The dialysis outcomes and practice patterns study phase 5 in the Gulf Cooperation Council countries: Design and study methods.

The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective cohort study of the relationships between hemodialysis (HD) care practices and HD patient outcomes. The DOPPS began in 1996, in the United States, and has since expanded to 21 countries, collecting detailed data from >75,000 HD patients, with >200 scientific publications, focused on describing HD practices associated with improved HD patient outcomes. The goal of DOPPS is to help HD patients "live better and live longer." Starting in 2012, the DOPPS was able to expand to all six of the Gulf Cooperation Council (GCC) countries, namely, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. The DOPPS study design consists of selecting HD facilities for study participation in each country to represent the different types of HD facilities and geographic regions within each GCC country. Within each study site, HD patients were randomly selected for detailed data collection to represent the HD practices within each participating HD facility. Altogether, 41 HD facilities have participated in the GCC-DOPPS Phase 5 study including 20 facilities from Saudi Arabia, nine from the United Arab Emirates, four each from Kuwait and Oman, two from Qatar, and one from Bahrain. Herein, we provide a detailed description of the study design and methods, data collection, study management, scientific investigator oversight and guidance, and study governance and support for the GCCDOPPS Phase 5 study.

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.

A single-center experience of renal transplantation in elderly patients.

BACKGROUND: We retrospectively reviewed the results of renal transplantation in patients over 60 years of age at our center. MATERIAL/METHODS: A retrospective study was conducted of 212 Bahraini patients receiving renal transplants from January 1979 to December 2007. All medical records were reviewed for demographic data, graft function and survival. Patient and graft survival was compared for patients above and below the age of 60. RESULTS: Seventeen patients >60 years with a mean age of 64.1+/-3.6 years at the time of transplantation. Diabetic nephropathy (52%) was the most common causes of end-stage renal disease. Mean donor age was 26+/-6 years and most of them were unrelated (82%). Of the elderly patients, 4 died: 3 with a functioning graft, 1 within one year of transplantation. Cardiovascular causes (3 patients, 75%) were the most common cause of death. Causes of graft loss were death with a functioning graft (4) and chronic rejection (1). Cox's proportional-hazards regression analysis showed on univariate analysis that pre-transplant hypertension, diabetes mellitus and vascular surgery (CABG) before transplant significantly affected the dependent variable of graft loss. Multivariate analysis did not show these variables to be significant. Kaplan Meier patient survival curves showed statistically significant differences between study (>60 years) and control (18-59 years) patients (p=0.04) at 10 year. CONCLUSIONS: We conclude that Patients older than 60 yr of age can be transplanted safely and successfully, especially when they are properly screened for the presence of significant risk factors such as severe cardiovascular disease and diabetes.

Hepatitis B and hepatitis C virus prevalence among dialysis patients in Bahrain and Saudi Arabia: a survey by serologic and molecular methods.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were assessed among 81 Bahraini and 34 Saudi hemodialysis patients and 7714 Bahraini and 2330 Saudi blood donors. Higher prevalence of HCV (9.24% vs 0.30%), hepatitis B surface antigen (5.88% vs 0.62%) were seen in patients versus control patients, and in Saudi patients compared with Bahraini patients. HCV genotypes were HCV 1a/1b plus HCV 4 among Bahraini patients and HCV 2/2a plus HCV 4 among Saudi patients. This is the first report on viral hepatitis in Bahrain and the first to compare HBV/HCV among dialysis patients in the Eastern Arabian Peninsula.

Renal biopsy findings in the kingdom of bahrain: a 13-year retrospective study.

Glomerular diseases continue to be the leading cause of end-stage renal disease globally. Hence, it is important to recognize the pattern of these diseases in any given geographical area. A total of 498 renal biopsies performed on patients with proteinuria, hematuria and mild to moderate renal impairment during a period of 13 years (between January 1990 and December 2002) at the Salmaniya Medical Complex (a tertiary care hospital of the Kingdom of Bahrain), were reviewed and categorized. Primary glomerular disease accounted for two-third of the glomerular diseases, which in turn constituted 44.8% of all renal biopsies. The most common histological lesion was minimal change disease (30%). Focal and segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary glomerular disease comprised 33.6% of glomerular diseases (22.7% of all the renal biopsies) with lupus nephritis forming the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies constituted 7.2% of all the biopsies. The results of this analysis were compared with surveys from other parts of the World.

Role of sequential biopsy study in the evaluation of renal transplant.

Renal biopsy is indicated in all cases of renal transplants showing renal dysfunction. This not only helps in the diagnosis but also in the institution of proper management. Study of sequential biopsies is essential for establishing the cause of renal dysfunction, evaluation of the effect of treatment and the progress of the disease. This report is based on the study of 14 samples (including three nephrectomy specimens) belonging to six patients who underwent two or more sequential renal transplant biopsies at the Salmaniya Medical Centre, Bahrain, between 1995-2000 because of deteriorating renal functions. Based on the sequential biopsies, the graft dysfunction was attributed to rejection in four cases and recurrence of primary glomerular disease in two. An important finding in this series is one case of type I membranoproliferative glomerulonephritis due to hepatitis C noticed five years after transplant and two cases of acute vascular rejection superimposed upon chronic rejection.

Brunner's gland polyp with upper gastrointestinal bleeding managed by endoscopic polypectomy: a report of two cases.

We report 2 rare cases of Brunner's gland adenoma presenting with upper gastrointestinal bleeding. They were removed by endoscopic polypectomy. In skilled hands, this method is safe and effective.

The use of alphacalcidol intravenously in hemodialysis patients: experience from bahrain.

While the effects of vitamin D, one-alphahydroxycholecalciferol (alphacalcidol) administered intravenously on the serum levels of parathormone (PTH) and calcium in dialysis patients have been well studied in the past few years, no detailed studies were conducted in patients from this part of the world. We studied nine patients (four men and five women) who received this drug for 12 weeks. The mean age of the patients was 54.4 +/- 19.8 (range: 23-81) years and the duration on dialysis was 40.1 +/- 15.6 (range: 18-62) months. The patients were selected on the basis of baseline serum intact PTH values of more than twice the upper limit of normal; all of the patients were on oral alphacalcidol, which was stopped before the study. Alphacalcidol was administered during the last fifteen minutes of each dialysis session, three times per week. The dose of the drug was upregulated weekly to a maximum of 6microg per session according to the degree of suppression of PTH and/or the development of hypercalcemia. The results showed a significant decrease of the mean serum PTH from baseline of 77.58 +/- 49.13 to 41.87 +/- 48.87 pmol/L (p< 0.02). Serum phosphate 2.01 +/- 0.27 and calcium 2.38 +/- 0.25 did not change significantly from baseline . None of the patients developed local or systemic adverse reaction to the injection; only one patient developed hypercalcemia requiring short interruption of the vitamin D with later resumption at a lower dose. In conclusion, alphacalcidol administered intravenously is effective and safe in hemodialysis patients.

Use of low molecular weight heparin for hemodialysis: a short-term study.

Although unfractionated heparin (UFH) is the anticoagulant commonly used for hemodialysis (HD), low molecular weight heparin (LMWH) has been found to be equally efficacious. The aim of this study was to explore the safety and efficacy of a single bolus dose of the LMWH, enoxaparin. Thirty-eight patients on maintenance HD were randomly divided into two equal groups. The mean age and body-weight of the two groups were comparable. While one group received 1 mg/kg body-weight (the manufacturer's recommended dose) of enoxaparin for three dialysis sessions of three-hours duration each, the other group received a fixed dose of 40 mg for the same number of dialyses. For the next three dialysis sessions, these doses were exchanged between the groups. In all, a total of 228 HD sessions were monitored for clotting of blood lines/dialyzers and bleeding from vascular access and other sites. The rate of complications was compared with the historical data while UFH was being used for the same patients. In general, enoxaparin was associated with fewer episodes of bleeding and clotting. Our study confirms that LMWH is of comparable efficacy to UFH and probably a lesser than recommended dose is adequate for a three-hour HD session.

Renal transplant pathology: bahrain experience.

A ten-year retrospective study on renal transplant biopsies performed at the Salmaniya Medical Complex, Bahrain was performed. The histological changes were classified according to Banff 1997 working classification of renal allograft pathology. A semi quantitative scoring was also given as per the guidelines. Out of a total of 26 cases, 10 belonged to hyperacute and acute forms, while 11 could be categorized to chronic sclerosing allograft nephropathy. In the remaining five, the graft pathology was unrelated to the rejection process. Despite effective management, four cases underwent nephrectomy due to severe vascular rejection. An interesting feature was recorded in two cases in whom transmural arteritis followed chronic histological changes. Presence of tubular atrophy and interstitial matrix increase were considered useful parameters for assessing the severity in cases with chronic allograft nephropathy.