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A Review of Thyroid Dysfunction due to COVID-19

Category: Articles » A Review of Thyroid Dysfunction due to COVID-19

 

A Review of Thyroid Dysfunction due to COVID-19

 

Please click to this link: 

 

 

 

<Article link>

 

 

 

 

A Review of Thyroid Dysfunction due to COVID-19

 

Alireza Arefzadeh 1
Abstract

Coronavirus disease 2019 (COVID-19) affects thyroid function.

 

These changes are due to the direct impact of the virus on thyroid

 

 

cells via angiotensin-converting–enzyme 2 (ACE2) receptors,

 

 

inflammatory reaction, apoptosis in thyroid follicular cells,

 

 

suppression of hypothalamus-pituitary-thyroid axis,

 

 

an increase in activity of adrenocortical axis,

 

 

and excess cortisol release due to cytokine storm

 

 

of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

 

 

Euthyroid sick syndrome (ESS), thyroiditis, clinical and subclinical

 

 

hypothyroidism, central hypothyroidism, exacerbation of

 

 

underlying autoimmune thyroid disease, and clinical and

 

 

subclinical hyperthyroidism can be associated with coronavirus.

 

 

Adjuvants in coronavirus vaccines induce autoimmune/inflammatory syndrome

 

 

known as vaccine adjuvants (ASIA) syndrome.

 

 

Thyroiditis and Graves’ disease have been reported

 

 

to be associated with ASIA syndrome after some coronavirus

 

 

vaccinations. Some coronavirus medications, such as hydroxychloroquine,

 

 

monoclonal antibodies, lopinavir/ritonavir, remdesivir, naproxen,

 

 

anticoagulants, and glucocorticoids can also affect thyroid tests,

 

 

and correct diagnosis of thyroid disorders will be more difficult.

 

 

Conclusion: Changes in thyroid tests may be one of the most

 

 

important manifestations of COVID-19.

 

 

These changes can be confusing for clinicians and can lead to

 

 

inappropriate diagnoses and decisions.

 

 

Prospective studies should be conducted in the future to increase

 

 

epidemiological and clinical data and optimize the management

 

 

of thyroid dysfunctions in patients with COVID-19.

 

 

Keywords: Coronavirus disease 2019; severe acute

 

 

respiratory syndrome coronavirus 2; thyroid hormone;

 

 

thyroiditis; autoimmune disease; hyperthyroidism;

 

 

hypothyroidism; euthyroid sick syndrome; pandemic;

 

 

subclinical thyroiditis; painless thyrotoxicosis; thyroid dysfunction; thyrotoxicosis.

 

 

The author of the article:

 

 

Dr. Alireza Arefzadeh,

 

 

 

 

Endocrinologist

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

درمان چاقی شکم با آر اف درمان چاقی شکم چاقی شکم آر اف شکم آر اف کویتیشن اولتراسوند فوق تخصص غدد در تهران فوق تخصص غدد تهران بهترین فوق تخصص غدد تهران شمال جنوب شرق غرب بهترین فوق تخصص غدد در تهران بهترین فوق تخصص غدد تهران بهترین فوق تخصص غدد در شمال تهران بهترین فوق تخصص غدد در غرب تهران دکتر غدد در تهران بهترین دکتر متخصص غدد در تهران لیست پزشکان فوق تخصص غدد در تهران بهترین دکتر فوق تخصص غدد در تهران بهترین متخصص غدد در تهران متخصص غدد تهران بهترین متخصص غدد تهران متخصص غدد در تهران متخصص تیروئید تهران متخصص دیابت تهران متخصص تیروئید متخصص دیابت متخصص دیابت در تهران آدرس دکتر متخصص غدد در تهران آدرس دکتر فوق تخصص غدد در تهران متخصص تیروئید در تهران دکتر متخصص تیروئید در تهران بهترین فوق تخصص غدد تهران شمال جنوب شرق غرب متخصص داخلی دیابت تیروئید چاقی رشد بلوغ نازایی متخصص غدد خوب تهران دکتر متخصص غدد خوب در تهران دکتر متخصص دیابت در تهران دکتر متخصص تیروئید در تهران کلینیک فوق تخصصی غدد دکتر فوق تخصص غدد تیروئید کلینیک فوق تخصصی تیروئید دکتر متخصص غدد تیروئید دکتر متخصص غدد دیابت دکتر متخصص دیابت دکتر فوق تخصص غدد دیابت متخصص غدد تیروئید فوق تخصص غدد دیابت بهترین دکتر فوق تخصص غدد در تهران بهترین دکتر فوق تخصص تیروئید در تهران بهترین دکتر فوق تخصص دیابت در تهران بهترین دکتر متخصص رشد در تهران بهترین دکتر فوق تخصص رشد در تهران کلینیک فوق تخصصی دیابت کلینیک فوق تخصصی دیابت در تهران معرفی دکتر فوق تخصص غدد در تهران دکتر غدد خوب در تهران دکتر خوب غدد در تهران دکتر علیرضا عارف زاده فوق تخصص غدد دکتر علیرضا عارف زاده دکتر عارف زاده فوق تخصص غدد Dr alireza arefzadeh بهترین فوق تخصص غدد تهران شمال متخصص غدد شرق غرب جنوب فوق تخصص غدد بهترین فوق تخصص غدد بهترین فوق تخصص غدد تهران بهترین فوق تخصص غدد در تهران فوق تخصص غدد در تهران فوق تخصص غدد تهران فوق تخصص خوب غدد تهران فوق تخصص خوب غدد شمال تهران بهترین فوق تخصص غدد شرق تهران بهترین شمال تهران متخصص غدد بهترین متخصص غدد جنوب تهران بهترین متخصص غدد غرب تهران بهترین فوق تخصص غدد شمال تهران بهترین فوق تخصص غدد در شمال تهران متخصص غدد متخصص غدد تهران بهترین متخصص غدد تهران متخصص غدد در شمال تهران بهترین متخصص غدد در تهران فوق تخصص غدد در شمال تهران بهترین فوق تخصص غدد غرب تهران بهترین فوق تخصص غدد در غرب تهران بهترین فوق تخصص متخصص غدد شمال تهران دکتر غدد خوب در تهران دکتر خوب غدد در تهران دکتر علیرضا عارف زاده فوق تخصص غدد دکتر علیرضا عارف زاده Dr alireza arefzadeh

ا

 

 

 

Tags for this article: A Review of Thyroid Dysfunction due to COVID-19, Thyroid COVID-19, Thyroid, بهتزین دکتر تیروئید تهران, بهترین دکتر فوق تخصص تیروئید در تهران, بهترین فوق تخصص غدد در تهران, بهترین فوق تخصص غدد تهران

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Association of the Thyroid Nodules With FNA

Category: Articles » Association of the Thyroid Nodules With FNA

 

 

 

 

Association of the Thyroid Nodules With FNA

 

 

 

 

 

 

Please cick this link in below:

 

    

<Article Link>

 

 

 

 

 

 

 

Abstract

 

Thyroid nodules are a common finding in clinical practice.

 

Although ultrasonography is an accepted method for evaluating

 

 

these nodules, Fine Needle Aspiration (FNA) is the procedure of

 

 

choice for assessing the risk of malignancy. This study aims to determine

 

 

the association between sonographic features of thyroid nodules based on

 

 

Thyroid Imaging Reporting and Data System classification and the cytology results.

 

 

In this prospective cohort study, 147 patients from Tehran Medical Imaging Center

 

 

 

who had thyroid nodules underwent ultrasonography-guided FNA,

 

 

and their sonographic features were recorded.

 

 

The pathologic findings were also obtained according to the Bethesda system.

 

 

 

inally, the association between sonographic features and cytological results was

 

 

analyzed.

 

 

Eighteen (12.3%) nodules were malignant, and 129 nodules (87.7%) were benign. The

 

 

 

association of TIRADS categories with the risk of malignancy is as follows:

 

 

 

TIRADS 1 (n=0, 0%), TIRADS 2 (n=10, 16.9%), TIRADS 3 (n=6, 10.5%), TIRADS 4 (n=2, 16.7%), and TIRADS 5 (n=0, 0%).

 

 

 

 

The bloody lamellae of thyroid nodules were significantly correlated with

 

 

the risk of malignancy (P<0.05).

 

 

However, there was no statistically significant association between

 

 

the risk of malignancy and gender (P=0.47), calcification (P=0.9),

 

 

firmness (P=0.19), halo sign (P=0.95), location of nodules (P=0.35),

 

 

and nodules' echogenicity (P=0.058).

 

 

 

Although there are trusted classifications such as TIRADS for

 

 

categorizing thyroid nodules, there is still uncertainty in utilizing them,

 

 

especially in the management of nodules classified as TIRADS 2,

 

 

.

 

in which various sonographic features are shared between benign and malignant nodules.

 

 

Although, based on the ACR guideline, we do not perform FNA

 

with all nodules that have TIRADS 2, regardless of the size or other characteristics

 

of the nodule,

 

there is a possibility that some of these nodules will be malignant in the future,

 

 

so it is considered.

 

It seems that the guideline should be revised regarding TIRADS 2,

 

and under certain circumstances,

 

 

these types of nodules should also be sampled under FNA ultrasound guidance

 

with some criteria such as size or other features,

 

because there may be problems in the future,

 

contrary to what the guideline currently recommends,

 

that sampling TIRADS 2 is not required.

 

 be created and find out that some of these types of nodules are malignant 

 

Although currently, the ACR guideline does not recommend performing

 

thyroid nodule FNA with TIRADS 2

 

unless the patient has a positive family history of thyroid cancer,

 

 

. especially if family history is the MTC type or MEN.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Author and compiler:

 

Dr. Alireza Arefzadeh

 

 

 

 

 

 

 

 

endocrinology and metabolism specialist in Tehran

 

specialist in endocrine diseases in Tehran

 

 

the best endocrinologist in Tehran

 

the best endocrinologist in Tehran

 

the best subspecialist in Iran

 

the best endocrinologist in Iran

 

the best endocrinologist in Tehran

 

the best endocrinologist in Iran

 

the best specialist Thyroid in Tehran

 

FNA

 

thyroid ultrasound

 

 

 

 

 

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Evaluation of Ethanol Injection, Radiofrequency Ablation, and Levothyroxine Therapy in the Management of Benign Thyroid Nodules

Category: Articles » RF and Thyroid nodule

Evaluation of Ethanol Injection, Radiofrequency Ablation, and Levothyroxine Therapy in the Management of Benign Thyroid Nodules

 

                                                                                 

                                                                                         <Click here>

 

 

Abstract

Background:

Thyroid nodules are common clinical findings. Although there are various accepted treatments for benign thyroid nodules, such as surgery and thermal treatment, there are some alternative methods for the management of these patients at lower costs with minimal complications.

Objectives:

This study aimed to compare volume reduction in radiofrequency (RF) ablation and single-session ethanol ablation (EA) and to investigate the effects of levothyroxine therapy (LT4) on benign thyroid nodules.

Patients and Methods:

In this clinical trial, 91 patients with benign thyroid nodules, presenting to different medical centers in Tehran, Iran, from December 6, 2018, to December 6, 2019, were included. Patients who met the inclusion criteria were selected and randomly allocated into three groups: group 1, a single session of RF ablation (n = 31); group 2, a single session of ethanol injection (n = 30); and group 3, a six-month LT4 treatment (n = 30). Thyroid tests, including thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), anti-thyroid peroxidase (anti-TPO), T3 resin uptake (T3RU), and serum calcitonin level, were recorded at baseline and within one-, three-, and six-month intervals. The nodule volume was also assessed using sonography at baseline and in the follow-ups.

Results:

The mean volume reduction was 73.6%, 80.1%, and 8.7% at six months after the intervention in the ethanol injection, RF ablation, and LT4 treatment groups, respectively (P < 0.001). There was a significant relationship between the mean volume reduction and the follow-up period (one, three, and six months) (P < 0.001).

Conclusion:

The RF ablation therapy was found to be the optimal modality for the management of benign thyroid nodules, as it was associated with the greatest mean volume reduction. Conversely, the lowest mean volume reduction was observed in the LT4 treatment group during six months of follow-up.
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Polycystic Ovary Syndrome

Category: Articles » Polycystic Ovary Syndrome

How to start a contraceptive in Patients with PCOS.

 

 

 

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News Media Technologies will create the revolution in education.

Category: Articles » Medical Education

News Media Technologies will create the revolution in education.

 

 

correspondent author:Alireza Arefzadeh

 

 

Abstract
Introduction:
News media, including content and methods for presenting it,
unmistakably contribute to the informal education of our students outside the
classroom. In addition to considering new media (television, video games, Internet,
etc.) as educative agents and keeping their influence in mind, educational institutions
incorporate these media into programs of study as content—including analysis of their
importance in society, function, and the repercussions, they may have in our lives.
Discussion:
News multimedia technologies must fulfill many basic functions:
- represent and present both real and virtual worlds.
- facilitate teaching.
- enhance student learning.
- improve IQ, residential, distance memory, and life-long learning.
- accommodate students’ learning styles.
- Digital Text Writing.
- Digital knowledge
- Connect people to teachers and Students and experts.
- Online courses registry.
-More Velocity and better quality Services.
-Immediately self Examination and scored, providing quick feedback.
With the arrival of computers, written textual language was first to be digitized
because it required the least amount of resources. The new Digital text can be
modified more easily, it can be sent from one place to another, words or strings of
characters can be searched for and found instantly, etc.
Social networking sites allow students to explore their interests on a global scale and
discuss their interests with a wider range of people. This has huge implications for
self-learning, as information and resources are much more available than they were
previously. However, for students that aren’t skilled at evaluating different content, it
can be hard for them to sort through various resources to find accurate and useful
information. Important Social networking sites are
Twitter,Wikipedia,Google,Yahoo, Facebook, and Youtube, Smartphones and
Iphone. Educational institutions will successfully wed academia and technology,
allowing students to learn in new and innovative ways. Technology has great potential
to help people learn, and businesses should capitalize on the advantages of technology
to create technologically advanced educational systems. They change to accommodate
students’ learning styles and significantly change education of the future. The Internet
allows people to search through digital knowledge and connect people to teachers and
experts. Textbooks can become interactive and can easily include updates and
corrections. Students will likely be able to get coursework from whichever university
they choose, and courses will likely be collaborative and public. These changes will
allow universities to teach anyone willing to learn, rather than only a select few in a
classroom. Technologies are already changing education, as online schools allow
students to earn degrees through only online courses Computer-Based Trainings are
self-paced activities on a computer that present content to a user. The trainings often
include assessments that can be immediately scored, providing quick feedback to the
users.
Conclusion: News Media Technologies provide revolution in education.

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Accuracy of three imaging modalities for evaluation of the posterior lens capsule in traumatic cataract

Category: Articles » Others

Accuracy of 3 imaging modalities for evaluation of the posterior lens capsule in traumatic cataract

 

Click below link:

 

Accuracy of three imaging modalities for evaluation of the posterior lens capsule in traumatic cataract

 

 

 

Accuracy of 3 imaging modalities for evaluation of the posterior lens capsule in traumatic cataract.

Abstract

PURPOSE:

To compare the accuracy of 3 imaging modalities for preoperative evaluation of the posterior lens capsule in traumatic cataract.

SETTING:

Farabi Eye Hospital, Tehran, Iran.

DESIGN:

Case series.

METHODS:

The study comprised eyes with traumatic cataract opaque enough to prevent visualization of the posterior lens capsule on slitlamp examination. To detect posterior lens capsule rupture before surgery, imaging was performed with 20 MHz echography (Eye Cubed), anterior segment optical coherence tomography (AS-OCT) (Visante model 1000), and Scheimpflug imaging (Pentacam). All patients subsequently had cataract extraction, and the intraoperative findings of the posterior lens capsule were compared with the preoperative findings of the imaging modalities.

RESULTS:

The study enrolled 21 eyes of 21 patients (20 men, 1 woman) with a mean age of 31.5 years ± 1.45 (SD). The nature of trauma was blunt (5 eyes) or sharp (16 eyes). To detect posterior lens capsule rupture, the sensitivity and specificity were, respectively, 80% and 86% for 20 MHz echography, 71% and 77% for AS-OCT, and 62% and 57% for Scheimpflug imaging (95% confidence intervals: sensitivity, 30.00-90.32; specificity, 54.81-92.95). Insufficient resolution for posterior lens capsule evaluation occurred in 33.3% cases for AS-OCT and 57.1% cases for Scheimpflug imaging. The accuracy of 20 MHz echography, AS-OCT, and Scheimpflug imaging was 76.1%, 61.9%, and 42.9%, respectively.

CONCLUSION:

In the evaluation of the posterior lens capsule in eyes with traumatic cataract, 20 MHz echography had higher accuracy than AS-OCT and Scheimpflug imaging.

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High prevalence sleep disordered breathing in patients with diabetic macular edema

Category: Articles » Diabetes Retinopathy

High prevalence sleep disordered breathing in patients with diabetic macular edema (1)

 

High prevalence sleep disordered breathing in patients with diabetic macular edema

 

Arefzadeh A, MD.

Endocrinology department; Imam Hospital; Tehran University of Medical Sciences; Tehran; Iran

 

Correspondent author: Arefzadeh Alireza

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Osteoprotegerin and VEGF are independently increased in normoalbuminuric type 1 diabetic patients

Category: Articles » Diabetes and Nephropathy

Comparison of osteoprotegerin and vascular endothelial growth factor in normoalbuminuric Type 1 diabetic and control subjects

Comparison of osteoprotegerin and vascular endothelial growth factor in normoalbuminuric Type 1 diabetic and control subjects
Alireza Esteghamati, M.D. 1,*, Alireza Arefzadeh, M.D. 1, Ali Zandieh, M.D., M.P.H. 1,
Mohammad Salehi Sadaghiani, M.D., M.P.H. 1, Sina Noshad, M.D., M.P.H. 1, Manouchehr
Nakhjavani, M.D. 1
1 Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of
Medicine, Tehran University of Medical Sciences, Tehran, Iran.
* Address correspondence to Alireza Esteghamati, Endocrinology and Metabolism
Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran.

 



Abstract:
Background: The aim of the current study was to evaluate the association of osteoprotegerin
and vascular endothelial growth factor (VEGF) with glycaemic indices and diabetes status.
Methods: A total of 44 normoalbuminuric type-1 diabetic patients and 44 healthy control
subjects, matched for age, body mass index, sex ratio and lipid measures were enrolled.
Univariate and multivariate logistic regression analyses were used to determine the association of
osteoprotegerin and VEGF with diabetes status. Further, linear regression analysis was
performed to investigate the roles of osteoprotegerin and VEGF as determinants of hemoglobin
A1c (HbA1c).
Results: Osteoprotegerin and VEGF were significantly elevated in diabetic subjects
(2.76±0.85 vs. 2.26±0.75 pmol/l and 187.1±92.7 vs. 125.9±52.3 pg/ml, respectively, P <0.01)
and were positively correlated with glycaemic indices (i.e. fasting plasma glucose and HbA1c, P
<0.001). After controlling for possible confounding factors odds ratios (confidence interval) of
osteoprotegerin and VEGF for diabetes were 2.113 (1.043-4.280) and 1.014 (1.002-1.026),
respectively (P <0.05). Further, linear regression analysis revealed that the association of
osteoprotegerin with HbA1c is independent of VEGF and vice versa (P <0.001).
Conclusion: Osteoprotegerin and VEGF are elevated in normoalbuminuric type 1 diabetic
subjects and are independently associated with glycaemic indices and diabetes status.

Tags for this article: Dr. alireza arefzadeh, alireza arefzadeh, arefzadeh, alireza, doctor alireza arefzadeh, tehran, iran, doctor arefzadeh alireza, arefzadeh alireza, Dr. Alireza Arefzadeh, Dr. Arefzadeh, dr, . arefzadeh alireza, dr. arefzadeh alireza

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The Cost of Hemodialysis In Iran

Category: Articles » Hemodialysis In Iran

 


The Cost of Hemodialysis in Iran
Alireza Arefzadeh, Mahboub Lessanpezeshki, Sepideh Seifi
Department of Nephrology, Imam Khomeini Hospital, Tehran University of Medical Sciences,
Tehran, Iran
ABSTRACT. The use of dialysis in patients with end-stage renal disease (ESRD) remains one of
the most resource-intensive and hence, expensive therapeutic interventions. The purpose of this
study was to assess the cost of hemodialysis (HD) in Iran. This study was conducted in the
Department of Nephrology at the Imam Khomeini Hospital of Tehran University of Medical
Sciences, Iran, between April 2006 and June 2007. Patients with ESRD on chronic HD were
involved in the study. Relevant data were collected using interview and questionnaire. Analyzed
costs included: transportation plus absence from work, treatment instruments, drugs and other
medical procedures, diet, staff salary, equipment and building support services, non-medical
supplies, depreciation of installations and equipments, depreciation of reverse osmosis (RO) and
building rent. Sixty-three patients of whom 47.7% were males and 52.3% were females, with
mean age of 47 ± 12 years were studied. The estimated cost of each HD session was about 74 US
dollars by which an annual cost of $11549 could be estimated for each patient. Transportation and
work leaves (28.9%), staff costs and salaries (21.5%), and treatment instruments (21.1%) were
among the greatest expenses. We conclude that the annual cost of dialysis in Iran is similar to
other developing countries, but significantly less than the cost in developed countries.
Keywords: Cost, End-stage renal disease, Hemodialysis, Iran
Introduction
End-stage renal disease (ESRD) is a serious
illness with significant health consequences
and high-cost treatment options.1 As seen
worldwide, the prevalence of ESRD has significantly
increased in developing countries.2 In
Iran, the prevalence/incidence of renal replacement
therapy (RRT) and ESRD have increased
from 238 and 49.9 per million population (pmp)
in 2000,3 to 357 and 63.8 pmp, respectively in
2006.4 Currently, 50% of these patients are on
hemodialysis (HD).4
The use of dialysis in patients with ESRD
remains one of the most resource-intensive and
hence, expensive therapeutic interventions.5-7
Additionally, the growing number of ESRD
patients will devour a greater proportion of
Correspondence to:
Dr. Alireza Arefzadeh
Department of Nephrology
Imam Khomeini Hospital
Tehran University of Medical Sciences
P.O. Box13185-1678, Tehran, Iran
Email: alireza.arefzadeh@gmail .com
health-care budget. Consequently, the worldwide
demand for, and cost of renal replacement
therapy (RRT) is rapidly becoming a
major burden for health-care systems. For this
reason, chronic kidney disease (CKD) and
ESRD are considered as emerging public health
problems in developing countries necessitating
changes in health-care policies.8,9 An accurate
estimate of the cost of caring for patients with
ESRD and a better understanding of the scope
and magnitude of the total economic burden of
ESRD would help in making policy decisions
and to enable ESRD programs to develop
strategies for more cost-efficient care.10 As
there are no studies on estimation of the cost
of HD in Iran, this study was performed.
Materials and Methods
Following the approval of the Institutional
Review Board, 63 patients with ESRD on
chronic HD at the Imam Khomeini Hospital of
Tehran University of Medical Sciences, Iran
between April 2006 and June 2007, were
recruited into the study. All patients were treated
with in-center HD. Patients who survived
less than three months after commencement of
HD were excluded. The frequency as well as
duration of HD was determined by the physician
based on available resources and medical
necessity.
To assess the overall cost of treating all the
patients as well as the unit cost per each dialysis
session, we collected cost data associated with
dialysis by a customized version of the method
utilized by Adomakoh et al.11 The method was
used to determine both direct (those directly
attributed to dialysis treatment) and indirect
costs (the proportion of overhead costs incurred
by hospital in providing the dialysis
service). Relevant data were collected using
interview and questionnaire. Cost analysis was
performed from ten different viewpoints as
follows:
a) Transportation cost of patients plus his/her
attendant to the dialysis center, the cost of
elapsed time, and the expenses related to
absence from work.
b) The cost of treatment instruments (e.g.
dialysis supplies like Shaldon catheter, injection
filters, and non-dialysis supplies like
printing material).
c) The cost of drugs such as erythropoietin,
all the solutions and other drugs which
were utilized during the dialysis session or
were prescribed after that, and other medical
procedures (e.g. blood transfusion,
laboratory investigations, X-rays, etc.).
d) Dietary costs.
e) Costs related to staff salaries (e.g. nursing
staff, physicians, and dietitians).
f) Non-medical supply costs (e.g. office supplies,
cleaning).
g) All equipment and building support services
including engineering (fixing and
maintenance services), and housekeeping.
h) Depreciation of installations and equipments
(e.g. dialysis machines).
i) Depreciation of reverse osmosis (RO)
machine.
Table 1. The breakdown of hemodialysis maintenance costs for each session in Iran
Cost Amount
(US$)
Proportion of
total cost
Transportation plus absence from work 21.4 28.9%
Treatment instruments 15.6 21.1%
Drugs and other medical procedures 8.7 11.7%
Dietary 1.6 2.2%
Staffs 15.9 21.5%
Equipment and building support services 3.9 5.2%
Non-medical supplies 0.1 0.1%
Depreciation of installations and equipments 2.1 2.8%
Depreciation of RO (Reverse osmosis) machine 0.3 0.3%
Building rent 4.5 6.1%
Total 74.0 100%
308 Arefzadeh A, Lessanpezeshki M, Seifi S
[Downloaded free from http://www.sjkdt.org on Saturday, March 14, 2009]
Table 2. Comparison of total hemodialysis cost per patient in some countries
Country (Reference) Total RRT expenses ($US)
Mexico (13) $ 9,631
Brazil (14) $ 10,065
Barbados (12) $ 17,029
Turkey (26) $ 22,759
New Zealand (19) $ 35,270
USA (21) $ 46,000
Japan (25) $ 46,000
Canada (16) $ 76,023
Australia’s Northern Territory (18) $ 78,600
France (24) $ 78,947
j) Building rental costs.
Data were expressed as mean ± SD for quantitative
variables and percentages for categorical
variables.
Results
The mean age of the study patients was 47 ±
12 years. Among the 63 patients studied,
47.7% were males and 52.3% were females.
All study patients received three sessions of
HD weekly with duration per session varying
between two and four hours.
The breakdown of HD maintenance costs are
shown in Table 1. The cost of each session of
HD was about US $ 74 through which an
annual cost of US $ 11,549 could be estimated
for each patient. Transportation and work leaves
(28.9%), staff costs and salaries (21.5%), and
treatment instruments (21.1%) were among the
principal contributors to the expenses.
Discussion
The results of this study revealed that the
annual cost of dialysis in Iran is higher than
that in Mexico,12 about the same as in Brazil,13
but lower than the cost in countries such as
Canada,14-16 Australia’s Northern Territory,17
New Zealand,18 Greece,19 United States,20 Italy,
5,21 Spain,22 France,10,23 Japan,24 and Turkey25
(Table 2).
The differences noted in the reported cost in
different studies are very high and cannot be
explained only in terms of their annual per
capita income. True differences in cost obviously
ensue as a result of various factors including
different management protocols, inpatient
care, an older population of patients
with more co-morbid illnesses (especially in
the United States), different local labor costs,
import duties and shipping charges, tariffs,
etc.11 For instance, while drugs constituted 53%
of overall expenses of dialysis in Greece,19 we
found that they constituted only 11.7% of the
cost. The availability of full medical insurance
coverage for these patients, makes treatment
modalities available for every patient, regardless
of the socioeconomic status. In Iran, all
patients with ESRD are eligible for government-
provided medical insurance. The ESRD
management program is mainly sponsored by
The Ministry of Health (MOH) which acts
through the Management Center for Transplantation
and Special Diseases (MCTSD).5
Thus, different modalities of RRT are provided
at no charge and are accessible to all
nationals in Iran. A fixed reimbursement rate
is paid for dialysis in both public and private
hospitals.4
There are several approaches to reduce the
annual cost of RRT. Obviously, in the longterm,
the most important factor to reduce the
overall yearly cost of RRT is to reduce the
number of patients with ESRD. This goal can
be achieved by preventing the progression of
renal disease.25 In Iran, the most frequent
causes of ESRD are diabetes mellitus, hypertension,
obstructive uropathy, cystic and congenital
disorders, glomerulonephritis, urinary tract
infections, vasculitis, tubulo-interstitial nephritis
and pregnancy related.26 Early detection of
these diseases is as important as their optimal
treatment and we should place initial focus on
The cost of hemodialysis in Iran 309

strategies and treatments that slow disease
progression, to postpone the need for RRT. 4
Furthermore, considering the fact that HD is
the most common RRT modality, accounting
for 53.7% of prevalent RRT patients in Iran,3 it
is highly recommended that we try to increase
the use of peritoneal dialysis as well as live or
cadaveric donor kidney transplantation.4 Kidney
transplantation is the most cost-effective
treatment for ESRD,27-29 and offers considerable
savings and a drastic improvement in quality
of life in these patients. It has been revealed
that compared with other countries, the
cost of kidney transplantation is low in Iran.30
Since transport expenses, which are paid directly
by the patients, and work leaves constitute
the main expenditure section in Iran, as
in Spain,22 we suggest greater use of such
modalities as home dialysis or autonomous incenter
HD, which are already well developed,
and could generate significant savings. 31,32 In
addition, there is room for the use of satellite
HD units, a dialysis mode that may prove costeffective
apart from offering psychological
benefits to the patients.19,21,32,33
Several factors limit interpreting the results
of this study. Firstly, we did not consider costs
which ESRD imposes on society in terms of
production losses due to treatment requirements,
morbidity, mortality, and time spent to
care for patients. On the other hand, if compensating
mechanisms are taken into account,
the estimated productivity losses are significantly
lower but still considerable. Additionally,
differences in funding of health-care
systems, in dialysis modality utilization, and
other cost estimation techniques limit the accuracy
of comparison of our results with other
countries.
Conclusions
In summary, in our single-center study from
Iran, we found that the annual cost of dialysis
is similar to other developing countries but
significantly less than the cost in developed
countries. In future studies, further in-depth
comparison between the cost of other modalities
of treatment of ESRD like continuous
ambulatory peritoneal dialysis and cadaver/living
donor transplantation should be taken into consideration.
Acknowledgement
The authors would like to thank Farzan Institute
for Research and Technology for technical
assistance.
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About Us :

Dr. Alireza Arefzadeh
Assistant Prof of Endocrinology & Metabolism
Faculty Member of Medical University
Internal Medicine Specialist
Endocrinology and Metabolism SubSpecialist
Clinician and Researcher
Member of American Diabetes Association(ADA).
Member of European Society of Endocrinology(ESE)and European Research Association(CORDIS).

Contact Us :

Address :Norrebrogade, Copenhagen N, 2200 Denmark.
Phone :004591731837
E-mail :info@drarefzadeh.com
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