney transplantation at our institution between 2003 and 2019 were reviewed. The volume of transplanted kidney was measured by ultrasonography on the fifth day after the operation and correlated with recipients' clinical parameters and then adjusted with first-month and first-year post-transplantation creatinine clearance. RESULTS: The mean allograft volume measured using ultrasonography was 175.0 ± 37.2 mL. Absolute donor kidney volume had a non-significant correlation with creatinine clearance at 1 month and at 1 year after transplantation. The kidney volume/recipient body weight ratio had a positive, and significant, correlation with creatinine clearance at 1 month and at 1 year after transplantation (r = 0.326, p < 0.001, and r = 0.183, p = 0.038, respectively). CONCLUSION: Our data demonstrated that 12-month creatinine clearance is influenced by ratio of donated kidney volume/recipient body weight.

Relation Between Fibroblast Growth Factor-23 and Red Cell Distribution Width in Patients with End-Stage Renal Disease Undergoing Hemodialysis.

INTRODUCTION: Fibroblast growth factor-23 (FGF23) is responsible for regulating the metabolism of phosphorus and vitamin D by affecting the kidneys and parathyroid gland. Phosphate is present in the 2, 3-diphosphoglycerate (2,3DPG) ester composition, which can shift the O2-Hb dissociation curve to the right. Therefore, we hypothesized that maybe there is an association between red cell distribution width (RDW) and FGF23 level. The aim of this study was to investigate the relationship between iFGF23 and RDW in patients with end-stage renal disease undergoing hemodialysis. METHODS: This cross-sectional study was performed on 254 endstage renal diseases (ESRD) patients undergoing hemodialysis who were admitted to Rasht Razi Hospital Hemodialysis Center, in 2017. We used Shapiro-Wilk, Spearman correlation coefficient, Mann- Whitney U-test, and Multiple Linear Regression Analysis. All statistical analyses were performed by SPSS software. RESULTS: The median age of patients was 60 years (IQR: 49 to 69). The mean and median iFGF23 concentration in patients were 59.5 ± 14.6 and 62 (IQR: 49 to 69) pg/mL, respectively. According to spearman test, iFGF23 had a statistically significant association with age (r = 0.856, P < 0.001), MCV (r = 0.202, P < .001), phosphorus (r = -0.176, P < .05), weight difference before and after dialysis (r = -0.264, P < .05), and Vitamin D (r = -0.201, P < .05). Also in multiple linear regression analysis, the variables of RDW, IDWG, iPTH, MCH, DM, HTN, Age, and CRP were considered as predictors of iFGF23 . CONCLUSION: RDW was identified as one of the predictors of iFGF23 changes. Perhaps in the future, more value will be given to the role of RDW in dialysis patients. DOI: 10.52547/ijkd.6502.

Bone Mineral Density and Related Factors in Renal Transplant Recipients, in the North of Iran.

INTRODUCTION: Renal transplantation can lead to or be associated with Low bone mineral density (BMD). The aim of this study is evaluation of BMD and related factors in our renal transplant patients. METHODS: In this descriptive cross-sectional analytical study, 148 kidney transplant patients from university hospital, were enrolled. BMD of hip and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA) and patients were divided into 3 groups: normal, osteopenia, and osteoporosis; according to T-score. Laboratory parameters and a series of variables were investigated, and the results were compared with BMD findings. RESULTS: In this study, 73 patients (49.3%) had osteopenia and 28 patients (18.9%) were osteoporotic. BMI was significantly lower in the osteoporosis group compared with the normal group (P < .05). Cumulative dose of prednisolone and calcium supplement were higher in osteoporotic group compared with normal group. CONCLUSION: According to our results, osteoporotic and osteopenia groups have lower BMI that is associated with lower BMD. This can lead to increased risk of bone fractures in the future. Early discontinuation or reduction of prednisolone dose can improve BMD.

Clinical characteristics and outcome of COVID-19 pneumonia in kidney transplant recipients in Razi hospital, Rasht, Iran.

BACKGROUND: In late December 2019, a novel coronavirus SARS-CoV-2 started to spread around the world in different populations. Its clinical and laboratory characteristics and outcome in kidney transplant recipients are little known. Therefore, we describe 22 kidney transplant recipients with SARS-CoV-2-induced pneumonia. METHODS: All kidney transplant recipients who referred to the Razi Hospital of Rasht with a diagnosis of SARS-CoV-2 infection from February 20 to 19th of April 2020 have been included in this observational study. RESULTS: We present 22 cases of COVID-19 in kidney transplant recipients (median age 52 years [interquartile range 40.75-62.75 years]) and baseline eGFR 60 (mL/min/1.73 m2 ) (44.75-86.75). Patients complained of cough (72.7%), dyspnea (63.6%), fever (68.2%), and chill (72.7%) with greater prevalence. We decreased the dose of immunosuppression and started stress dose of intravenous hydrocortisone or equivalent oral prednisolone. Each patient received antiviral therapy based on the latest updated version of local protocol at the time of admission. CT scan findings in 90.9% of patients showed bilateral multifocal lesions. Acute kidney injury (AKI) was observed in 12 patients during hospitalization. Six patients died after a median of 12 days from admission (IQR, 1-21). CONCLUSIONS: In this small observational study, we observed high AKI occurrence and mortality rate in kidney transplant recipients with COVID-19.

The Effect of Nutritional Education Based on Health Belief Model on Nutritional Knowledge, Health Belief Model Constructs, and Dietary Intake in Hemodialysis Patients.

BACKGROUND: Based on the results of many studies on the relationship between nutritional status and clinical implications in dialysis patients, malnutrition is one of the most important factors associated with mortality in these patients. The current study examined the effect of nutritional education based on Health Belief Model (HBM) on nutritional knowledge, HBM constructs, and dietary intake in Hemodialysis (HD) patients. MATERIALS AND METHODS: One-hundred chronic HD patients entered to this randomized clinical trial in 2017 in Iran; 41 in control group and 45 in intervention group completed the study. Demographic data and four 24-h recalls were collected. To evaluate the nutritional knowledge and HBM constructs, a researcher-made questionnaire was used. Patients were evaluated before, immediately after, and 3 months after intervention. Eight 1-h education sessions in 4 weeks were considered for intervention group. Independent samples t-test, Chi-square test, and repeated measures ANOVA were used to analyze the data. RESULTS: Repeated measures ANOVA test showed significant increases in scores of the nutritional knowledge test, perceived susceptibility, perceived severity, perceived barriers (p = < 0.001), perceived benefits (p = 0.010), and self-efficacy (p = 0.019) after the study in the intervention group. There were no significant differences between two groups in energy, protein, High Biologic Value (HBV) protein, carbohydrate, fat, cholesterol, fiber, vitamin B2, B3, B6, B12, E, calcium, phosphorus, and potassium intake. CONCLUSIONS: It seems that education based on HBM can improve nutritional knowledge but in order to influence on dietary intake, longer interventions that are more comprehensive are needed.

Investigating the Relationship Between Blood Pressure and Serum FGF23 Level in Patients Undergoing Hemodialysis in Guilan Province, A Cross Sectional Study.

INTRODUCTION: The aim of current study is investigation of theimpact of serum FGF23 levels on blood pressure of patients withend-stage renal disease (ESRD) undergoing hemodialysis. METHODS: Based on registry, 68 patients who underwent hemodialysis(HD) in the dialysis center of Shahid Beheshti hospital, Anzali,north of Iran, from April 2016 to May 2017 were enrolled. Enzyme-Linked ImmunoSorbent Assay (ELISA) was used to determineserum FGF23 levels. 24 hours blood pressure monitoring method,AMBB, was used to monitor the mean arterial pressure of patients.Spearman related analysis method was used to statistically analyzethe correlation of serum FGF23 level with mean arterial pressure,age, HD duration, kt/v, URR weight gaining, cause of ESRD, andthe mentioned laboratory parameters. RESULTS: Serum FGF23 levels of ESRD patients were not significantlyrelated to age, time of HD and gaining weight. Furthermore,these parameters were not related to blood pressure. However,FGF23 expression levels in serum were positively correlated withphosphorous and calcium- phosphorous. The mentioned laboratoryparameters had no significant correlation with 24 hours bloodpressure changes. Meanwhile, the minimum diastolic pressureand intact parathyroid hormone (iPTH) level showed a significantdirect linear correlation. CONCLUSION: We suggest that understanding relationship betweenphosphate, FGF23 and cardiovascular disease can be applied intargeted phosphate-based treatment. Kidney failure and the nondippercondition may be highly related to one another and leadto ESRD. Therefore, a special investment in controlling bloodpressure and examining it with a tool such as ABPM can greatlyhelp patients to progress effectively.

Prevention of Contrast-induced Nephropathy With Oxygen Supplementation: a Randomized Controlled Trial.

INTRODUCTION: The aim of the study was to investigate the efficacy of nasal oxygen as a supplementation to hydration therapy in reducing the risk of developing contrast-induced nephropathy (CIN). MATERIALS AND METHODS: In a randomized controlled trial, 348 patients scheduled to undergo elective coronary angiography were randomly allocated to standard hydration plus 2 L/min to 3 L/min nasal oxygen (from 10 minutes before the procedure until the end of the procedure) (n = 176) or standard hydration alone (n = 176). The primary outcome measure was development of CIN defined as either an increase of 25% or more in serum creatinine concentrations or an increment of at least 0.5 mg/dL in serum creatinine concentrations 48 hours after catheterization. RESULTS: Of the 348 patients who completed the study, 105 developed CIN (30.2%; 95% confidence interval, 25.4% to 35.0%). A diagnosis of CIN was made in 32 (18.6%) and 73 (41.5%) patients in the nasal oxygen and control arms, respectively (P < .001). In the intervention arm, creatinine concentrations postcontrast remained relatively constant (average change, 2.7%), whereas a significant increase of 17.3% was recorded in the control arm (P < .001; effect size, 11.8%). CONCLUSIONS: Supplementation with nasal oxygen in addition to standard hydration appears to be an effective strategy in reducing CIN. The effect size for this intervention seems to be moderate.