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Author(s): Sepanlou, Sadaf G; Barahimi, Hamid; Najafi, Iraj; Kamangar, Farin; Poustchi, Hossein; Shakeri, Ramin; Hakemi, Monir Sadat; Pourshams, Akram; Khoshnia, Masoud; Gharravi, Abdolsamad; Broumand, Behrooz; Nobakht-Haghighi, Ali; Kalantar-Zadeh, Kamyar; Malekzadeh, Reza | Abstract: BackgroundThe burden of chronic kidney disease (CKD) is increasing globally in particular in fast emerging economies such as Iran. Population-based studies on prevalence of CKD in Iran are scarce. The objective of the current study was to explore the prevalence and determinants of CKD in the setting of Golestan Cohort Study (GCS), the largest prospective cohort in the Middle East.MethodsIn this observational study, 11,409 participants enrolled in the second phase of GCS were included. Sex, age, literacy, residence, anthropometric measurements, smoking, opium use, self-reported history of cardiovascular diseases (heart disease and/or stroke), hypertension, diabetes, and lipid profile were the predictors of interest. The outcomes of interest were eGFR and CKD defined as eGFRl 60 ml/min/1.73m2.ResultsMean (SD) of GFR was 70.0 ± 14.7 ml/min/1.73m2 among all participants, 68.2 ± 14.2 among women, and 72.0 ± 15.0 among men. Prevalence of CKD was 23.7% (26.6% in women, 20.6% in men). The prevalence of CKD stages 3a, 3b, 4, and 5 were 20.0%, 3.3%, 0.4% and 0.1%, respectively. Female sex, older age, urban residence, history of CVD, hypertension or diabetes, larger body mass and surrogates of body fat and opium use were all associated with CKD. Opium had a significant positive association with CKD in adjusted model. All anthropometric measurements had positive linear association with CKD. Being literate had inverse association. Sex had significant interaction with anthropometric indices, with higher odds ratios among men compared with women. A significantly high association was observed between the rate of change in waist circumference and systolic blood pressure with risk of CKD.ConclusionOne in four people in this cohort had low eGFR. Obesity and overweight, diabetes, hypertension, and dyslipidemia are major risk factors for CKD. Halting the increase in waist circumference and blood pressure may be as important as reducing the current levels.

Shortage of deceased donor kidneys has resulted in an increased rate of kidney transplantation from living unrelated donors (LURDs). However, there are concerns about short-term and long-term morbidity of the donors. This study reports the clinical and biochemical factors in a follow-up program of Iranian LURDs, one of the largest reported series of kidney donors.Of 7500 individuals who underwent living donor nephrectomies between 2005 and 2008, a total of 1549 participated in this study. They were followed for 18 to 48 months after the kidney donation. The average time for the first study visit was 316.72 days after donation.The mean age of donors was 30.43 ± 6.16 years old. Men consisted 82.5% of the group. Systolic hypertension was detected in 0.2% and diastolic hypertension in 1% of the LURDs; however, anemia prevalence was as high as 47.2%. Hyperuricemia was found in 21.2% of the LURDs, while proteinuria was seen in 13.7%. Glomerular filtration rate was greater than 90 mL/min in 38.2% of the donors, 60 mL/min to 90 mL/min in 54.5%, and less than 60 mL/min in 7.3%. A GFR less than 45 mL/min was seen in 0.1% of the donors.Data suggested that the LURDs in Iran have an appropriate health condition comparable to other donors in other parts of the world. Considering the high prevalence of hyperuricemia in our population and its importance as a risk factor for kidney failure, monitoring serum uric acid in follow-up programs is suggested.

The incidence of major risk factors of chronic kidney disease (CKD) in the world is on the rise, and it is expected that this incidence and prevalence, particularly in developing countries, will continue to increase. Using data on urinary sediment and microalbuminuria, we aimed to estimate the prevalence of CKD in northeast Iran.In a cross-sectional study, the prevalence of CKD in a sample of 1557 regionally representative people, aged ≥ 18 years, was analyzed. CKD was determined based on glomerular filtration rate (GFR) and microalbuminuria. Life style data, urine and blood samples were collected. Urine samples without any proteinuria in the initial dipstick test were checked for qualitative microalbuminuria. If the latter was positive, quantitative microalbuminuria was evaluated.1557 subjects with a mean age of 56.76 ± 12.04 years were enrolled in this study. Based on the modification of diet in renal disease (MDRD) equation, 137 subjects (8.89%) were categorized as CKD stages III-V. Based on urine abnormalities, the prevalence of combined CKD stages I and II was 10.63%, and based on macro- and microalbuminuria it was 14.53%. The prevalence of CKD was significantly associated with sex, age, marital status, education, diabetes mellitus (DM), hypertension (HTN), ischemic heart disease (IHD), waist to hip ratio, myocardial infarction (MI), and cerebrovascular accident (CVA).CKD and its main risk factors are common and represent a definite health threat in this region of Iran. Using and standardizing less expensive screening tests in low resource countries could be a good alternative that may improve the outcome through early detection of CKD.

IntroductionThe incidence of end-stage renal disease is increasing worldwide. Earlier studies reported high prevalence rates of obesity and hypertension, two major risk factors of chronic kidney disease (CKD), in Golestan Province, Iran. We aimed to investigate prevalence of moderate to severe CKD and its risk factors in the region.MethodsQuestionnaire data and blood samples were collected from 3591 participants (≥18 years old) from the general population. Based on serum creatinine levels, glomerular filtration rate (GFR) was estimated.ResultsHigh body mass index (BMI) was common: 35.0% of participants were overweight (BMI 25-29.9) and 24.5% were obese (BMI ≥30). Prevalence of CKD stages 3 to 5 (CKD-S3-5), i.e., GFR ConclusionA considerable proportion of inhabitants in Golestan have CKD-S3-5. Screening of individuals with major risk factors of CKD, in order to early detection and treatment of impaired renal function, may be plausible. Further studies on optimal risk prediction of future end-stage renal disease and effectiveness of any screening program are warranted.

Renal transplantation is the best treatment modality for end-stage renal disease (ESRD) patients. In Iran, a living unrelated donor (LURD) transplant program was started in 1988, because of the shortage of living related and cadaver donors. In this study, we evaluated the socioeconomic status of LURD in Iran. We enrolled 478 LURDs from 30 transplant centers between October 2005 and March 2006. The demographic data, education, employment, motivation, and satisfaction status were asked. Economic status was assessed using criteria of the statistics center of Iran. Ninety-six percent of donors were referred from the Kidney Foundation of Iran (KFI). The mean age of the donors was 27 ± 4.8 years and 85% were men (n = 408). Fifty-one percent were smokers, 82% married, and 79% the breadwinner; 29% were unemployed; 2.7%, 90.8%, and 6.5% were illiterate, school graduates, and university graduates, respectively. Coercion was documented for only one donor. Financial issues were the most frequent motive. Among them, 91% were satisfied with the donation. Finally, 53% suggested kidney donation to others. Of donors, 62% were living below the poverty line. In the Iran model, the KFI is a bridge that connects recipients and donors. As a result, there is no middle man or broker introducing donors to recipients. The transplantation team knows nothing about money transactions between recipient and donor. Most donors were satisfied with the donation. However, establishment of a government-regulated program for social support of donors, such as lifelong health insurance may be a compensation for donors.

Introduction. The epidemiology of end-stage renal disease (ESRD) and renal replacement therapy (RRT) is under continuous evolution all over the world. We report here the epidemiological analysis of ESRD and RRT in Iran and discuss it against the background of the international situation. Methods. This epidemiological report is based on data from centre questionnaires which were collected in Iran from 1997 onwards, with a response rate of 100%. Results. The prevalenceuincidence of RRT patients were 238u49.9 p.m.p. in the year 2000. Haemodialysis and kidney transplantation were the most common RRT modalities, accounting for 53.7% and 45.5% of prevalent RRT patients, respectively. The proportion treated by peritoneal dialysis was very low (-1%). Home haemodialysis was not performed. The majority of haemodialysis centres used synthetic membranes (70%) and 100% of the sessions were performed using acetate as a buffer; 42.5% of haemodialysis patients were treated with a twice-weekly regimen, whilst 49.6% were on the standard thrice-weekly regimen. The majority of RRT patients in Iran were young to middle aged. The great majority of renal allografts came from living donors (mainly unrelated to recipients). The main renal diseases leading to ESRD were diabetes and hypertension. The third most common category was ‘cause unknown’. Conclusion. The epidemiology of RRT in Iran is characterized by: (i) young patient age (younger than the international average); (ii) high proportion of patients receiving renal allograft; (iii) use of living-unrelated donors as the major source of renal allografts.

In the September and November 2006 issues of Nature Clinical Practice Nephrology, two articles regarding living unrelated kidney donor transplantation alluded to the practices in Iran. Having served in the planning, supervision and implementation of various aspects of health care in Iran, including organ transplantation (ANH), and as transplant nephrologists who have actively participated in the care of transplanted patients in Iran (ANH and NG), we feel obligated to elucidate the realities surrounding organ transplantation in Iran. So that unbiased researchers are provided with information to judge for themselves.