Validity and reliability of Persian version of Low Physical Activity Questionnaire (LoPAQ).

BACKGROUND: The Low Physical Activity Questionnaire (LoPAQ) was specifically developed to measure the low activity level observed in extremely inactive hemodialysis (HD) patients. This study aims to evaluate reliability and validity of Persian version of the LoPAQ. METHODS: This study was a cross sectional study, conducted in three HD centers in Iran. The LoPAQ was translated into Persian. After cultural adaptions, it was filled out by 120 HD patiens. Convergent validity, was evaluated by calculating the correlations among the Persian version of the LoPAQ and Persian version of the Community Healthy Adults Model Program for Seniors (CHAMPS) questionnaire, physical function scale of the SF-36 and physical function (Short Physical Performance Battery (SPPB) test) using Spearman's correlation coefficients. The test-retest reliability was analyzed using the intraclass correlation coefficient (ICC). RESULTS: In total, 109 patients completed all of the questionnaires, took part in physical performance tests and had valid data. Their mean age was 64 ± 11 years, with a dialysis history of 31 ± 10 months. For total calories, there was a strong correlation between the Persian version of the LoPAQ and CHAMPS-measured physical activity (rho = 0.85, p < 0.001). In addition, the higher physical activity level reported by Persian version of the LoPAQ was also correlated with better self-reported physical function (rho = 0.7, p < 0.001) and better physical performance (rho = 0.67, p < 0.001). The ICC ranged from 0.65 to 0.78, indicating strong reliability. CONCLUSION: The assessment of the validity and reliability of the Persian version of the questionnaire confirmed its suitability for evaluating the level of physical activity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05930964, Registered on 05/07/2023. Registered trial name: Validity and Reliability of Persian Version of Low Physical Activity Questionnaire (LoPAQ).

First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults.

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.

The side effect profile of sirolimus and its relationship with some variables: A retrospective study of Iranian renal transplant patients.

Background: Sirolimus is a potent immunosuppressive in renal transplantation. However, its use is limited by some reported side effects. The objective of this study was to determine the side effect profile of sirolimus in renal transplant patients. Materials and Methods: In the present study, we retrospectively reviewed the medical records of 116 renal transplant patients treated with sirolimus alone or in combination with other immunosuppressive agents at private therapeutic centers in Isfahan, Iran, between March 2009 and February 2020. A checklist was used to collect data on demographic and clinical variables. Data were analyzed with independent samples t-test and Chi-squared test. Results: Our findings indicated that the most prevalent sirolimus-related side effects were edema (42.3%), proteinuria (37.5%), cytopenia (26.9%), abnormal level of liver enzymes (11.7%), and pneumonitis (9.7%). Stratification of side effects by sirolimus dose (<2 mg and ≥2 mg) demonstrated their dose-independent occurrence (P > 0.05). Pneumonitis was the most frequent reason for sirolimus cessation (58.7%). No significant differences were observed between males and females regarding the frequency of reasons for sirolimus cessation (P > 0.05). Conclusion: Edema, proteinuria, cytopenia, abnormal level of liver enzymes, and pneumonitis were the most prevalent sirolimus-related side effects in renal transplant patients. Further prospective cohort studies are warranted to detect underlying mechanisms and determinants of these side effects in renal transplant patients treated with sirolimus.

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.

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.

Evaluating the effect of intradialytic cycling exercise on quality of life and recovery time in hemodialysis patients: A randomized clinical trial.

Background: The aim of this study was to assess the effect of intradialytic cycling exercise on quality of life (QOL) and recovery time in patients who underwent hemodialysis. Materials and Methods: Hemodialysis patients were recruited from the referral dialysis centers affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. Patients were randomly assigned into the intervention and the control groups. Patients in the intervention group exercised on a stationary bike for 12 weeks (3 times per week for 30 min); however, patients in the control group received usual hemodialysis. The kidney disease QOL (KDQOL)-short-form version 1.3 was used to assess QOL. Patients were asked to answer the question "How long does it take to recover from a dialysis session?" to assess recovery time. Results: A total of 110 hemodialysis patients, including 60 in the intervention group and 50 in the control group were analyzed. A significant increase was observed in the generic (mean difference ± SE: 1.50 ± 0.44, P = 0.001), kidney disease (mean difference ± SE: 0.84 ± 0.28, P = 0.004), and overall QOL (mean difference ± SE: 1.18 ± 0.33, P = 0.001) scores after 12 weeks of intradialytic cycling exercise in the intervention group. Furthermore, a significant difference was noted between the intervention and the control group regarding the mean difference of all QOL scores after the intervention (P < 0.05). We also found a significant difference in the mean difference of recovery time between the intervention and the control group after the intervention (P < 0.001). Conclusion: KDQOL and recovery time could improve in hemodialysis patients after 12-week intradialytic exercise.

Molecular epidemiology of blaCTX-M gene-producing uropathogenic Escherichia coli among Iranian kidney transplant patients: clonal dissemination of CC131 and CC10.

BACKGROUND: This study aimed to investigate the phylogenetic characterization and virulence traits of uropathogenic Escherichia coli (UPEC) isolated from kidney transplant patients (KTPs) as well as non-KTPs and analyze the clonal distribution of Extended spectrum ß-lactamases (ESBLs)-producing UPEC containing blaCTX-M gene. METHODS: To this end, we determined virulence marker and the phylogenetic characterization of UPEC in non-KTPs (n = 65) and KTPs (n = 46). The non-KTPs were considered the control group of the study. Also, according to the Achtman scheme, we performed multilocus sequence typing to assess the relationship between twenty-nine of ESBL-producing isolates containing blaCTX-M gene. RESULTS: According to the results of PCR assay, the prevalence of virulence factor genes ranged from 0% (cnf and papG III) to 93.7% (fimH). Also, KTP isolates significantly differed from non-KTP isolates only in terms of the prevalence of pap GI elements. Moreover, the most frequent UPEC isolates were in phylogenetic group B2, followed by group D (18.9%), and group A (13.5%). Furthermore, except for phylogenetic group C, there was no significant correlation between phylogenetic distribution in KTPs and non-KTPs. Additionally, MLST analysis of blaCTX-M carrying isolates identified 18 unique sequence types (ST) the most common of which was ST131 (24.1%), followed by ST1193 (10.3%), while fourteen STs were detected only once. CONCLUSIONS: The results further revealed significant differences between the UPEC isolates from KTPs and non-KTPs regarding the phylogroups C and PAI gene. Based on MLST analysis, we also observed a relatively high diversity in UPEC isolates obtained from KTPs and non-KTPs. Moreover, clonal complex (CC) 131 and ST131 were found to be the most prevalent clones and ST types, respectively. Besides, for the first time, ST8503 were reported in KTPs. These results suggested regular studies on characterization of UPEC isolates among KTPs.

Hemoperfusion in patients with severe COVID-19 respiratory failure, lifesaving or not?

BACKGROUND: The new coronavirus outbreak quickly filled hospital beds and stunned the world. Intensive care is required for 5% of patients, and the mortality rate for critically ill patients is 49%. The "cytokine storm" is considered as the main cause of pathogenesis for coronavirus disease-19 (COVID-19)-related respiratory failure, hemoperfusion may be a modality for treatment of disease. MATERIALS AND METHODS: Thirty-seven an patients with positive real-time polymerase chain reaction for SARStions2 in an upper respiratory tract sample or typical chest computed tomography lesion were eligible for this case-control study. Patients meeting the criteria for hemoperfusion including clinical and laboratory indices, were evaluated for outcomes such as hospitalization length and mortality. Patients were divided into three groups, i.e., patients who received hemoperfusion without a need for mechanical ventilation (MV), patients who received hemoperfusion before MV, and patients who received hemoperfusion after MV. RESULTS: Among 37 patients with COVID-19 respiratory failure, 32% were female with a mean age of 55.54 (standard deviation 14.1) years. There was no statistically significant difference between the three groups in terms of length of hospital stay and intensive care unit (ICU) stay (P-tayns: 0.593 and 0.243, respectively, confidence interval [CI]: 95%). Heart rate, respiratory rate, PaO2/FIO2, high-sensitivity C-reactive protein, and ferritin significantly improved after the application of hemoperfusion in all groups (P < 0.05, CI: 95%). CONCLUSION: It seems that applying hemoperfusion in the inflammatory phase of the disease, especially before the intubation, reduce the need for MV. However, hemoperfusion does not have any impacts on the duration of hospital and ICU stay.

Curcumin as a major active component of turmeric attenuates proteinuria in patients with overt diabetic nephropathy.

BACKGROUND: Diabetic nephropathy (DN) is a common cause of end-stage renal disease (ESRD). The benefits and effects of renin-angiotensin system blocker drugs are obvious in decreasing albuminuria, but there is a need to find other drugs that can decrease albuminuria. The aim of our study is to evaluate the effect of short-term administration of curcumin on overt albuminuria in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: A randomized, double-blind clinical trial was performed on 46 patients with T2DM, overt albuminuria ≥300 mg/24 h, and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2. After the random allocation of the patients, they were divided into two groups. In the curcumin group, the patients received 500 mg (one capsule) of curcumin with each meal (three times/day after meal) for 16 weeks. Other variables including blood urea nitrogen (BUN), creatinine (Cr), fasting blood sugar (FBS), 2-h postprandial blood sugar (2-h pp BS), lipid profile, 24-h urine analysis for albuminuria, serum albumin, and hemoglobin A1C (HbA1C) were checked at baseline and bimonthly too. RESULTS: two groups at baseline were comparable in terms of basic characteristics (P > 0.05). Albuminuria decreased significantly from 900.42 ± 621.91 at the baseline to 539.68 ± 375.16 at the end of the study in the curcumin group (P Time = 0.002); however, no statistically significant changes were observed in the placebo group (519.94 ± 214.33 at the baseline vs. 444.00 ± 219.10 at the end of the trial; P Time = 0.43), and the decrease was significantly higher in the curcumin group than that of the placebo group (P Intervention = 0.01). No significant differences were observed between the placebo and curcumin in terms of changes in serum BUN, Cr, FBS, 2-h pp BS, HbA1C, lipid profile, and albumin. CONCLUSION: Our study showed that curcumin as an active turmeric metabolite was an effective adjuvant therapy for ameliorating macroscopic proteinuria in type 2 diabetic patients. Its effect may appear after 2 months of therapy and even in patients with a mild decrease in GFR. Further studies with larger sample size and longer duration are recommended.

Incidence of nonmelanoma skin cancer in renal transplant recipients: A systematic review and meta-analysis.

BACKGROUND: Nonmelanoma skin cancer (NMSC) in renal transplant recipients is common and associated with significant morbidity and mortality. The aim of the present systematic review and meta-analysis was to estimate the incidence of NMSC among renal transplant recipients. MATERIALS AND METHODS: We systematically searched PubMed, Medline, Scopus, and Web of Science databases for studies that assessed the incidence of NMSC in renal transplant recipients using a combination of relevant keywords. Two independent investigators included studies and extracted necessary information. Random effect meta-analysis was used to estimate pooled incidence of NMSC with 95% confidence intervals (CIs). RESULTS: Twenty-nine studies comprising 36,021 patients meet the criteria for the systematic review. The pooled incidence of NMSC in renal transplant recipients was 12.6% (95% CI: 12%-14%) with a majority of squamous cell carcinoma (SCC) 55% (95% CI: 47%-63%). The pooled estimate of the incidence rates of SCC and basal cell carcinoma was 2.7% (95% CI: 2%-3.4%) and 2.2% (95% CI: 1.5%-2.8%), respectively. Subgroup analysis per geographic location showed that pooled incidence of NMSC was 39.1% (95% CI: 26.3%-51.8%), 12.4% (95% CI: 8.8%-16%), and 1.2% (95% CI: 0.4%-2%) in Australia and New Zealand, Europe, and Middle East, respectively. CONCLUSION: The results of the current meta-analysis demonstrated that the incidence of NMSC in renal transplant recipients varies widely. Regarding the high incidence of NMSC among renal transplant recipients, awareness of associated risk factors and early diagnosis of the malignancy in the population is a major clinical need.

Concordance of the tuberculin skin test and T-SPOT(®).TB test results in kidney transplant candidates.

BACKGROUND: Detection of latent tuberculosis infection (LTBI) in transplant candidates is very important. The tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are standard immunologic tools for LTBI detection. The aim of this study was to compare the TST results and T-SPOT(®).TB test (a type of IGRAs) in kidney transplant candidates for the screening of LTBI and follow the patients with positive test for an activation of tuberculosis (TB) after transplantation and using anti-TB prophylaxis. MATERIALS AND METHODS: This study was a prospective study and carried out in 44 renal transplant candidates from March 2010 to February 2011 in the teaching hospitals of Isfahan University of Medical Sciences, Iran. TST and T-SPOT(®).TB test were performed and their results evaluated. Patients with a positive skin test and/or T-SPOT(®).TB test were started on anti-TB prophylaxis and followed after transplantation for an activation of their LTBI for 1 year. RESULTS: Overall, 8 (18.2%) patients were positive for TST and 6 (13.6%) patients for T-SPOT(®).TB test. The agreement between TST and T-SPOT(®).TB test was moderate (κ = 0.49, 95% confidence interval 0.145-0.839). The overall agreement between TST and T-SPOT(®).TB test was 86%. No relation was found between the underlying diseases and TST or T-SPOT(®).TB test positivity. Although isoniazid prophylaxis was used for patients with positive TST and/or T-SPOT(®).TB test, one patient had reactivation of TB. CONCLUSION: In kidney transplant candidates both TST and T-SPOT(®).TB test were comparable for the diagnosis of LTBI with reasonable agreement between the tests. However, further studies are needed to determine the ability of T-SPOT(®).TB test to detect LTBI and to evaluate the need for prophylaxis in these patients.

Effect of magnesium supplementation on carotid intima-media thickness and flow-mediated dilatation among hemodialysis patients: a double-blind, randomized, placebo-controlled trial.

OBJECTIVES: The aim of the present study was to determine the efficacy of oral magnesium (Mg) supplementation on endothelial function through evaluation of carotid intima-media thickness (cIMT), brachial artery flow-mediated dilatation (FMD), and C-reactive protein (CRP) among hemodialysis (HD) patients. METHODS: This randomized, controlled, double-blind clinical trial consisted of 54 patients on HD. One group was treated orally with 440 mg of Mg oxide 3 times per week for 6 months (n = 29). The control group (n = 25) was given placebo using the same administration protocol. cIMT, FMD, serum calcium levels, phosphorus, lipid, CRP, and bicarbonate were measured at baseline and at 6 months in both groups. RESULTS: At 6 months, cIMT was significantly decreased in the Mg group (0.84 ± 0.13 mm at baseline and 0.76 ± 0.13 mm at 6 months, p = 0.001). However, in the placebo group, cIMT was significantly increased (0.73 ± 0.13 and 0.79 ± 0.12 mm, respectively, p = 0.003). When hypertension, diabetes mellitus, smoking, hyperlipidemia, and systemic lupus erythematosus were controlled for in the analysis, the effect of Mg remained significant in both groups (p = 0.000). CONCLUSION: Our results indicate that Mg might not improve endothelial function (CRP level and FMD) and that a decreased cIMT as a marker of atherosclerosis may be due to the inhibition of calcification through the regulation parathormone, calcium, and phosphorus.

Aerobic exercise improves signs of restless leg syndrome in end stage renal disease patients suffering chronic hemodialysis.

BACKGROUND: Restless leg syndrome (RLS) is one of the prevalent complaints of patients with end stage renal diseases suffering chronic hemodialysis. Although there are some known pharmacological managements for this syndrome, the adverse effect of drugs causes a limitation for using them. In this randomized clinical trial we aimed to find a nonpharmacological way to improve signs of restless leg syndrome and patients' quality of life. MATERIAL AND METHODS: Twenty-six patients were included in the study and divided into 2 groups of control and exercise. The exercise group used aerobic exercise during their hemodialysis for 16 weeks. The quality of life and severity of restless leg syndrome were assessed at the first week of study and final week. Data were analyzed using SPSS software. RESULTS: The difference of means of RLS signs at the first week of study and final week was -5.5 ± 4.96 in exercise group and -0.53 ± 2.3 in control group. There was not any statistical difference between control group and exercise group in quality of life at the first week of study and final week. CONCLUSIONS: We suggest using aerobic exercise for improving signs of restless leg syndrome, but no evidence was found for its efficacy on patient's quality of life.

Designing, implementing, and evaluating the process of action plan management at Isfahan Medical School.

BACKGROUND: Planning, organizing, and coordinating are inevitable in pursuing the faculty and university's goals, which cannot be achieved without having desirable goals, prioritization, and AP (action plan). This study designed, implemented, and evaluated APM (Action plan management) to increase the quality of educational, research, and management programs. MATERIALS AND METHODS: A developmental study was conducted at Isfahan Medical School in 2019. The participants were selected by census sampling, and the target population comprised all deputies (8 ones) and departments (33 ones). This study was carried out in seven steps with a combined method of reviewing literature, document analysis, focus group, and questionnaire. The steps were forming the APM committee, regulating a planned process, designing and issuing the faculty's general policies, using expertise and getting feedback, monitoring the program, final reporting, and the poll. RESULTS: The response rate of the departments was 90.2%; the highest and lowest comprehensiveness scores of AP were 100% and 38%, and the highest and lowest performance monitoring scores were 100% and 25%. The mean and standard deviation of comprehensiveness and monitoring were 76 ± 0.1% and 69 ± 0.4%, 82 ± 0.1% and 73 ± 0.1%, and 72 ± 0.2% and 63 ± 0.4% in the basic science departments, clinical departments, and deputies, respectively. The highest agreement (4.8 ± 0.4) was related to the items "AP is as one of the important functions of management, looking to the future" and "AP is effective in the development of any organization." CONCLUSION: Regulating a designed process with a clear guideline, developing 24 general policies for the faculty, forming a committee to monitor the AP, and evaluating and giving feedback to the units were the most important results of this study. Also, the selected departments were introduced, and the progress report was presented to the faculty councils. Further studies were proposed to develop long-term plans, and information management was suggested to measure the progress of different units over time according to the defined goals.

Nutritional vitamin D supplementation in chronic hemodialysis: An uncontrolled open-label trial.

The present study was evaluated by the incidence of vitamin D deficiency and management of hemodialysis (HD) patients with low doses of vitamin D over 6 months. This uncontrolled open-label trial was fulfilled in descriptive and then analytical phases from 2008 to 2010 recruiting chronic HD patients in our province. For this purpose, 169 patients undergoing regular HD were randomly selected and their vitamin D level was measured. Then, 54 patients with vitamin D levels less than 30 ng/mL entered the second phase. This group received 50,000 IU vitamin D3 monthly for 6 months. The mean vitamin D level in 169 patients was 21.73 ± 20.27 ng/mL. As well, 62.7% had vitamin D levels less than 30 ng/mL. Following the six-month intervention, mean vitamin D levels elevated significantly from 17.03 ± 7.4 to 42.8 ± 16.9 ng/mL (P < .0001). In this study, the incidence rate of vitamin D deficiency was 62.7%, lower than that in previous research in patients undergoing chronic HD. Vitamin D3 administration at lower doses than healthy people could significantly increase vitamin D level.

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.

The comparative evaluation of patients' body dry weight under hemodialysis using two methods: Bioelectrical impedance analysis and conventional method.

BACKGROUND: Dry weight (DW) is an important concept related to patients undergoing hemodialysis. Conventional method seems to be time consuming and operator dependent. Bio impedance analysis (BIA) is a new and simple method reported to be an accurate way for estimating DW. In this study, we aimed to compare the conventional estimation of DW with measuring DW by BIA. MATERIALS AND METHODS: This study involved 130 uremic patients, performed in Isfahan, Iran. DW was calculated by both conventional (CDW) and BIA (BIADW) method and results were compared based on different grouping factors including sex, underlying cause of renal failure (RF) (diabetic RF and non-diabetic RF), body mass index (BMI) status, and sessions of hemodialysis. We also calculated the difference between DWs of 2 methods (DW diff = CDW-BIADW). RESULTS: The mean of BIADW was significantly lower than CDW (57.20 ± 1.82 vs 59.36 ± 1.77, P value < 0.001). After grouping cases according to the underlying cause, BMI, sex, and dialysis sessions BIADW was significantly lower than CDW. CONCLUSION: Based on the combination of problems with CDW measurement which are corrected by BIA, and more clinical reliability of CDW, we concluded that although conventional method is a time-consuming and operator-dependent way to assess DW, DW could be estimated by combining both of these methods by finding the mathematic correlation between these methods.

Metabolic Disorders in Patients with Nephrolithiasis in Iran.

Nephrolithiasis is a common disease entity around the world, with an increasing prevalence and incidence. There is no consolidated information available on the cause of kidney stones in Iranian patients. As a result, we decided to review the etiology of kidney stones in Iran. PubMed, Scopus, Web of Science, Google scholar, and Scientific Information Database (SID) were searched with the following keywords "Nephrolithiasis", "Renal stone", "Kidney stone", "Urolithiasis", "Etiology", "Metabolic abnormalities", and "Iran". There was no time period limit for selection of the papers. The inclusion criteria included any paper on evaluation of urine biochemistry regarding stone formation in Iranian adult patients (with or without children) with nephrolithiasis. We found 217 articles, of which 9 were eventually included. In conclusion, 1896 patients with nephrolithiasis from 6 provinces and 7 cities of Iran with different climates from 2000 to 2019 were evaluated collectively. The results showed that in contrast to western countries, hypercalciuria was not the most common biochemical disorder of patients with nephrolithiasis (18.2% vs. 30 to 60%). Low urine volume (49.6%) and hypocitraturia (27%) were the most frequent urine abnormalities in our country.  DOI: 10.52547/ijkd.7055.

Cilostazol-induced Acute Kidney Injury in A Patient With Diabetic Foot Ulcer: A Case Report and Review of Literature.

INTRODUCTION: Cilostazol is an antiplatelet agent, that has been recently used as an adjunctive therapy in the management of diabetic foot ulcers. Headache, diarrhea, palpitations, and edema are reported as common side effects. CASE PRESENTATION: A 53-year-old woman was admitted to hospital, with decreased urine output and increased serum creatinine level. She had taken Cilostazol for the first time, for only one day, so the diagnosis of acute kidney injury, probably drug-induced acute interstitial nephritis, due to Cilostazol use, was made. Her kidney function did not improve despite Cilostazol discontinuation and therefore, empirical corticosteroid therapy was initiated. Her urine output increased and her serum creatinine level significantly decreased, on the third day of treatment. She was discharged with acceptable kidney function. Follow-up visits showed gradual normalization of serum creatinine in the next 62 days. CONCLUSION: Based on our case, we may draw the conclusion that, Cilostazol may cause nephrotoxicity at any point after ingestion.  DOI: 10.52547/ijkd.6980.

Components of curriculum supervision regarding the accountability of universities of medical sciences.

BACKGROUND: This study was conducted on accountability, aiming to design components for monitoring the curricula of universities of medical sciences. MATERIALS AND METHODS: This study was a developmental one, conducted in Isfahan University of Medical Sciences with the document and literature review, a focus group, and a survey from 2018 to 2020. The first version of the components was designed by the library research and content analysis method. Following developing the initial tool, its validity was evaluated with a focus group, and the questionnaire was prepared according to face and content validity. RESULTS: In this study, 73 components were designed in eight domains for curriculum supervision, including requirements (12), needs and goals (6), content (10), teaching-learning strategies (10), educational materials and resources (5), educational time (2), educational setting (10), and evaluation (18). CONCLUSION: The components of curriculum supervision were designed due to their importance in the evolution and innovation of medical sciences, particularly accountability in the education system, and lack of relevant research. With these components, the current and optimal status of curricula can be determined in universities.