Background: The assessment of body composition during the course of treatment of hemodialysis patients is crucial for optimal treatment. We intended to assess the diagnostic performance of bioelectrical impedance analysis (BIA), which could be used at the bedside in dialysis wards, and compare it with the results of dual-energy X-ray absorptiometry (DEXA). Methods: In a cross-sectional study, 43 patients with end-stage renal disease (ESRD) after hemodialysis sessions underwent direct segmental multi-frequency BIA. Volume status and body composition indices with eight electrodes connected to four limbs were measured at 1, 5, 50, 250, 500, and 1000 kHz frequencies. Then, the patients were sent to the nuclear ward for the corresponding assessments by DEXA. The results of the two methods were compared by a paired t-test and the correlations were assessed using general linear models and regression analyses. For the assessment of agreements, Bald-Altman plots were used. Results: The whole body values for bone, fat, and lean body mass were different between BIA (3.4, 22, and 44.5 kg, respectively) and DEXA (1.5, 28.5, and 40.4 kg, respectively). However, the results were strongly linearly correlated even after adjustment for age and sex (r = 0.67, P = 0.001 for bone mass; r = 0.93, P = 0.001 for fat mass; and r = 0.96, P = 0.001 for lean body mass). The same strong correlation was found for the segmental values. Conclusions: The results of BIA and DEXA are correlated strongly and are interchangeable. As the BIA is more easily available and less expensive, the routine use of BIA at hemodialysis departments is reasonable.

Background: Delayed graft function (DGF) can affect short-and long-term allograft outcomes in kidney transplant recipients. One of the pathophysiological pathways in the occurrence of DGF is ischemia-reperfusion injury (IRI). High dose intravenous vitamin C has proven efficacy in decreasing IRI consequences. Accordingly, we designed this study to assess the effect of high dose intravenous vitamin C on the incidence and duration of DGF. Methods: This is a pilot, single-center, double-blinded, randomized, placebo-controlled trial. In the treatment group, kidney transplant recipients received vitamin C infusion at the dose of 70 mg/kg diluted in 0.45% saline, and in another study arm, only the diluent solution was administered. Data regarding allograft function and other clinical information was recorded. Results: This preliminary study on 19 patients (9 cases in the vitamin C and 10 cases in the placebo group) showed that after administration of single, high dose vitamin C the incidence of DGF was not significantly different between the groups, but the duration of DGF was substantially shorter in the vitamin C group than the placebo group (7.33 ± 5.68 versus 19.66 ± 0.57 days; P = 0.02). Acute rejection episodes were more seen in the vitamin C group than in the placebo group. Although this data was not statistically significant (P = 0.37), it led to the termination of the study. Conclusion: A high dose of intravenous vitamin C before allograft implantation was effective in decreasing DGF duration but not DGF incidence. Trial registration: The trial was registered in the Iranian registry of clinical trials encoded IRCT20100111003043N13 on June 24, 2019.

Background: Fibroblast growth factor-23 (FGF23) is a phosphaturic factor that is released from bone. A variety of bone diseases can occur in renal diseases. Objectives: This study aimed to investigate the association of FGF23 with mineral factors, PTH, and 25-hydroxyvitamin D among hemodialysis patients. Methods: This cross-sectional multicenter study was performed on 135 patients aged 18 years or over with end-stage renal disease treated with hemodialysis maintenance. FGF-23, phosphorus, Ca, Mg, PTH, 25-hydroxyvitamin D, Uric Acid, Na, and K were measured in each patient's fasting blood sample. We used univariate and multivariate linear regressions. Results: The mean age of patients was 56.45 ± 13.64 years. The mean and median FGF23 concentration in patients were 855.07 ± 43.33 and 762.6 (IQR = 456.6-1430.3) pg/mL, respectively. Different variables did not show any significant difference between the two sexes. After adjustment for age, sex, dialysis time, uric acid, Na, K, and kt/V, FGF23 had a linear association with 25-hydroxyvitamin D and every 10-unit (pg/mL) increase in FGF23 was significantly associated with a 0.03 mg/mL increase in 25-hydroxyvitamin D (P = 0.04). In addition, other variables showed no significant association with FGF23. Conclusions: According to the results, FGF23 had a linear association with vitamin D and an increase in FGF23 was significantly associated with an increase in vitamin D. In addition, there was no significant association between mineral factors and PTH, and FGF23.

Background: Chronic Kidney Disease (CKD) is a disease in which the kidney’s functionality declines gradually. The aim of this study was to identify significant laboratory prognostic factors on death due to CKD in a clinical complex. Materials and Methods: A retrospective study including 109 patients with the end-stage renal disease treated at Iran Helal pharmaceutical and the clinical complex was conducted between 2014-2018. The survival time was set as the time interval between starting dialysis until death due to CKD. Also, the transplantation was considered as competing risk, which was occurred for a few patients. A three-parameter Gompertz model was used that considers both the event of interest and the competing event simultaneously. Results: Death due to CKD occurred in 29 (26.6%) of the patients and 19(17.4%) with transplantation. Serum uric acid was a significant prognostic factor that decreased the hazard of mortality by 21%. Serum phosphorus and age by increasing the risk of death, were poor prognoses for the event of interest. Serum uric acid and phosphorus 6.9-9.9 (mg/dl) were associated with 72% and 4.05-fold increased hazard of transplant, respectively. The 4-year cumulative incidence of death and transplant was 48.4% and 29.2%, respectively. Conclusion: We have deduced that high serum phosphorus levels and increased levels of age were associated with worse outcomes. High serum uric acid level was related to better survival, which could be explained by having a better protein-rich diet alongside the high albumin level. [GMJ.2020;9:e1798]

Background:Recently, an association between impaired diastolic function and increased urinary albumin excretion has been hypothesized.Objectives:We tried to assess the association between diastolic function and micro albuminuria in normotensive no diabetic obese individuals.Patients and Methods:This cross-sectional study was conducted on 186 consecutive obese normotensive no diabetic individuals who were older than 18 years and attended the outpatient health clinic at the Tehran Municipality in 2011. Systolic and diastolic blood pressures were measured using a standard mercury sphygmomanometer. Micro albuminuria was defined as abnormal urinary albumin to creatinine ratio (UACR) between 30 and 300 mg/g/d.Results:An adverse significant linear correlations was found between the UACR measurement and diastolic function (r = -0.184 and P = 0.012); however, this correlation was insignificant for systolic function (r = 0.007 and P = 0.926). Multivariable linear regression analysis showed that UACR index had a significant reverse correlation with diastolic function (Standardized Beta = -0.218 and P = 0.006).Conclusions:Our study obtained some evidences on the association of micro albuminuria with diastolic dysfunction in obese normotensive no diabetic individuals. Nonetheless, more assessment is necessary for obtaining a causal relationship between micro albuminuria and diastolic dysfunction.