Introduction: Cardiovascular and noncardiovascular mortality and morbidity rates of hemodialysis ... more Introduction: Cardiovascular and noncardiovascular mortality and morbidity rates of hemodialysis patients are high despite improvement in dialysis delivery. Materials and methods: Hemodialysis patients (n = 532) from 9 hemodialysis facilities were enrolled in this cohort study in September 2012. Causes of death, hospitalization, and hemodialysis exit were recorded during a 28-month follow-up period. A Cox proportional hazard model was used to predict death adjusting for case-mix variables, nutrition variables, bone mineral variables, Kt/V, vascular access, and Charlson comorbidities index. Results: Patients were 56.0 ± 15.4 years old (57% men). A total of 161 patients (30%) died (17 per 100 patient years), and the most common causes of death were cardiovascular diseases (42%) and infections (25%). Transplantation rate was 7 per 100 patient years and hospitalization frequency was 0.76 per patient year. Based on the multivariable Cox proportional hazard model, the mortality hazard ratio was 1.03 (95% confidence interval [CI], 1.01 to 1.05; P = .007) for age (years), 0.21 (95% CI, 0.11 to 0.40; P < .001) for serum albumin (g/dL), 1.21 (95% CI, 1.03 to 1.42; P = .02) for serum phosphorus (mg/dL), 1.001 (95% CI, 1.0005 to 1.002; P = .001) for serum intact parathyroid hormone (pg/mL), 1.58 (95% CI, 1.01 to 2.51; P = .047) for hemodialysis catheter (compared to arteriovenous fistula), and 1.75 (95% CI, 1.59 to 1.94; P < .001) for the Charlson score. Conclusions: Nutritional factors, comorbidities, vascular access, and abnormal mineral metabolism are the main determinants of mortality and morbidity in hemodialysis patients.
Introduction: Serum cystatin C is more sensitive for glomerular filtration rate (GFR) measurement... more Introduction: Serum cystatin C is more sensitive for glomerular filtration rate (GFR) measurement, but it is not available for clinical use in all laboratories. Regarding the importance of accurate estimation of GFR in kidney transplant recipients, we compared cystatin C-based equations with creatinine-based formulas to estimate GFR as precisely and simply as possible in kidney transplant recipients. Materials and methods: Seventy living donor kidney transplant recipients with stable kidney function were enrolled in our study. The patients' GFRs were estimated by 3 creatinine-based equations (the modification of diet in renal disease [MDRD], abbreviated MDRD, and Cockcroft-Gault) and 5 cystatin C-based equations (Filler, Le Bricon, Rule, Hoek, and Larsson), and the results were analyzed. Results: The mean age of the recipients was 38.7 +/- 13.4 years. The mean GFRs were 67.1 +/- 25.9 mL/min/1.73 m2, by the Cockcroft-Gault; 61.0 +/- 17.7 mL/min/1.73 m2, by the abbreviated MDRD; and 60.0 +/-18.6 mL/min/1.73 m2, by the MDRD formulas. Cystatin C-based GFR estimations were 43.6 +/- 16.2 mL/min/1.73 m2, 44.0 +/- 13.2 mL/min/1.73 m2, 33.8 +/- 14.1 mL/min/1.73 m2, 35.6 +/- 13.7 mL/min/1.73 m2, and 36.9 +/- 13.6 mL/min/1.73 m2 by the Filler, Le Bricon, Larsson, Rule, and Hoek equations, respectively. The estimates by creatinine-based and cystatin C-based equations were significantly different and the MDRD estimate was the closest to the cystatin C-based GFRs. Conclusions: Our findings revealed the MDRD equation could be provide a closer estimate of GFR to the cystatin C-based equations than other creatinine-based GFR calculations in kidney transplant recipients.
Introduction: There are some clinical trials showing that short-term ischemia in one organ can pr... more Introduction: There are some clinical trials showing that short-term ischemia in one organ can protect different organs against higher intensity and longer ischemic insult. We designed a study to assess whether remote ischemic preconditioning (RIPC) on one organ can decrease the rate of contrast-induced acute kidney injury (AKI) in diabetic patients who undergo coronary artery angiography (CAA). Materials and methods: This randomized control trial included 96 diabetic patients who were candidates for CAA. Exclusion criteria were congestive heart failure and complications during CAA. All of the patients received 1000 mL of normal saline before CAA. The RIPC group underwent 3 cycles of 5-minute ischemia in their right arm. Serum creatinine was measured before and 24 hours after CAA. Results: Contrast-induced AKI was reported in 5 cases in the control group and 1 case in the RIPC group (P = .13, odds ratio, 5.4). The differences in serum creatinine level before and after the procedure was significantly lower in RIPC group than that in the control group (P = .04, odds ratio, 0.08). Serum creatinine rise significantly correlated with contrast dose (P = .02) and a history of hypertension (P = .02) in both groups. Conclusions: Ischemic preconditioning had a protective effect on contrast-induced AKI in our study. Since this method is harmless and cost effective, further studies on patients with chronic kidney disease is required to evaluate addition of ischemic preconditioning to our clinical practice for prevention of contrast-induced AKI.
Background: Following the outbreak of coronavirus and its impact on the educational process of me... more Background: Following the outbreak of coronavirus and its impact on the educational process of medical students, attention was paid to e-learning due to importance of education and research. The aim of present study is to evaluation of virtual and actual education models on the learning of internal interns during the pandemic of COVID-19. Results: The mean±SD age of the participants was 24.9±2.3 years, 46% of participants were men and 54% of them live in dormitory. Results of study shows that difference of pre-test and post-test score with actual and virtual education models in the male and female is significantly different (P value=0.020). Virtual education for men and actual education for women have resulted in higher difference scores in pre-test and post-test. Actual and virtual education models were no different in academic achievements of participants. Thus, the scores obtained in 9 areas did not make a significant difference between the two types of educational models.Discuss...
Introduction: Cardiovascular and noncardiovascular mortality and morbidity rates of hemodialysis ... more Introduction: Cardiovascular and noncardiovascular mortality and morbidity rates of hemodialysis patients are high despite improvement in dialysis delivery. Materials and methods: Hemodialysis patients (n = 532) from 9 hemodialysis facilities were enrolled in this cohort study in September 2012. Causes of death, hospitalization, and hemodialysis exit were recorded during a 28-month follow-up period. A Cox proportional hazard model was used to predict death adjusting for case-mix variables, nutrition variables, bone mineral variables, Kt/V, vascular access, and Charlson comorbidities index. Results: Patients were 56.0 ± 15.4 years old (57% men). A total of 161 patients (30%) died (17 per 100 patient years), and the most common causes of death were cardiovascular diseases (42%) and infections (25%). Transplantation rate was 7 per 100 patient years and hospitalization frequency was 0.76 per patient year. Based on the multivariable Cox proportional hazard model, the mortality hazard ratio was 1.03 (95% confidence interval [CI], 1.01 to 1.05; P = .007) for age (years), 0.21 (95% CI, 0.11 to 0.40; P < .001) for serum albumin (g/dL), 1.21 (95% CI, 1.03 to 1.42; P = .02) for serum phosphorus (mg/dL), 1.001 (95% CI, 1.0005 to 1.002; P = .001) for serum intact parathyroid hormone (pg/mL), 1.58 (95% CI, 1.01 to 2.51; P = .047) for hemodialysis catheter (compared to arteriovenous fistula), and 1.75 (95% CI, 1.59 to 1.94; P < .001) for the Charlson score. Conclusions: Nutritional factors, comorbidities, vascular access, and abnormal mineral metabolism are the main determinants of mortality and morbidity in hemodialysis patients.
Introduction: Serum cystatin C is more sensitive for glomerular filtration rate (GFR) measurement... more Introduction: Serum cystatin C is more sensitive for glomerular filtration rate (GFR) measurement, but it is not available for clinical use in all laboratories. Regarding the importance of accurate estimation of GFR in kidney transplant recipients, we compared cystatin C-based equations with creatinine-based formulas to estimate GFR as precisely and simply as possible in kidney transplant recipients. Materials and methods: Seventy living donor kidney transplant recipients with stable kidney function were enrolled in our study. The patients' GFRs were estimated by 3 creatinine-based equations (the modification of diet in renal disease [MDRD], abbreviated MDRD, and Cockcroft-Gault) and 5 cystatin C-based equations (Filler, Le Bricon, Rule, Hoek, and Larsson), and the results were analyzed. Results: The mean age of the recipients was 38.7 +/- 13.4 years. The mean GFRs were 67.1 +/- 25.9 mL/min/1.73 m2, by the Cockcroft-Gault; 61.0 +/- 17.7 mL/min/1.73 m2, by the abbreviated MDRD; and 60.0 +/-18.6 mL/min/1.73 m2, by the MDRD formulas. Cystatin C-based GFR estimations were 43.6 +/- 16.2 mL/min/1.73 m2, 44.0 +/- 13.2 mL/min/1.73 m2, 33.8 +/- 14.1 mL/min/1.73 m2, 35.6 +/- 13.7 mL/min/1.73 m2, and 36.9 +/- 13.6 mL/min/1.73 m2 by the Filler, Le Bricon, Larsson, Rule, and Hoek equations, respectively. The estimates by creatinine-based and cystatin C-based equations were significantly different and the MDRD estimate was the closest to the cystatin C-based GFRs. Conclusions: Our findings revealed the MDRD equation could be provide a closer estimate of GFR to the cystatin C-based equations than other creatinine-based GFR calculations in kidney transplant recipients.
Introduction: There are some clinical trials showing that short-term ischemia in one organ can pr... more Introduction: There are some clinical trials showing that short-term ischemia in one organ can protect different organs against higher intensity and longer ischemic insult. We designed a study to assess whether remote ischemic preconditioning (RIPC) on one organ can decrease the rate of contrast-induced acute kidney injury (AKI) in diabetic patients who undergo coronary artery angiography (CAA). Materials and methods: This randomized control trial included 96 diabetic patients who were candidates for CAA. Exclusion criteria were congestive heart failure and complications during CAA. All of the patients received 1000 mL of normal saline before CAA. The RIPC group underwent 3 cycles of 5-minute ischemia in their right arm. Serum creatinine was measured before and 24 hours after CAA. Results: Contrast-induced AKI was reported in 5 cases in the control group and 1 case in the RIPC group (P = .13, odds ratio, 5.4). The differences in serum creatinine level before and after the procedure was significantly lower in RIPC group than that in the control group (P = .04, odds ratio, 0.08). Serum creatinine rise significantly correlated with contrast dose (P = .02) and a history of hypertension (P = .02) in both groups. Conclusions: Ischemic preconditioning had a protective effect on contrast-induced AKI in our study. Since this method is harmless and cost effective, further studies on patients with chronic kidney disease is required to evaluate addition of ischemic preconditioning to our clinical practice for prevention of contrast-induced AKI.
Background: Following the outbreak of coronavirus and its impact on the educational process of me... more Background: Following the outbreak of coronavirus and its impact on the educational process of medical students, attention was paid to e-learning due to importance of education and research. The aim of present study is to evaluation of virtual and actual education models on the learning of internal interns during the pandemic of COVID-19. Results: The mean±SD age of the participants was 24.9±2.3 years, 46% of participants were men and 54% of them live in dormitory. Results of study shows that difference of pre-test and post-test score with actual and virtual education models in the male and female is significantly different (P value=0.020). Virtual education for men and actual education for women have resulted in higher difference scores in pre-test and post-test. Actual and virtual education models were no different in academic achievements of participants. Thus, the scores obtained in 9 areas did not make a significant difference between the two types of educational models.Discuss...
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Papers by Shokoufeh Savaj