RENAL DATA FROM THE ASIA - AFRICA
Year : 2009 | Volume
: 20 | Issue : 3 | Page : 501--504
Causes of chronic renal failure among Iranian hemodialysis patients
Leila Malekmakan1, Sezaneh Haghpanah2, Maryam Pakfetrat3, Alireza Malekmakan4, Parviz Khajehdehi5,
1 Shiraz Nephro-Urology Research Center (SNURC), Shiraz University of Medical Sciences, Shiraz, Iran
2 Health System Research Department, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4 Sloter vaar Hospital, Amsterdam, Netherlands
5 Shiraz Nephro-Urology Research Center (SNURC); Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, P.O. Box 71348-14336, Shiraz
Chronic Renal Failure (CRF) is characterized by impaired renal function, which is progressive and irreversible. This study was carried out to investigate the status and causes of CRF in HD patients in Fars Province, Iran. In this cross-sectional study, HD patients were evaluated in Fars province. Information for demographic characteristics, and medical history were obtained by using a questionnaire administered by trained staff. 633 cases including 371 male and 262 female were studied. The mean KT/V was 1 0.4. KT/V > 1.2 was achieved in only 32.1% (203/633) of all patients. The mean BMI was 24 ± 4.5. The most common causes of CRF were hypertension (30.5%) and diabetes mellitus (30.1%). In conclusion most common causes of CRF in this region were hypertension and diabetes mellitus. Better management of hypertension and diabetes could prevent patients from ending up with end stage renal disease.
|How to cite this article:|
Malekmakan L, Haghpanah S, Pakfetrat M, Malekmakan A, Khajehdehi P. Causes of chronic renal failure among Iranian hemodialysis patients.Saudi J Kidney Dis Transpl 2009;20:501-504
|How to cite this URL:|
Malekmakan L, Haghpanah S, Pakfetrat M, Malekmakan A, Khajehdehi P. Causes of chronic renal failure among Iranian hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Nov 29 ];20:501-504
Available from: https://www.sjkdt.org/text.asp?2009/20/3/501/50793
Awareness of the cause of CRF helps the nephrologists to anticipate problems during renal replacement therapy (RRT) and plan preventive measures for the community.  Over 1.1 million patients are estimated to have ESRD worldwide, and an addition of 7% annually. In USA incidence and prevalence counts are expected to increase by 44 and 85%, respectively, from 2000 to 2015 and incidence and prevalence rates per million population by 32 and 70%.  In the developing countries growth of ESRD population has similar trends.  Average incidence of ESRD in Middle East countries with similar renal care systems is 93 per million population.  Similarly, the incidence and prevalence of HD patients in Iran recently in year 2000 was 49.4 and 130.5 per million population respectively.  Unfortunately in most of the developing countries like Iran, patients with renal disease present late and it is not possible to diagnose the cause of ESRD. Because of lack of proper follow up these patients can only be evaluated while they are undergoing dialysis or enlisted for renal transplantation.  ESRD may be preventable or at least delayed based on the etiology. This study was therefore carried out to investigate the status and causes of CRF in HD patients in Fars Province, Iran.
Material and Methods
This is a cross-sectional study designed to determine the etiology and status of dialysis among HD patients in Fars province, Iran in 2007. The population examined here consisted of all HD patients (633 cases) who were treated at 15 HD centers in 13 cities. Informed consent was obtained from each patient. Patients were undergoing dialysis using Fresenius 4008B machines, bicarbonate dialysate, low-flux polysulphone membrane and dry weight individualized to the patinet 72% of our patients had fistula, 8% had catheter, and 20% had graft as access for hemodialysis.
Information for demographic characteristics, and medical history were obtained by using a standardized questionnaire administered by trained staff. For all subjects the clinical performance measures examined for hemoglobin (Hb), albumin (Alb), blood urea nitrogen (BUN), Triglyceride (TG), and cholesterol. KT/V was calculated by Daugirdas formula (-ln(R-0.03) + [(43.5R) × (UF χ W).  We also collected data on demographic and clinical characteristics. Height and weight used to calculate body mass index (BMI). The formula for BMI was weight in kilograms divided by height in meters squared. Underweight was defined as BMI less than 18.5 kg/m 2 ; normal weight, as BMI of 18.5 to 24.9 kg/m 2 ; overweight, as BMI of 25.0 to 29.9 kg/m 2 ; and obesity, as BMI of 30 kg/m 2 or greater.
The blood pressure measurements were obtained on a single occasion by trained staff.
Data were analyzed by SPSS 15. Quantitative data presented using the mean and standard deviation. Comparison of qualitative data was done by Chi-square and P value of 1.2. The mean BMI of our patients was 24 ± 4.5, and 10.3%, 48.2%, 31.6%, and 9.8% of them were under weight, normal weight, over weight, and obese, respectively. A significant correlation between BMI and KT/V (r: 0.09, P= 0.02) was observed. Nine cases (1.4%) were positive for HBS Ag, three cases (0.5%) were positive for HCV Ab, and one case (0.2%) was positive for HIV Ab.
[Table 2] shows the etiology of CRF among HD patients according to age in Farse province. Hypertension (30.5%) and diabetes mellitus (30.1%) were the most common causes of ESRD, followed by glomerulonephritis (GN) (7.6%). The main causes of CRF did not differ significantly between men and women (P> 0.05).
In patients with 60 years of age; diabetes mellitus (33.5%, 36.6%, respectively) was the most common cause. The cause of CRF was unknown in 14.8% of our patients.
In this study hypertension and diabetes mellitus were the most common causes of ESRD in the Fars province of Iran. GN and hypertension was the commonest cause of ESRD in Iran, five years ago, in contrast to the present study.  This change may be due to increasing prevalence of obesity, diabetes and hypertension in developing countries, as noted by Krzesinski et al. 
Study from Netherlands found renal vascular disease (20.4%) followed by, Diabetic nephropathy (16.7%) as the leading causes of ESRD  whereas in Switzerland hypertensive nephropathy was the leading cause of ESRD.  But in contrast to these studies, a study was done in southern India in 2006 that determined etiology of CKD by analyzing renal biopsies, which showed 70.5%, had GN as the histological diagnosis, 12% had interstitial nephritis, and 6.6% had hypertensive arteriosclerosis.  A significant proportion of patients with uncertain etiology are reported in the literature, 16.2% of elderly Indian cases,  5.9% in the US, 18% in the UK,  and similarly 14.8% of our cases. This is due to the late presentation of patients when ESRD has already developed and it is impossible to diagnose the cause.
CRF in elderly was associated with a number of co-morbid conditions, which contributed significantly to morbidity and mortality.  The results of this study demonstrated in patients > 60 years old diabetes mellitus was the most common cause of ESRD (36.6%). Overall spectrum of renal disease in our elderly patients is similar to the other studies, as in Indian diabetic nephropathy was the most common cause of CRF in elderly, fallow by hypertensive nephrosclerosis.  In our patients with age 40-60 years diabetes mellitus was the most common cause (33.5%) of ESRD as similarly reported in Indian ESRD patients of > 40 years of age36.8%. 
BMI in our patients had a positive correlation to KT/V suggesting better nutritional status with adequate dialysis. Patients with higher BMI have better chances of survival as compared to underweight patients,  majority of our patients (42.6%) were overweight and only 10.3% were underweight.
In conclusion, we believe that large numbers of ESRD patients have hypertension and diabetes as the etiologic factor that could be prevented by an aggressive approach in controlling blood pressure and blood sugar. A local registry is necessary to help in identifying the causes of renal failure and develop management and research initiatives to reduce the burden of kidney disease.
This study was funded by the Shiraz NephroUrology Research Center of Shiraz University of Medical Science, Shiraz, Iran.
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