Hepatitis: Ossareh S

Oreopoulos DG, Ossareh S, Thodis E. · Peritoneal Dialysis Program, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada. · Iran J Kidney Dis. · Pubmed #19377234 links to  free full text

Abstract: Approximately, 10% to 15% of patients with end-stage renal disease are on peritoneal dialysis (PD) worldwide, with a dramatic difference in the use of PD among various countries. Recent data show a survival benefit of PD over hemodialysis which is maintained up to the 3rd year. The quality of life studied by various models is as good as, if not better than, that in patients on hemodialysis, for at least the first 2 years. In most countries that locally manufacture PD solutions, PD is significantly cheaper than hemodialysis. Several studies have found a better immediate graft function, lower rate of delayed graft function, and lower use of immunosuppressive medication after kidney transplantation in patients previously on PD compared to those on hemodialysis. There is a significantly lower rate of hepatitis C and hepatitis B infections in patients on PD compared to those on hemodialysis. Longer maintenance of residual renal function in PD compared to hemodialysis adds to the lower morbidity and the survival benefit of PD mentioned above. Many developments in the prevention of the causes of technique failure, including measures to prevent serious peritonitis episodes and new biocompatible PD solutions, together with the possible advantages of some types of catheters and implantation techniques, encourage us to believe that we can offer successful long-term PD in the near future. Overall, the new insight into the pathogenesis of peritoneal membrane changes, the response of the industry to this knowledge by producing new biocompatible PD solutions, the decrease in the peritonitis rate and the introduction of assisted PD at home encourages us to believe that the future of PD is indeed bright.

Savaj S, Abdi E, Nejadgashti H, Eris S, Prooshaninia F, Ataipoor Y, Ossareh S, Abbasi MA, Heidari H, Saheb-Jamii H, Ebrahimzadeh K, Ghods AJ. · Department of Kidney Transplantation, Shaheed Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran. · Iran J Kidney Dis. · Pubmed #19367009 links to  free full text

Abstract: INTRODUCTION: Our aim was to evaluate the frequency and risk factors of posttransplant diabetes mellitus (PTDM) at our kidney transplant center, and to compare graft and patient outcomes between the kidney recipients with and without PTDM. MATERIALS AND METHODS: We studied 203 kidney transplant recipients with a negative history of diabetes mellitus before transplantation. We examined them for PTDM and made diagnosis on the basis of the American Diabetes Association criteria. Measurements of plasma glucose were carried out from 3 months to 24 months after transplantation. All data including recipient and donor demographics, cause of end-stage renal disease, cytomegalovirus and hepatitis C virus antibody tests, and patient and graft outcomes were assessed in relation to PTDM. RESULTS: High fasting plasma glucose was seen in 24 (11.8%), 19 (9.4%), 16 (7.9%), and 13 (6.4%) patients at 3, 6, 12, and 24 posttransplant months, respectively. Moreover, impaired glucose tolerance was seen in 17 (8.4%), 16 (7.9%), 17 (8.4%), and 19 (9.4%) patients at the corresponding times, respectively. Accordingly, 39 patients (19.2%) were diagnosed to have PTDM. The mean age of the kidney recipients with PTDM was 46.5 +/- 12.3 years as compared to 38.6 +/- 13.4 years in nondiabetic kidney recipients (P = .02). The 5-year patient and graft survival rates were not significantly different between the kidney recipients with and without PTDM. CONCLUSIONS: This study showed that PTDM is a common metabolic disorder in our kidney transplant patients. We recommend a less diabetogenic immunosuppressive protocol, especially for our older recipients.