Papers by Farsad Afshinnia
Diabetes Research and Clinical Practice, 1997
The objective of this study was to estimate the prevalence of diabetes among people aged 40 or mo... more The objective of this study was to estimate the prevalence of diabetes among people aged 40 or more and to compare selected factors such as systolic and diastolic blood pressure, body mass index and lipid profile in diabetic and non-diabetic subjects. This is a cross-sectional study of subjects aged over 40 in Isfahan. Selection of diabetic subjects were based on multi-stage random sampling. Diabetes status was defined by the World Health Organization criteria and was based on fasting plasma glucose and oral glucose tolerance test results. Data on age, body mass index, blood pressure and lipid profile were obtained. Results show that a total of 3910 eligible subjects were examined and classified into different diabetes status. The overall age-standardized prevalence of diabetes was 7.54% (95% CI: 6.24-8.84%) in males and 7.97% (95% CI: 6.75 -9.19%) in females with no difference. Similarly, the overall age standardized prevalence was 7.76% (95% CI: 6.87-8.65%). The prevalence of diabetes was shown to increased in the older age groups. Multiple logistic regression analysis showed that age, systolic blood pressure, hypertriglyceridemia, being overweight and also obesity were independently associated with diabetes. A large number of newly-diagnosed diabetic subjects were identified, which necessitates powerful screening programs. High levels of blood pressure, body mass index and lipid profile should draw attention to probable presence of diabetes. © 1997 Published by Elsevier Science Ireland Ltd.
Nephrology Dialysis …, Jan 1, 2010
The Journal of clinical endocrinology and metabolism, Jan 24, 2015
Human studies have reported conflicting results on the association of hypoalbuminemia with osteop... more Human studies have reported conflicting results on the association of hypoalbuminemia with osteoporosis. Aim is to test the independent association between hypoalbuminemia and osteoporosis. This is a cross-sectional observation. Patients are the outpatient consecutive individuals with available clinical, laboratory, and densitometry data from 2001 to 2013 in our tertiary care academic medical center. Exposure is hypoalbuminemia defined as serum albumin <3.5 g/dL. Osteoporosis is defined as bone mineral density of ≤2.5 standard deviations (SD) below the mean peak bone mass of young, healthy adults. Overall 21,121 patients were included. Mean of age was 61 years (SD=14). There were 4,244 males (20.1%) and 1,614 patients (7.6%) of African-American ethnicity. There was a graded decrease in rate of osteoporosis from 28.0% (n=33) at albumin ≤3 g/dL to 9.3% (n=1548) at albumin >4 g/dL (P<0.001) at femoral neck, and from 20.3% (n=24) to 6.1% (n=1011) at total hip (P<0.001). In a...
Chronic Renal Disease, 2015
Renal Failure, 2009
There are no national level data on types of dialysis in use for acute kidney injury (AKI). We ai... more There are no national level data on types of dialysis in use for acute kidney injury (AKI). We aimed to assess trends in dialysis modality for AKI and mortality associated with each modality from 1998 to 2005. Using data from the 5% Medicare cohort, we identified individuals with AKI requiring dialysis. Individuals with preexisting end-stage renal disease were excluded. Intermittent hemodialysis (IHD), daily intermittent hemodialysis, and continuous renal replacement therapy (CRRT) were defined using Current Procedure Terminology codes. Mortality was defined as death during 30 days after the first dialysis session. Between 1998 and 2005, there were a total of 18,249 patients identified with AKI requiring renal replacement therapy. CRRT was increasingly used for AKI, with 9.9% of patients in 1998 to 18.3% by 2005. Proportion of daily dialysis decreased during this period, while use of IHD remained stable at approximately 68%. Overall 30-day mortality declined from 44.4% in 1998 to 40.2% in 2005. Crude mortality for CRRT was highest in all years (51.0-61.8%), followed by daily (38.2-49.9%) and IHD groups (35.8-43.4%). Multinomial logistic regression analysis showed that white race, presence of sepsis, atherosclerotic heart diseases, peripheral vascular diseases, dysrhythmia, gastrointestinal and liver diseases, and any year after 2000 were independently associated with higher odds of using CRRT after adjusting for other variables. The proportion of patients using CRRT has increased over time. Mortality associated with IHD has decreased from 1998 to 2005. Mortality associated with different dialysis modalities is likely the result of severity of illness.
Clinical kidney journal, 2013
[This corrects the article on p. 208 in vol. 6, PMID: 23805377.].
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, Jan 20, 2015
♦ Background: Reverse epidemiology of blood pressure (BP) in end-stage kidney disease (ESKD) is m... more ♦ Background: Reverse epidemiology of blood pressure (BP) in end-stage kidney disease (ESKD) is manifested as higher mortality at lower blood pressure. We hypothesize that this phenomenon is partially mediated by deterioration of cardiac structure andfunction. ♦ Methods: Seventy-seven prevalent ESKD patients starting renal replacement therapy on peritoneal dialysis (PD) from 2007 to 2012 were evaluated for the primary outcome of all-cause mortality. Longitudinal data were obtained from 1,930 patient-encounters including monthly clinic BP and serial echocardiograms. Generalized linear mixed models using data from the last observation moving backward, and time-to-event analysis using time-varying Cox-survival models to estimate mortality risk at different blood pressure categories were applied. ♦ Results: There were 39 males (50.6%). Mean age was 51 years (standard deviation [SD] = 15). During follow-up, 20 patients (25%) died. As compared to systolic blood pressure (SBP) of 140 - 159...
Nephrology Dialysis Transplantation
Obesity is a risk factor for the progression of chronic kidney disease (CKD). The impact of weigh... more Obesity is a risk factor for the progression of chronic kidney disease (CKD). The impact of weight loss on proteinuria and renal function is less clear. We aimed to determine the effect of intentional weight loss on proteinuria and kidney function. Three bibliographic databases including Medline, Cochrane and SCUPOS as well as reference list of articles were searched. We included randomized and non-randomized controlled trials as well as single-arm trials published in English through May 2009 which examined urinary protein among obese or overweight adults before and after weight loss interventions including dietary restriction, exercise, anti-obesity medications and bariatric surgery. Study characteristics and methodological quality of trials were assessed. Five hundred twenty-two subjects from five controlled and eight uncontrolled trials were included. Weight loss interventions were associated with decreased proteinuria and microalbuminuria by 1.7 g [95% confidence interval (95% C...
... Key words: Intern Comprehensive Exam-Basic Medical Sciences Address: Emami Seye Mohammad Ha... more ... Key words: Intern Comprehensive Exam-Basic Medical Sciences Address: Emami Seye Mohammad Hassan, EDC, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran. Sources: Iranian Journal of Medical Education ٢٠٠٠ ١(١): ١٩‐٢٣ ...
Journal of the American Society of Nephrology
Model systems demonstrate that progression to ESRD is driven by progressive podocyte depletion (t... more Model systems demonstrate that progression to ESRD is driven by progressive podocyte depletion (the podocyte depletion hypothesis) and can be noninvasively monitored through measurement of urine pellet podocyte mRNAs. To test these concepts in humans, we analyzed urine pellet mRNAs from 358 adult and pediatric kidney clinic patients and 291 controls (n=1143 samples). Compared with controls, urine podocyte mRNAs increased 79-fold (P<0.001) in patients with biopsy-proven glomerular disease and a 50% decrease in kidney function or progression to ESRD. An independent cohort of patients with Alport syndrome had a 23-fold increase in urinary podocyte mRNAs (P<0.001 compared with controls). Urinary podocyte mRNAs increased during active disease but returned to baseline on disease remission. Furthermore, urine podocyte mRNAs increased in all categories of glomerular disease evaluated, but levels ranged from high to normal, consistent with individual patient variability in the risk for...
New England Journal of Medicine, 2006
... columbia.edu T. Scott Stroup, MD, MPH University of North Carolina School of Medicine Chapel ... more ... columbia.edu T. Scott Stroup, MD, MPH University of North Carolina School of Medicine Chapel Hill, NC 27599 Sonia M. Davis ... repair.4 Richard A. Krasuski, MD Brian P. Griffin, MD Cleveland Clinic Foundation Cleveland, OH 44195 [email protected] Scognamiglio R, Rahimtoola ...
Journal of the American Society of Nephrology : JASN, Jan 2, 2015
Kidney aging is associated with an increasing proportion of globally scarred glomeruli, decreasin... more Kidney aging is associated with an increasing proportion of globally scarred glomeruli, decreasing renal function, and exponentially increasing ESRD prevalence. In model systems, podocyte depletion causes glomerulosclerosis, suggesting age-associated glomerulosclerosis could be caused by a similar mechanism. We measured podocyte number, size, density, and glomerular volume in 89 normal kidney samples from living and deceased kidney donors and normal poles of nephrectomies. Podocyte nuclear density decreased with age due to a combination of decreased podocyte number per glomerulus and increased glomerular volume. Compensatory podocyte cell hypertrophy prevented a change in the proportion of tuft volume occupied by podocytes. Young kidneys had high podocyte reserve (podocyte density >300 per 10(6) µm(3)), but by 70-80 years of age, average podocyte nuclear density decreased to, <100 per 10(6) µm(3), with corresponding podocyte hypertrophy. In older age podocyte detachment rate (...
Clinical Kidney Journal, 2013
A 42-year-old Caucasian female with history of neurofibromatosis type 1 presented with nephrotic ... more A 42-year-old Caucasian female with history of neurofibromatosis type 1 presented with nephrotic range proteinuria and focal segmental glomerulosclerosis (FSGS). On final dose of lisinopril 20 mg/day, protein-creatinine ratio declined to 0.33 within 10 months. We propose the hypothesis that development of FSGS in NF1 may be mediated by activation of mitogen-activated protein kinase (MAPK) and mammalian target of rapamycin (mTOR) signaling pathways secondary to upregulation of ras proteins due to deficient neurofibromin. Since mTOR signaling pathway is partially mediated through angiotensin-II activation, angiotensin-converting enzyme (ACE) inhibition may serve as an effective initial treatment beyond anti-proteinuric properties of ACE-inhibitors.
Journal of the American Society of Nephrology : JASN, Jan 11, 2014
The attrition rate of functioning allografts beyond the first year has not improved despite impro... more The attrition rate of functioning allografts beyond the first year has not improved despite improved immunosuppression, suggesting that nonimmune mechanisms could be involved. Notably, glomerulopathies may account for about 40% of failed kidney allografts beyond the first year of engraftment, and glomerulosclerosis and progression to ESRD are caused by podocyte depletion. Model systems demonstrate that nephrectomy can precipitate hypertrophic podocyte stress that triggers progressive podocyte depletion leading to ESRD, and that this process is accompanied by accelerated podocyte detachment that can be measured in urine. Here, we show that kidney transplantation "reverse nephrectomy" is also associated with podocyte hypertrophy and increased podocyte detachment. Patients with stable normal allograft function and no proteinuria had levels of podocyte detachment similar to levels in two-kidney controls as measured by urine podocyte assay. By contrast, patients who developed t...
Renal Failure, 2012
Electrolyte changes during dialysis affect corrected QT (QTc) and QTc dispersion (QTcd), a surrog... more Electrolyte changes during dialysis affect corrected QT (QTc) and QTc dispersion (QTcd), a surrogate marker of arrhythmogenicity. The impact of magnesium on QTcd is not clear. Twenty-two stable patients on maintenance hemodialysis were enrolled in this study. Each underwent two consecutive hemodialysis sessions at least 2 days apart, the first against normal magnesium dialysate (with magnesium at 1.8 mg/dL) followed by a low magnesium dialysate (with magnesium at 0.6 mg/dL). Pre- and post-dialysis weights, blood pressure, electrolytes, and 12-lead surface EKG were recorded. The QT interval and the QTcd were calculated before and after dialysis in both sessions. Of 22 patients, 16 were female. The mean age ± SD was 53.7 ± 18.0 years. The mean change of QTcd (pre- vs. post-dialysis) was 9.5 ms (p = 0.120) and 9.3 ms (p = 0.145) in low and normal magnesium groups, respectively. Using univariate analysis, there was a statistically significant decrease in the mean blood pressure, weight, potassium, magnesium, and QTc interval post-dialysis (compared to pre-dialysis) in both groups (p ≤ 0.049). Post-dialysis concentrations of sodium and calcium were unchanged (compared to pre-dialysis) but bicarbonate increased with both dialysate groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The mean change of QTcd was not significant pre- versus post-dialysis by univariate analysis in either group. Multiple linear regression analysis adjusting for pertinent factors did not change the results in either of the two groups. Using a low magnesium dialysate bath in hemodynamically stable hemodialysis patients without preexisting advanced cardiac disease does not significantly impact QTcd.
Renal Failure, 2009
There are no national level data on types of dialysis in use for acute kidney injury (AKI). We ai... more There are no national level data on types of dialysis in use for acute kidney injury (AKI). We aimed to assess trends in dialysis modality for AKI and mortality associated with each modality from 1998 to 2005. Using data from the 5% Medicare cohort, we identified individuals with AKI requiring dialysis. Individuals with preexisting end-stage renal disease were excluded. Intermittent hemodialysis (IHD), daily intermittent hemodialysis, and continuous renal replacement therapy (CRRT) were defined using Current Procedure Terminology codes. Mortality was defined as death during 30 days after the first dialysis session. Between 1998 and 2005, there were a total of 18,249 patients identified with AKI requiring renal replacement therapy. CRRT was increasingly used for AKI, with 9.9% of patients in 1998 to 18.3% by 2005. Proportion of daily dialysis decreased during this period, while use of IHD remained stable at approximately 68%. Overall 30-day mortality declined from 44.4% in 1998 to 40.2% in 2005. Crude mortality for CRRT was highest in all years (51.0-61.8%), followed by daily (38.2-49.9%) and IHD groups (35.8-43.4%). Multinomial logistic regression analysis showed that white race, presence of sepsis, atherosclerotic heart diseases, peripheral vascular diseases, dysrhythmia, gastrointestinal and liver diseases, and any year after 2000 were independently associated with higher odds of using CRRT after adjusting for other variables. The proportion of patients using CRRT has increased over time. Mortality associated with IHD has decreased from 1998 to 2005. Mortality associated with different dialysis modalities is likely the result of severity of illness.
Renal Failure, 2013
Background-Hypocalcemia is very common in critically ill patients. While the effect of ionized ca... more Background-Hypocalcemia is very common in critically ill patients. While the effect of ionized calcium (iCa) on outcome is not well understood, manipulation of iCa in critically ill patients is a common practice. We analyzed all-cause mortality and several secondary outcomes in patients with acute kidney injury (AKI) by categories of serum iCa among participants in the Acute Renal Failure Trial Network (ATN) Study.
Phytotherapy Research, 2004
The antioxidant effect of three different extracts of Morus nigra fruit (fruit juice, hydroalcoho... more The antioxidant effect of three different extracts of Morus nigra fruit (fruit juice, hydroalcoholic and polyphenolic) on haemoglobin glycosylation, peroxidative damage to human erythrocytes, liver hepatooytes of rats and human low-density lipoprotein (LDL) were studied. The results show that all three extracts inhibited haemoglobin glycosylation induced by glucose to differing degrees. The haemolysis of human erythrocytes induced by hydrogen peroxide was also inhibited. The production of malondialdehyde (MDA) during peroxidative damage to plasma membranes of isolated rat hepatocytes induced by tert-butyl hydroperoxide (tBH) was also inhibited. Inhibition of lipid peroxidation of LDL induced by copper (II) ion was achieved during the study. The results suggest that Morus nigra fruit has a protective action against peroxidative damage to biomembranes and biomolecules.
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Papers by Farsad Afshinnia