Serum zinc levels in hemodialysis and peritoneal dialysis patients: A retrospective observational study.

Background: Zinc is vital for cellular functions, but kidney failure increases zinc deficiency risk. We compared zinc levels in hemodialysis (HD) and peritoneal dialysis (PD) patients in Isfahan, Iran. Materials and Methods: A retrospective study included 150 patients (75 PD and 75 HD). Serum zinc levels were assessed through photometry. Statistical analysis employed Chi-square, independent t-test, and correlation. Results: Serum zinc was below normal in both groups (P < 0.01). HD patients had lower zinc levels (70.85 ± 7.68 mg/dL) compared to PD (75.04 ± 13.55 mg/dL, P = 0.021), remaining significant after adjusting for confounders (P = 0.011). Conclusion: Zinc levels in PD and HD patients are lower than in the general population, with HD patients having lower levels than PD patients.

Metabolic health status and renal disorders: a cross-sectional study.

Previous surveys suggests that body mass index (BMI) may be positively related to development of chronic kidney disease (CKD). However, this association might be altered by metabolic syndrome. Therefore, we aimed to evaluate the association of metabolic health status with CKD. The present cross-sectional study was carried out on 3322 representative sample of Iranian adults. Metabolic syndrome was identified based on the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and BMI was assessed by anthropometric measurements. Estimated glomerular filtration rate (eGFR) was calculated by modification of diet in renal disease-Chronic Kidney Disease Epidemiology Collaboration (MDRD-EPI) formula. Subjects were categorized into four phenotypes: metabolically healthy normal weight (MHNW), metabolically healthy overweight and obesity (MHO), metabolically unhealthy normal weight (MUHNW), and metabolically unhealthy overweight and obesity (MUHO). Based on multivariate-adjusted models, the risk of CKD was significantly higher in MUHO compared with MHNW (OR: 1.48; p < 0.05). Although MUHNW and MUHO were associated with lower eGFR and albuminuria, the significant association was not observed in case of hematuria. Furthermore, subjects with kidney stones tended to be in MHO (OR: 1.42; p < 0.05) and MUHO phenotypes (OR: 1.64; p < 0.05), in comparison to the MHNW phenotype. The odds of kidney disorders were higher in adults with metabolic syndrome, regardless of BMI. However, this relationship might be strengthened by the concomitance of metabolic syndrome and obesity. To verify our findings, clarify the causality, and elucidate the underlying mechanisms, further research are warranted.

Dietary and Sleep Quality Association in Hemodialysis Patients.

Background: Poor sleep quality is a common issue among patients with end-stage renal disease (ESRD) who undergo dialysis. Nutritional habits are associated with sleep hygiene in patients undergoing dialysis. The objective of this study was to examine the potential correlation between nutritional status and sleep quality in individuals receiving hemodialysis treatment. Materials and Methods: This cross-sectional study included 160 hemodialysis patients. A food frequency questionnaire (FFQ) was used to measure food intake in participants. The Persian-validated version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Patients were classified as poor or good sleepers with a PSQI score of <5 and >5, respectively. Results: Eighty-four percent of hemodialysis patients had bad sleep hygiene. There was a significant association between sleep quality and educational status and age (P < 0.001). Poor sleepers were older (61.65 years versus 51.12) and less educated (31.1% versus 4%). However, there was no significant difference in the intake of micro- and macronutrients between poor and good sleepers (P > 0.05). Conclusion: The results of this study suggest that sleep quality has no significant relationship with nutrient intake in hemodialysis patients. Demographic factors, such as age and educational status, have played a more effective role than nutritional factors in patients' sleep quality.

Assessing physical inactivity as a risk factor for chronic kidney diseases in Iranian population.

OBJECTIVES: Physical inactivity is a major adjustable lifestyle risk factor in renal patients; nevertheless, research on the association of physical activity (PA) with chronic kidney disease (CKD) is unclear. DESIGN: Cross-sectional. SETTING: We evaluated the secondary care related to the nephrology specialists. PARTICIPANTS: We evaluated PA in 3374 Iranian patients with CKD aged ≥18 years. Exclusion criteria were current or prior kidney transplantation, dementia, institutionalisation, expected to start renal replacement therapy or leave the area within study duration, participation in a clinical trial or inability to undergo the informed consent process. PRIMARY AND SECONDARY OUTCOME: The renal function parameters were measured and compared with PA, assessed by the Baecke questionnaire. Estimated glomerular filtration rate, haematuria and/or albuminuria were used to estimate decreased kidney function and the incidence of CKD. To estimate the relationship between PA and CKD, we used the multinomial adjusted regression models. RESULTS: In the first model, findings indicate that the patients with the lowest PA score had significantly higher odds of CKD (OR 1.44, 95% CI 1.16 to 1.78; p=0.01), adjustment for age and sex attenuated this relationship (OR 1.25, 95% CI 1.56 to 1.78, p=0.04). Furthermore, adjusting for low-density lipoprotein, high-density lipoprotein, triglyceride, fasting blood glucose, body mass index, waist circumference, waist/hip ratio, coexisting diseases and smoking made this relationship insignificant (OR 1.23, 95% CI 0.97 to 1.55; p=0.076). After adjusting for potential confounders, we found that patients with lower PA have higher odds of CKD stage 2 (OR 1.62, 95% CI 1.13 to 2.32; p=0.008), no association with other CKD stages. CONCLUSION: These data suggest that physical inactivity contributes to the risk of early CKD, so encouraging patients with CKD to maintain higher PA levels could be used as a simple and useful tool to decrease the risk of disease progression and its related burden.

Association of alcohol consumption with the prevalence and various stages of chronic kidney disease.

Background: Considering that the effect of alcohol consumption trend on the prevalence of kidney damage and its progression has not been determined yet, the study aimed at investigating the association between alcohol consumption and the risk of chronic kidney disease (CKD) prevalence and progression at various stages of the disease. Materials and Methods: This cross-sectional study was performed on 3374 participants that referred to health-care centers in Isfahan from 2017 to 2019. Participants' basic and clinical characteristics (such as sex, age, education level, marital status, body mass index, blood pressure, alcohol consumption, comorbidities, and laboratory parameters) were evaluated and recorded. The alcohol consumption trend was classified as never, occasional (<6 drinks/week), and frequent (≥6 drinks/week) based on the amount of alcohol consumption over the last 3 months. Moreover, CKD stages were recorded based on the Kidney Disease: Improving Global Outcomes guideline, as well. Results: In the present study, the occasional and frequent drinking of alcohol did not have a significant effect on the odds of CKD prevalence (odds ratio [OR]: 1.32 and 0.54; P > 0.05) and the odds of stage 2 CKD prevalence as compared to stage 1 CKD prevalence (OR: 0.93 and 0.47; P > 0.05). However, adjusting the confounding factors revealed that occasional drinking as compared to nondrinking increased the odds of stage 3 and 4 CKD prevalence as compared to stage 1 CKD prevalence by 3.35 folds, respectively (P < 0.05). Conclusion: According to the results of this study, occasional drinking as compared to nondrinking significantly increased the odds of stage 3 and 4 CKD prevalence as compared to stage 1 CKD prevalence.

Is Chronic Kidney Disease, a Predictor of In-Hospital Mortality in Coronavirus Disease 2019 (COVID-19) Patients?

Background: Chronic kidney disease (CKD) is an important comorbidity in Coronavirus Disease 2019 (COVID-19) patients considering its high prevalence. We aimed to figure out the relationship between CKD and COVID-19 mortality in this study. Materials and Methods: In total, 116 CKD patients (estimated glomerular filtration rate [eGFR] lower than 60 mL/min/1.73 m2) and 147 control subjects confirmed with COVID-19 were studied. Data regarding demographics, sign and symptoms, laboratory findings, and chest computed tomography were collected. Association between CKD and in-hospital mortality were analyzed using logistic regression models adjusted for confounders. Results: Mortality rate was significantly higher in CKD than non-CKD (30.17 vs 4.76, P < 0.001) COVID-19 patients. Multivariate logistic regression showed that CKD was significantly correlated with in-hospital mortality in the total sample (Odds ratio (OR) = 8.64, confidence interval (CI): 3.67-20.35) and gender subgroups (females: OR = 4.77, CI: 1.38-16.40, males: OR = 13.43, CI: 3.85-46.87) (P < 0.05) of COVID-19 patients in the crude model. Whereas, the correlation did not remain significant in the fully adjusted model in the total sample (OR = 1.70, CI: 0.35-8.19) and gender subgroups (females: OR = 1.07 CI: 0.06-19.82, males: OR = 0.87, CI: 0.07-10.33) (P > 0.05) of COVID-19 patients. Conclusion: This study suggested an independent association between CKD and in-hospital mortality in COVID-19 patients. Therefore, more intensive surveillance of COVID-19 patients with CKD is to be warranted.

The effect of oral zinc on hemoglobin and dose of erythropoietin in hemodialysis patients.

Background: In hemodialysis (HD) patients, low serum zinc level could cause hyporesponsivity to erythropoiesis-stimulating agents and lead to anemia. This study investigated the effects of oral zinc supplements on the required dose of erythropoietin in patients undergoing HD. Materials and Methods: In a double-blinded randomized trial, 76 HD patients were assigned to 2 groups of 38. One group (intervention) was treated with oral zinc supplements of 210 mg, daily for 6 months, and the other group (control) used placebo capsules for 6 months. The serum zinc level, hemoglobin level, and required dose of erythropoietin, albumin, ferritin, ferrous, and total iron-binding capacity were evaluated 3 and 6 months after intervention. Results: Repeated measures ANOVA did not show a significant increase in Hb level after 6 months of intervention (P = 0.28). However, the required dose of erythropoietin was decreased, but the changes were not statistically significant (P > 0.05). The changes in the other variables were not statistically significant. Conclusion: Oral zinc supplementation in HD patients could not increase hemoglobin level irrespective of their serum zinc level.

Chronic Kidney Disease in Isfahan Province, Action Plan for Screening in A Population-based Study.

INTRODUCTION: We intended to explore the prevalence of chronic kidney disease (CKD) and its different stages, as well as CKD associated variables in the adult population in Isfahan province, Iran. METHODS: Adults aged ≥ 18 were recruited in a cross-sectional study from 2017 to 2019. Data including demographics, anthropometrics, and laboratory findings were collected from each subject. The equation of chronic kidney disease- Epidemiology Collaboration (CKD-EPI) was used to estimate glomerular filtration rate (eGFR), and eGFR and UACR values were utilized to determine the stages of CKD. RESULTS: Data from a total of 3374 subjects was analyzed. The mean age of participants was 49.3 ± 14.09 years and 59.3% were female. The prevalence of CKD was 18.5%. Only 0.25 and 3.5% of the population were in CKD stage 3 and 4, while most of the patients were in CKD stage 2 (7.6%) and stage 1 (7.1%). CKD patients were mostly on refined grains diet and used lesser dairy products compared to healthy participants. Variables including systolic blood pressure (OR = 1.018; P < .001), diastolic blood pressure (OR = 1.005; P < .05), fasting blood sugar (OR = 1.011; P < .001), female sex (OR = 1.319; P < .05), body mass index (OR = 1.030; P < .05), married status (OR = 1.335; P < .05), and smoking (OR = 1.529; P < .05) were significantly associated with increased risk of CKD in the logistic regression analysis. CONCLUSION: According to our results, the prevalence of CKD, especially stages 1 and 2, is quite high in central part of Iran. These findings help us to improve the screening for CKD patients and perform larger scale studies to identify the challenges ahead.  DOI: 10.52547/ijkd.7201.

Effect of Selenium Supplementation on Lipid Profile, Anemia, and Inflammation Indices in Hemodialysis Patients.

Objective: Trace elements deficiency is common among end-stage renal disease (ESRD) patients due to excessive loss during dialysis and the lower intake secondary to loss of appetite. Selenium (Se) is a trace element that plays an important role in the radical scavenging system and helps the body defend against oxidative stress. This study aims to evaluate the effects of Se supplementation on lipid profile, anemia, and inflammation indices in ESRD patients. Methods: Fifty-nine hemodialysis patients enrolled and were randomly divided into two groups. Two hundred microgram Se capsules once daily for the case group and matching placebo for the control group were administered for three months. Demographic data were collected at the study beginning. Uric acid (UA), anemia and inflammation indices, and lipid profiles were recorded at the beginning and the end of the study. Findings: UA and UA-to-HDL (high-density lipoprotein) ratio decreased significantly in the case group (P < 0.001). The changes in lipid profile were not significant among both groups. Hemoglobin slightly increased in the case group, however, it decreased significantly in the control group (P = 0.031). High-sensitivity C-reactive protein (hs-CRP) decreased in the case group and increased in the control group, however, none of these changes were significant. Conclusion: According to the results of this study, selenium supplementation in ESRD patients could reduce some risk factors related to their mortality, such as the ratio of uric acid to HDL. However, the changes related to lipid profile, hemoglobin level and hs-CRP biomarker were not significant.

Effect of Omega-3 Fatty Acids Supplementation on Homocysteine Level in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis.

Objective: One of the most common diseases with high morbidity and mortality rates is chronic kidney disease. Cardiovascular disease affects most patients with chronic kidney disorders, particularly patients undergoing dialysis; hence, appropriate prevention and management approaches are essential. This study aimed to evaluate the reduction of inflammatory biomarkers, especially homocysteine, by omega-3 fatty acids in peritoneal dialysis patients. Methods: This study enrolled 60 peritoneal dialysis patients who met specified inclusion and exclusion criteria and were randomized to intervention or placebo groups. Omega-3 capsules were given at a dose of 3 g/d for 8 weeks. Inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), homocysteine, albumin, and lipid profile measured before and after the study. Findings: Results of this trial revealed that the levels of homocysteine, hs-CRP, and albumin did not change significantly during the study. Analysis of lipid profiles before and after intervention showed omega-3 has no significant effect on the level of total cholesterol or low-density lipoprotein cholesterol; However, the level of triglyceride reduced remarkably (P = 0.002). In addition, serum levels of high-density lipoprotein cholesterol increased at the end of the study (P < 0.001). Conclusion: Omega-3 does not seem to be able to change the inflammatory markers significantly, particularly homocysteine. More extensive trials must be conducted to better understand the impact of omega-3 on inflammatory and nutritional markers, particularly in peritoneal dialysis patients.

Chronic Kidney Disease and COVID-19 Infection: A Case-Control Study.

Background: To organize efforts to manage the coronavirus disease 2019 (COVID-19), it is necessary to understand which groups are at higher risk of infection. Kidney disease seems to be substantial in COVID-19 patients, but there are limited data on COVID-19 incidence and fatality among chronic kidney disease (CKD) patients. In this study, we intend to examine the association between CKD and susceptibility to COVID-19 infection. Materials and Methods: Participants were selected from those recruited in a population-based cross-sectional survey of CKD prevalence and associated risk factors in Iranian people 18 years and older. A three-part questionnaire was used for COVID-19 infection clinical symptoms and epidemiologic and hospitalization data. Results: A total of 962 individuals including 403 CKD patients and 559 healthy controls were recruited in this study. Healthy controls were suffering more from common cold signs, cough, fever, sore throat, headache, anosmia, dyspnea, and abdominal pain (all P < 0.05). Furthermore, the number of healthy individuals with myalgia was marginally higher compared to the CKD patients (P = 0.057). Data regarding the number of CKD patients with/without COVID-19 infection throughout different CKD stages revealed that there was no significant difference between the two groups in terms of COVID-19 infection in different stages of CKD (P = 0.956). Conclusion: We found that some of the clinical presentations of COVID-19 including common cold symptoms, cough, fever, sore throat, headache, anosmia, dyspnea, and abdominal pain were higher among healthy individuals compared to the CKD group. On the other hand, the susceptibility to COVID-19 infection was not significantly different in various early stages of CKD.

Potential Benefits of Selenium Supplementation in Patients with Kidney Disease.

Trace element deficiency is common among patients with end-stage renal disease (ESRD); the reason is that since these patients undergo dialysis, they lose these elements more than healthy people, and also the use of trace elements is restricted due to loss of appetite. Selenium (Se) is a trace element that is essential for the oxidative stress defense system. Se deficiency leads to some complications similar to those often seen in ESRD patients, such as all-cause mortality due to cardiovascular diseases, bone loss, uric acid elevation, and anemia. This article aims to review the evidence on consequences of Se deficiency in ESRD patients, as well as effects of Se supplementation in hemodialysis patients. Multiple databases were searched to summarize the available evidence on selenium's role in kidney diseases. Since the complications of ESRD and those of Se deficiency are mostly similar, this triggers the idea that Se deficiency may be considered as a cause of these problems, but it needs to be more assessed that Se deficiency is a single factor or there are other factors participated in. Also the role of Se supplementation on resolving the mentioned complications, needs to be more studied through welldesigned clinical studies.

Dietary nutrients' intake and sleep quality in peritoneal dialysis patients.

Sleep disturbances are common in dialysis patients. However, there is a lack of information on nutritional determinants of sleep disorders in dialysis patients. The objective of the current study was to investigate the association between nutrients' intake and sleep quality in peritoneal dialysis patients. The cross-sectional study was done on 114 peritoneal dialysis patients referred to Alzahra and Khorshid hospitals, Isfahan, Iran. Information on sleep quality and dietary intakes were collected using Pittsburgh sleep quality index and 168-item food frequency questionnaire respectively. Anthropometric measurements were done by a trained dietitian based on standard protocols. Socio-demographic and clinical data were obtained through a structured questionnaire. The binary logistic regression model was used to detect the association between nutrients' intake and sleep quality. Our results indicated that there was not any significant difference in basic (socio-demographic and clinical) characteristics between peritoneal dialysis patients with good and poor sleep quality (p>0.05). The results of logistic regression indicated a positive significant association between dietary intake of carbohydrate (OR:3;95% CI:1.32-6.81; p<0.05), fat (OR:3;95% CI:1.32-6.81; p<0.05), and fiber (OR:2.53;95% CI: 1.12-5.67; p<0.05) with poor sleep quality in crude and adjusted models (p<0.05). However, there was not any significant association between dietary intake of protein and poor sleep quality (p>0.05). The results of the present study indicated that dietary intake of nutrients affect sleep quality in dialysis patients. These results help healthcare professionals in making nutritional interventions to improve sleep quality in dialysis patients.

Homocysteine-Lowering Interventions in Chronic Kidney Disease.

The incidence of cardiovascular events and mortality is higher in patients with chronic kidney disease (CKD) compared to the general population. Homocysteine (Hcy) appears to be an independent risk factor for cardiovascular diseases in general populations and patients with CKD. Further, hyperhomocysteinemia can cause endothelial damage and increase the activity and production of coagulation factors, and its prevalence among patients with end-stage renal disease is approximately 85%-100%. Most treatments, which lower Hcy levels and have been considered in previous studies, include folic acid, B vitamins, omega-3 fatty acids, and N-acetylcysteine. However, the effect of therapies that can decrease Hcy levels and thus cardiovascular events in these patients is still unclear. The results are conflicting and require further investigation. To guide treatment decisions and improve patient outcomes, multiple databases were searched, including Web of Science, PubMed, and Medline to summarize the available evidence (i.e., clinical trial and meta-analyses) on Hcy-lowering interventions and cardiovascular events.

Potential of Drug Interactions as a Cause of Adverse Drug Reactions in Patients with Kidney Diseases.

OBJECTIVE: Adverse drug reactions (ADRs) are one of the major causes of mortality. One of the major causes of ADR is drug-drug interactions. The purpose of this study was to evaluate the prevalence and characteristics of ADRs caused by the drug interactions in the nephrology departments. METHODS: This cross-sectional prospective study was carried out in the nephrology department on 117 patients who received at least two medicines. Drug interactions were determined, and the patients were evaluated for the presence of a drug complication. FINDINGS: A total of fifty ADRs were observed in 39 patients, whereas 26% of total ADRs (13 drug complications) were due to drug interactions. About 69% and 31% of complications were classified in terms of severity, in the category of "severe" and "moderate" complications, respectively. Warfarin had the highest contribution to major interactions (33.33%). CONCLUSION: ADRs, which specially occurred due to drug interactions, are particularly important for patients taking multiple medications (e.g., patient with renal insufficiency). Therefore, special attention should be paid to preventing and reducing ADRs in these patients' population.

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach.

BACKGROUND: In peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously. METHODS: This retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk. RESULTS: Using joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as -0.720 (95% confidence interval [CI], -0.971 to -0.472) for diabetic and -0.784 (95% CI, -0.963 to -0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients. CONCLUSION: The results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period.

Comparing the Effect of Dressing Versus No-dressing on Exit Site Infection and Peritonitis in Chronic Ambulatory Peritoneal Dialysis Patients.

BACHGROUND: Peritonitis and exit site (ES) infection are two main complications of peritoneal dialysis. There are some controversies regard to preventive strategies for ES care. In this study we compared peritonitis and ES infection rates in patients with and without dressing. MATERIALS AND METHODS: This historical cohort study carried out on 72 patients under continuous ambulatory peritoneal dialysis treatment, 54 with dressing versus 18 patients without dressing, followed from October 1, 2010 to March 31, 2011 for peritonitis and ES infection. RESULTS: A total of 17 episodes of ES infection occurred in 12 patients in dressing group, but no case was seen in no-dressing group (P = 0.02). Twenty-one episodes of peritonitis occurred in 15 patients in both groups (one episode every 20.6 patient-months). In no-dressing group two episodes occurred in only one patient (one episode every 54 patient-months), and in dressing group, 19 episode in 14 patients (one episode every 17.1 patient-months) (P = 0.03). Peritonitis was significantly more frequent in male versus female in overall patients (38% vs. 14%, P = 0.025) and in dressing group (52% vs. 15%, P = 0.003). In dressing group, peritonitis was more frequent in diabetics versus non-diabetics (48% vs. 11%, P = 0.01). Odds ratio for developing peritonitis was 9.4 in dressing group (95% confidence interval [CI] =1.05 - 84.4; P = 0.045), and 4.4 in men (95% CI = 1.26 - 15.19; P = 0.02). CONCLUSION: In this study, chronic ES care without dressing was associated with lower risk of peritonitis and ES infection.

Recurrent Attacks of Hypokalemic Quadriparesis: An Unusual Presentation of Primary Sjögren Syndrome.

We herein report the case of a 64-year old woman with recurrent attacks of hypokalemic quadriparesis which resulted from distal renal tubular acidosis (dRTA) secondary to Sjögren syndrome. The patient presented with sudden onset quadriparesis. A physical examination showed symmetric weakness of all four limbs. Severe hypokalemia (1.8 mEq/L), accompanied by normal anion gap metabolic acidosis, a positive urine anion gap and an inappropriately high urine pH pointed toward the diagnosis of dRTA. Further investigations disclosed primary Sjögren syndrome, which had not previously been recognized. On the basis of the current report and a review of the literature we suggest investigating the possibility of Sjögren syndrome in all patients with clinically unexplained dRTA.

Acute oxalate nephropathy following kidney transplantation: Report of three cases.

Calcium oxalate (CaOx) crystal deposition is a common finding immediately after kidney transplantation. However, small depositions of CaOx could be benign while extensive depositions lead to poor graft outcome. Here we report three cases with end-stage renal disease (ESRD), bilateral nephrolithiasis, and unknown diagnosis of primary hyperoxaluria (PH) who underwent a renal transplant and experienced an early-onset graft failure. Although an acute rejection was suspected, renal allograft biopsies and subsequent allograft nephrectomies showed extensive CaOx deposition, which raised a suspicion of PH. Even though increased urinary excretion of CaOx was found in all patients, this diagnosis could be confirmed with further tests including genetic study and metabolic assay. In conclusion, massive CaOx deposition in kidney allograft is an important cause of poor allograft survival and needs special management. Furthermore, our cases suggest patients with ESRD and a history of nephrolithiasis should be screened for elevated urinary oxalate excretion and rule out of PH.