Background:Diabetic nephropathy is the most common cause of end stage renal disease (ESRD) in developed countries. Several trace elements were reported to be changed in diabetic nephropathy.Objectives:The aim of this study was to investigate changes in serum levels of zinc, copper and chromium and their association with the incidence of ESRD in patients with diabetes.Patients and Methods:This study was performed on 70 patients with type 2 diabetic nephropathy (macro and micro-albuminuria) and 70 healthy individuals. Samples were collected to survey metals by atomic absorption spectrophotometer. Data was analyzed by SPSS18 using descriptive and inferential analysis methods.Results:Mean ± SD levels of Zn, Cu and Cr were significantly decreased in blood samples of patients compared to healthy subjects (P < 0.01). Also the mean concentrations of Cu, Zn and Cr in drinking water of Sari were lower than the accepted limit. Only in one case, Cu was higher than the accepted limit, which was the possibility of contamination by water supply pipes.Conclusions:Cu, Zn and Cr play a specific role in the pathophysiology of diabetic nephropathy. Meanwhile in these patients, low serum levels of Cu, Zn and Cr were not associated with factors such as drinking water. Possible causes should be sought in other factors like urine, intervention factors in absorption and utilization and individual conditions.

Background:Free radical induced damages are thought to be involved in chronic kidney disease (CKD), especially in patients who are on hemodialysis (HD) for prolonged periods. Hemodialysis can influence multiple biochemical factors, several of which are useful, although the rest can be harmful and increase the severity of disease.Objectives:The purpose of this study was to evaluate the effect of the HD membrane polysulfone on oxidative stress markers, by measuring the level of lipid peroxidation and total antioxidant activity (TAC), in the blood of HD patients.Patients and Methods:This study was carried out on 31 HD patients and 31 healthy persons, matched for age and sex, as control group. Blood samples were drawn before and after HD from arteriovenous fistulas, and once from the controls. Superoxide dismutase (SOD), catalase (CAT) and thiobarbituric acid-reactive substance (TBARS) in blood hemolyzate, Glutathione peroxidase (GpX) of whole blood and TAC of plasma were measured, respectively. Then, we investigated the association between TAC of plasma, measured by ferric reducing antioxidant power (FRAP), and lipid peroxidation level with its related parameters, in HD patients.Results:The SOD, GpX and CAT were decreased after HD (P < 0.05). Also, FRAP was shown to decrease after HD (P < 0.05). However, erythrocyte TBARS levels (μmol/gr of Hb) were increased after HD, in comparison with controls, and before HD (P < 0.05). There was a significant negative correlation between TBARS and antioxidant indices, such as SOD (r = -0.67, P = 0.001), GpX (r = -0.76, P = 0.001), CAT (r = -0.63, P = 0.001) and FRAP (r = -0.84, P = 0.001). The FRAP was significantly and directly correlated with uric acid (r = +0.62, P = 0.001), SOD (r = +0.72, P = 0.001), GpX (r = +0.87, P = 0.001) and CAT (r = +0.84, P = 0.001).Conclusions:The results of our study proposed that there is a loss or inactivation of antioxidant factors, coupled with increased lipid peroxidation during the procedure of HD, possibly through the dialyzer membrane, with probable consequences on the severity of illness.

Background:Oxidative stress is thought to be involved in the pathogenesis of diabetic nephropathy. Selenium (Se), and antioxidant enzymes such as glutathione peroxidase (GPx) play an important protective role in diabetes complications.Objectives:This study aimed to evaluate the association between plasma Se and GPx levels with severity of diabetic nephropathy.Patients and Methods:In a case-control study, we measured plasma Se and GPx concentrations in patients with type two diabetes without microalbuminuria (group 1), with microalbuminuria (group 2), with macroalbuminuria (group 3), and healthy control subjects (group 4). We also assessed plasma glucose, urea, creatinine, and glycated hemoglobin levels in all study patients.Results:Plasma Se and GPx concentrations were significantly lower in diabetic patients with macroalbuminuria than other study groups (P < 0.001). Albuminuria (Alb/Cr in random urine sample) had a negative correlation with plasma Se (r = -0.40, P = 0.01), and GPx (r = -0.23, P = 0.03) concentrations.Conclusions:Plasma Se and GPx levels were lower in type two diabetic patients with macroalbuminuria and related to the stage of diabetic nephropathy.

Background:Plasma selenium (Se) concentration and glutathione peroxidase (GSH-Pxs) enzyme activity of the patients with chronic kidney disease (CKD) are usually lower than healthy individuals; however, the effect of Se supplementation on the GSH-Pxs activity in those patients remains unclear.Objectives:This study aimed to assess the effect of Se supplementation on plasma Se concentration and red blood cell (RBC) GSH-Pxs activity in patients with different stages of CKD.Patients and Methods:In this randomized clinical trial, forty-five patients with CKD who attended in a nephrology clinic were recruited. The patients were randomly allocated into three groups according to their creatinine clearance rate and were supplemented with daily Se 200 mcg for three months. Plasma Se concentration and RBC GSH-Pxs activity were measured in each patient at the beginning and at the end of the study. This clinical trial was registered in the Iranian Registry of Clinical Trials (www.irct.ir) with registration number ID of IRCT201305318501N2.Results:Plasma Se concentration and RBC GSH-Pxs activity increased significantly in all three groups of patients with CKD (P < 0.05). There were no significant differences between three groups regarding baseline plasma Se (P = 0.268) and RBC GSH-Pxs activity (P = 0.741).Conclusions:Se supplementation can increase plasma Se concentration and RBC GSH-Pxs activity in patients with different stages of CKD.

Background:Beta-2 microglobulin (B2M) is considered as a surrogate marker for middle molecule uremic toxins and a key component in dialysis-related amyloidosis. However, few studies have evaluated role of B2M in patients with chronic kidney disease (CKD).Objectives:The purpose of this study was to evaluate the association of plasma B2M level with some metabolic and cardiac performance factors in patients with CKD.Patients and Methods:In this case-control study, we measured plasma B2M level in 86 patients with different stages of CKD and 78 age- and sex-matched individuals, as healthy control group. Then we investigated the association between plasma B2M level and left ventricular hypertrophy, ejection fraction (EF), and left ventricular end-diastolic diameter (LVEDD) in echocardiography and some inflammatory and metabolic factors in patients with CKD.Results:Mean plasma B2M level was significantly higher in patients with CKD than in control group (P < 0.001). It was directly correlated with serum C-reactive protein (r = 0.167, P < 0.001), phosphate (r = 0.112, P < 0.001) levels, and left ventricular mass index (r = 0.438, P < 0.001) and LVEDD (r = 0.275, P < 0.001) in echocardiography. It was also inversely correlated with glomerular filtration rate (r = -0.033, P < 0.001), albumin (r = -0.521, P < 0.001), hemoglobin (r = -0.748, P < 0.001), and EF (r = -0.625, P < 0.001).Conclusions:Our findings suggested that plasma B2M level is inversely associated with GFR and EF and directly correlated with some metabolic and cardiac performance factors.

BackgroundFunctional iron deficiency (FID) may cause erythropoietin resistance in patients under hemodialysis (HD). Since the role of chronic inflammation or oxidative stress in its pathogenesis is unclear, controversy remains to whether intravenous iron or intravenous ascorbic acid (an antioxidant) can improve this anemia due to decreased iron availability.ObjectivesThe current study compared the effect of intravenous iron versus intravenous ascorbic acid in the management of FID in HD patients.Patients and MethodsForty HD patients with hemoglobin (Hb) ≤ 11 g/dL, serum ferritin ≥ 500 ng/mL and transferrin saturation (TSAT) ≤ 25% were randomly divided into two groups. 20 patients received 100 mg of intravenous (IV) iron (group I), and 20 patients received 300 mg of IV ascorbic acid (group II) postdialysis, twice a week for 5 consecutive weeks. Hb and iron metabolism indices were measured before the onset of the study and after 12 weeks following therapy.ResultsTwenty one percent of all HD patients, exhibited high serum ferritin, low TSAT and sufficient data for analysis. Both Group I (n = 20) and Group II (n = 20) patients showed a significant increase in Hb, serum iron, and TSAT (P < 0.001). There were no significant differences between both groups in increasing Hb (P = 0.076), serum iron (P = 0.589), serum ferritin (0.725), and TSAT (P = 0.887).ConclusionsThis study showed that both IV iron and IV ascorbic acid can improve FID in HD patients. A larger randomized trial is warranted to determine the optimal management of FID in HD patients.

Aim:This study was conducted to evaluate the validity of serum uric acid (UA) in prediction of mortality among patients in the emergency department.Materials and Methods:This is a prospective cohort study which was conducted during 2014. In this study, 120 critically ill patients who required Intensive Care Unit care services were included. For evaluation of severity of the disease, mortality in emergency department score (MEDS) in the first 24 h of admission, the requirement of using mechanical ventilation, taking vasopressor during the hospitalization time and severity of the disease based on MEDS score were measured. The patients were divided into two groups: Patients with serum UA level lower than 7.3 mg/dl and patients with serum UA level of equal or more than 7.3 mg/dl. For comparison of the mortality rate in groups, Chi-square and fisher exact tests were applied.Results:In patients, who needed mechanical ventilation, average of serum UA was 7.82 ± 2.82; however, in the patients who did not need mechanical ventilation this amount was 6.16 ± 2.7, a difference was statically significant. We found a statically meaningful difference between serum UA level with requiring mechanical ventilation and the predictive level of UA 6.95 ± 0.73 (F = 8.52; P ≤ 0.004). In the evaluation of MEDS, most patients with serum UA levels lower than 7.3 mg/dl had lower MEDS points (on average 4.6 ± 3.21) in compared to patients with serum UA level higher than 7.3 mg/dl (on average 12 ± 2.99). This difference was found to be statistically significant which indicates the patients whose serum UA was 7.3 mg/dl or higher, were at higher risk of mortality.Conclusion:The serum UA level in the 1st day of hospitalization of a critically ill patient is not an independent indicative factor in relation to mortality. High level of UA reveals critical status of the patient and requires mechanical ventilation.

Purpose: Investigations, in which oxidized-low density lipoprotein (ox-LDL), serum paraoxonase (PON1) and homocysteine (Hcy) are considered together as important agents involved in the development of oxidative and atherogenic events in non-diabetic hemodialysis (HD) population, are limited. This case-control study was designed to evaluate these parameters in the patients and control subjects and to determine the correlations among the factors. Methods: Forty-nine age- and sex- matched subjects, including 28 non-diabetic HD patients (paired pre-and post-dialysis samples) and 21 control subjects, were enrolled. Ox-LDL and Hcy levels were measured with ELISA and EIA methods, respectively. Arylesterase activity of PON1 was measured by spectrophotometric assay. Results: Compared with the control group, ox-LDL levels were significantly increased both before (p=0.001) and after HD (p=0.036). Arylesterase activity-to-HDL ratio in HD patients was significantly higher than control subjects (p=0.003). Homocysteine levels in the ESRD patients were higher than control subjects both in pre-dialysis and post-dialysis. There was a significant positive correlation (r= 0.25, p= 0.026) between ox-LDL and homocysteine in samples obtained before HD. Logistic regression analysis revealed ox-LDL levels (OR=3.02, p < 0.001) and arylesterase activity/HDL ratio (OR=2.43, p=0.01) to be associated with the increased risk of ESRD. Conclusions: Ox-LDL levels and arylesterase activity/HDL ratio indicated the strongest association with ESRD risk. These factors, especially ox-LDL as an indicator of oxidative stress, may be biomarkers in evaluating the status of non-diabetic ESRD patients. Because of the pathogenic relationship between ox-LDL and homocysteine as nontraditional risk factors of atherosclerosis, therapeutic strategies adopted to reduce them may be useful in decrease of high prevalence of cardiovascular mortality in dialysis patients. In addition, measurement of PON1 activity to HDL ratio is possibly a more valuable biomarker than arylesterase activity alone in non-diabetic ESRD.