In late December 2019, an outbreak of a novel coronavirus which caused coronavirus disease 2019 (COVID-19) was initiated. Acute kidney injury (AKI) was associated with higher severity and mortality of COVID-19. We aimed to evaluate the effects of comorbidities and medications in addition to determining the association between AKI, antibiotics against coinfections (AAC) and outcomes of patients. We conducted a retrospective study on adult patients hospitalized with COVID-19 in a tertiary center. Our primary outcomes were the incidence rate of AKI based on comorbidities and medications. The secondary outcome was to determine mortality, intensive care unit (ICU) admission, and prolonged hospitalization by AKI and AAC. Univariable and multivariable logistic regression method was used to explore predictive effects of AKI and AAC on outcomes. Out of 854 included participants, 118 patients developed AKI in whom, 57 used AAC and 61 did not.Hypertension and diabetes were the most common comorbidities in patients developed AKI. AAC, lopinavir/ritonavir, ribavirin, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, and corticosteroids had significant higher rate of administration in patients developed AKI. AAC were associated with higher deaths (odds ratio [OR] = 5.13; 95% confidence interval (CI): 3-8.78) and ICU admission (OR = 5.87; 95%CI: 2.81-12.27), while AKI had higher OR for prolonged hospitalization (3.37; 95%CI: 1.76-6.45). Both AKI and AAC are associated with poor prognosis of COVID-19. Defining strict criteria regarding indications and types of antibiotics would help overcoming concomitant infections and minimizing related adverse events.

Introduction: The epidemiology of pulmonary hypertension (PHT) among long-term hemodialysis patients has been described in relatively small studies in Iran. Objectives: The purpose of this study was to evaluate the prevalence of PHT and its relationship among end-stage renal disease (ESRD) patients undergoing long-term hemodialysis (HD). Patients and Methods: In a cross-sectional study, patients with ESRD treated with HD for at least 3 months in the Imam hospital enrolled for the study. PHT was defined as an estimated systolic pulmonary artery pressure (PAP) equal to or higher than 25 mm Hg using echocardiograms performed by cardiologist. Results: A total of 69 HD patients were included in the investigation. The mean of age of our patients was 52.6±15.3 years. The mean duration of HD was 39±36 months. The mean ejection fraction was 45±7%. The prevalence of PHT was 62.3%. These patients were more likely to have lower ejection fraction. The PHT was more common among female HD patients. We did not find any association between PHT and cause of ESRD, duration of HD, anemia and serum calcium, phosphor and parathyroid hormone levels. Conclusion: Our findings show that PHT is a common problem among ESRD patients undergoing maintenance HD and it is strongly associated with heart failure. It is necessary to screen this disorder among these patients.

Introduction: The importance of secondary hyperparathyroidism (SHPT) are frequently neglected in hemodialysis (HD) centers. Objectives: The aim of this study is to determine the prevalence of SHPT in a group of ESRD patients under routine HD. Patients and Methods: From May 2016 to August 2016, this cross sectional study was conducted on ESRD patients undergoing HD in our HD center in Beharlou hospital, Tehran province, Iran. Blood samples were obtained prior to HD session to assess laboratory parameters including intact PTH level, serum calcium, phosphorus, and alkaline phos phatase. Immunoradiometric assay was used to measure serum intact PTH (iPTH) level. Results: Forty-five HD patients, including 19 females (42.2%) with mean age of 60±14.3 years were enrolled to the study. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for mineral metabolism, 60% of our patients (n = 27) had accepted normal range of serum calcium (8.4 to 9.5 mg/dL) while 28.9% of patients had serum calcium of below 8.4 mg/dL. Around 60% of our patients (n = 27) had accepted normal range of serum phosphorus (3.5 to 5.5 mg/dL) while serum phosphorus above 5.5 mg/dL was detected in 31.1% of HD patients. Sixteen patients (35.55%) had iPTH lev els between 150-300 ρg/mL which was in the accepted ranges for iPTH lev els among HD patients. Seventeen patients (37.78%) had iPTH lev els above accepted range. Conclusion: This study showed that PTH abnormalities and disorders of mineral metabolism are common among patients with ESRD. It is crucial to better understand the pathogenesis and treatment of these disorders among ESRD patients.

Introduction: Unfortunately the restless leg syndrome (RLS) is a neglected issue among hemodialysis (HD) centers. Objectives: The aim of our study was to find the efficacy of gabapentin at a low dose of 100 mg three times a week among HD patients with RLS. Patients and Methods: Around 21 patients with fulfilled the criteria of RLS were randomized to receive either gabapentin (100 mg) or placebo after HD session for 4 weeks. After 2 weeks of washout period, the patients were switched from gabapentin to placebo or placebo to gabapentin for another 4 weeks. Severity of RLS symptoms before and after management with medication or placebo was evaluated with standardized questionnaire. Results: Twenty-one patients (10 females and 11 males with mean age of 58 years) were enrolled to the study. Before the study, all patients had questionnaire scores of 16 or greater and the mean score was 24.19± 7.96. After gabapentin administration (before or after crossover), the mean score significantly decreased from 24.19± 7.96 to 19.24± 9.87 (P=0.04). The mean score before and after placebo administration (before or after crossover) were 24.19± 7.96 and 18.89± 11.15 with no significant difference (P=0.09). Conclusion: According to the results of the study gabapentin at a dose of 100 mg at the end of HD is a safe effective therapy for RLS. It can significantly reduce the intensity of RLS among these patients.