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Background&Objective: Decrease in production of erythropoietin has been noted as one of the main factors causing anemia in ESRD patients, and administration of recombinant human erythropoietin (rhEPO) has been used to correct the anemia. Iron deficiency, including functional iron deficiency, limits the efficacy of rhEPO therapy in ESRD patients. This study examined the effects of maintenance intravenous iron sucrose (Venofer) on haemoglobin level and, optimization of erythropoietin therapy. Materials&Methods: Forty eight haemodialysis patients with haemoglobin level<9 gr/dl who were dialyzed three times weekly went under the study. Two thousands units of rhEPO were given subcutaneously at the end of each dialysis for seven weeks. At the end of the seventh week, those with haemoglobin level<9 gr/dl and with ferritin level <200 ng/dl (29 patients) were chosen for intravenous administration of 100 mg Venfor during the next five consecutive haemodialysis while maintaining the rhEPO dose at 2000 units with each dialysis. A week after the last dose of Venofer, haemoglobin and serum ferritin were determined. Results: Average haemoglobin level among the patients before administration of rhEPO was 7.5 gr/dl. After seven weeks of subcutaneous rhEPO at 2000 units with each haemodialysis, the average haemoglobin level raised to 8.5 gr/dl. The effect of maintenance IV Venofer was an increase in average haemoglobin level to 10.4 gr/dl. The same effect was seen on the ferritin level. The ferritin level of 131 ng/dl increased to 237 ng/dl a week after last dose of IV venofer. Conclusion: Intravenous (IV) iron improves haemoglobin response and, thus, optimizes rhEPO therapy.

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Background and Objective: Hemodialysis is one of the common therapulic proceduce for terminal renal failure. Insufficient and low efficient hemodialysis increases the mortality rate, therefore the assessment of hemodialysis efficacy is important. This study was done to determine the hemodialysis efficacy based on urea reduction ratio (URR) model and kt/v (Clearance Time Volume) criteria in Gorgan, Northern Iran. Materials and Methods: In this descriptive and analytical study 113 heomdilysis patients were selected prior to hemodilysis and five minutes after pump stopping, arterial blood urea nitrogen (BUN) was measured and then kt/v and URR were calculated. Also kt/v relations with weight, gender, educational level, length of hemodialysis session, blood flow rate, TMP (Terans Membran Presure), filter Ku/f (Clearance Ultrafiltration), preliminary disease, time of hemodialysis per week and the type of vessel access were determined. Data analyzed using SPSS-13 and independent t-test, chi-square, fisher exact test and Pearson correlation coefficient. Results: The mean of hemodilysis history was 37 months and mean of Patient's ages were 51.6 years. 77.9% of subjects had hemodialysis efficacy according to Kt/v and URR critrial. There was a statistical significant correlation between hemodialysis efficacy and time of hemodialysis session, blood flow rate, time of hemodialysis per week and type of vessels access (P<0.05), but there was not any significant correlation between hemodialysis efficacy and weight, gender, education, TMP, filter Ku/f and preliminary disease. Conclusion: This study suggested that hemodialysis efficacy in this center was better that other studies in Iran.

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Background and Objective: Mucocutaneons manifestations are common in hemodialysis patients.The aim of this study was evaluate the prcvalence of cutaneous and mucosal manifestations in end stage renal disease (ESRD) patients who are on the maintenance hemodialysis.

Materials and Methods: This cross sectional study was performed on 100 (51 males, 49 females) hemodialysis patients in 5 Azar hospital in Gorgan, North of Iran during 2009. Patients selected on randomly based an all of them completely examined by a deramatologist for any changes in skin, hair, nail and mucous membrane. If necessary biopsy perform and refer to a pathologist. Data analysed with SPSS-13, mann-whitney, t-test, Chi-Square and Fisher tests.

Results: The average age was 49±12.3 years. The most common causes of ESRD was dibetes mellitus. The most common skin lesion was xerosis (78.3%), after that pruritis (39.1%) lentigo (34.8%) skin discoloration (32.6%) leukonychia (32%) thining of nail bed (24%) were common lesions. Lentigo was more common in female than male 42.85% vs 21.50% (p=0.042). Xerosis (p<0.01), scaling (p=0.042), lentigo (p<0.01), folliculitis (p<0.01), idio pathic guttate hypopigmentation (p<0.01) leukonychia (p<0.01) and half and half nail (p<0.01) have meaningful correlation with age. There was also meaningful correlation between dialyis duration and skin discoloration (p<0.031) and leukonychia (p<0.041). Clubhing and ca-p product also have meaningful correlation (p<0.027). Pruritis (p<0.048) and skin fungal infection (p<0.047) (tinea versi color) also have meaningful correlation with serum ferritin level.

Conclusion: Mucocutaneous manifestation were common in end stage renal disease patients.

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Background and Objective: Hemodialysis is an important replacement therapy for 70-90% of patients with end-stage renal disease (ESRD). Arteriovenous fistula (AVF) is the vascular access of choice in these patients due to its higher efficiency and lower risk of mortality compared to arteriovenous grafts. This study was conducted to determine the frequency of vascular access types used in hemodialysis centers of Gorgan, Iran.
Methods: This descriptive-analytical study was done on 200 hemodialysis patients (101 men and 99 women) at 5 Azar and Sayyad Shirazi hospitals in Gorgan, north of Iran, during April 2020 to July 2021. The subjects were selected by the census method. Information including age, sex, education level, duration of dialysis, the initial and current types of vascular access, site of vascular access, history of diabetes or hypertension, race, and history of smoking were recorded in a checklist.
Results: The mean age of women and men was 58.34±4.71 and 57.95±13.76 years, respectively. In addition, 61.5% of the patients were under 3 years old. The most commonly used vascular access to initiate dialysis was non-cuffed temporary catheters (69%) and AVF (24%). Smoking, ethnicity, diabetes, hypertension, and gender had no significant association with the type of vascular access used. In addition, there was no significant relationship between the duration of dialysis and the type of vascular access.
Conclusion: Considering the diversity of catheters and fistulas, it is necessary to emphasize that the use of AVF in patients undergoing dialysis for the first time and the timely placement of AVF in ESRD patients can improve the quality of life of the patients. It is also recommended to use jugular catheters instead of subclavian catheters when required.