Association between sleep parameters and chronic kidney disease: findings from iranian ravansar cohort study.

INTRODUCTION: The relationship between sleep duration and chronic kidney disease (CKD) has received relatively little attention in the Kurdish community. Considering the ethnic diversity of Iran and the importance of the Kurdish community, the present study investigated the association between sleep parameters and CKD among a large sample of Iranian-Kurds. METHODS: This cross-sectional study was conducted among 9,766 participants (Mage: 47.33, SD = 8.27, 51% female) from the Ravansar Non Communicable Disease (RaNCD) cohort study database. Logistic regression analyses were applied to examine the association between sleep parameters and CKD. RESULTS: Results showed that prevalence of CKD was detected in 1,058 (10.83%) individuals. Time to fall asleep (p = 0.012) and dozing off during the day (p = 0.041) were significantly higher in the non-CKD group compared to the CKD group. Daytime napping and dozing off during the day in females with CKD were significantly more than males with CKD. A long sleep duration (> 8 h/day) was associated with 28% (95% CI: 1.05, 1.57) higher odds of CKD compared to normal sleep duration (7 h/d), after adjusting for confounding factors. Participants who experienced leg restlessness had a 32% higher probability of developing CKD than those who did not experience leg restlessness (95% CI: 1.03, 1.69). CONCLUSION: Results suggest that sleep duration and leg restlessness may be associated with an increased likelihood of CKD. Consequently, regulating sleep parameters may play a role in improving sleep and preventing CKD.

Effect of add-on pentoxifylline on proteinuria in membranous glomerulonephritis: a 6-month placebo-controlled trial.

BACKGROUND: Membranous glomerulonephritis (MGN) may cause proteinuria as the main complication and is a strong risk factor for end-stage renal disease. Current therapeutic regimens provide only partial renoprotection. Data derived from both animal and human studies provide a scientific basis for the use of pentoxifylline as an antiproteinuric agent. OBJECTIVE: This study was designed to evaluate the antiproteinuric effect of add-on pentoxifylline therapy in non-diabetic patients with MGN. STUDY DESIGN: This was a double-blind, placebo-controlled trial. SETTING: Non-diabetic patients with histologically proven MGN and urinary protein excretion (UPE) > 500 mg/24 h, entered a 6-month study period. Enrolled patients were selected from a university and three private clinics. INTERVENTION: Patients were assigned to one of the two treatment groups: pentoxifylline 400 mg two or three times a day, or matching placebo. MAIN OUTCOME MEASURES: Baseline and follow-up assessments included estimated glomerular filtration rate (eGFR) and UPE. Differences in the changes in variables within the placebo and pentoxifylline treatment groups during the study period were assessed using Friedman's test. RESULTS: Treatment with pentoxifylline for 6 months resulted in a significant reduction of mean UPE (p < 0.001) along with a slight, non-significant increase of eGFR, in comparison to the mean UPE and eGFR increase in the placebo group. CONCLUSION: This study showed that add-on therapy of pentoxifylline in MGN was beneficial, and could be considered as a potential new therapeutic indication for the drug in such kidney diseases.

The use of pharmaceutical care to improve health-related quality of life in hemodialysis patients in Iran.

BACKGROUND: Compared with the general population, hemodialysis patients suffer from worse health-related quality of life (HRQoL). Poor HRQoL results in the higher risk of hospitalization and mortality. OBJECTIVE: This study was designed to assess the impact of pharmaceutical care on HRQoL of hemodialysis patients. SETTING: This study was performed in a university hemodialysis center in Iran. METHODS: At the initiation of the study HRQoL of dialysis patients were assessed using SF-36 instrument and patients' demographic and laboratory data were gathered. Hemodialysis patients were randomized to receive either only standard care of the ward consisted of brief medication review by nurses and monthly visits by nephrology fellow and attending physicians as the control group or receive clinical pharmacist-led pharmaceutical care in addition to the standard care of the ward as the case group. Finally patients' HRQoL were assessed at the end of the month six of the study in both groups. MAIN OUTCOME MEASURE: Quality of life as measured with the SF-36 was compared between case and control groups and within each group at the initiation and at the end of 6 months study. RESULTS: During this study, median (IQR) of HRQoL improved significantly from 56.9 (37.7-71.7) at the initiation of the study to 72.2 (55.3-83.7) at the end of the study in the case group (P = 0.001) especially in the role-emotional [from 66.6 (33.3-66.6) to 100.0 (100.0-100.0); P = 0.001], mental health [from 54.2 (40.8-73.5) to 68.3 (58.9-90.2); P = 0.007], social functioning [from 73.6 (37.5-100.0) to 93.4 (75.0-100.0); P = 0.01], and general health [from 45.0 (30.0-70.0) to 65.0 (48.8-75.0); P = 0.001] dimensions. Conversely, HRQoL did not change or decreased in the control group. This decrease was statistically significant in the general health domain [from 47.5 (33.8-56.3) to 40.0 (23.7-51.2); P = 0.04]. CONCLUSION: Providing pharmaceutical care significantly improved HRQoL of hemodialysis patients especially in the role-emotional, mental health, social functioning, and general health dimensions.

Effect of herbal medicine achillea millefolium on plasma nitrite and nitrate levels in patients with chronic kidney disease: a preliminary study.

INTRODUCTION: Increased plasma nitric oxide concentration has been supposed as one of the possible mechanisms of bleeding tendency in patients who suffer chronic kidney disease. Nitric oxide-scavenging properties have been reported with some Achillea species. This study was designed to find any possible effect of Achillea millefolium on plasma nitric oxide concentration in these patients. MATERIALS AND METHODS: Thirty-one chronic kidney disease patients were included in this randomized controlled trial, of whom16 received 1.5 g of powdered A millefolium flower 3 days a week for 2 months, and 15 received placebo for the same period. Plasma samples were collected before and after the study period to estimate the effect of A millefolium on plasma nitric oxide metabolites (nitrite and nitrate). RESULTS: Although not statistically significant, plasma nitrite and nitrate concentrations decreased after 2 months' administration of A millefolium (0.82 ± 0.51 µmol/L to 0.63 ± 0.42 µmol/L and 50.55 ± 17.92 µmol/L to 44.09 ± 17.49 µmole/L, respectively). These concentrations were slightly increased in the placebo group after the study period. CONCLUSIONS: Countercurrent to the placebo group, plasma nitric oxide metabolites were marginally decreased after A millefolium administration in chronic kidney disease patients. Higher doses or longer duration of plant administration may make these changes more significant.

Peripheral neuropathy response to erythropoietin in type 2 diabetic patients with mild to moderate renal failure.

This study assessed the added effect of 6 months of erythropoietin (EPO) administration in patients suffering from diabetic neuropathy with mild to moderate chronic kidney disease (CKD) managed with gabapentin. Twenty diabetic patients with mild to moderate CKD were included; 12 in gabapentin and 8 in EPO+gabapentin group. The subjects underwent nerve conduction studies (NCS) at the initiation of the investigation and after 6-month treatment. NCS were made in deep and superficial peroneal, tibial, and sural nerves. After 6 months, in both the groups, proximal motor latency (PML) nonsignificantly improved in deep peroneal and tibial nerves; conversely, dorsal motor latency (DML) got slightly impaired in these two nerves. A nonsignificant disruption and improvement was observed in deep peroneal and tibial motor nerve conduction velocity (MNCV), respectively, in gabapentin group. Although the F-wave of tibial and deep peroneal nerves remained stable in gabapentin group, a nonsignificant improvement was observed in EPO+gabapentin group. H-reflex of tibial nerve and all the evaluated parameters of sural and superficial peroneal nerves remained constant in all patients. Thus, it can be concluded that 6-month administration of EPO+gabapentin, or gabapentin alone in mild to moderate CKD patients with diabetic neuropathy could not improve nerve performance.

Cough induced by losartan with resolution after substitution with enalapril.

INTRODUCTION: Cough is an adverse event associated with the angiotensin-converting enzyme (AA inhibitor drugs. ACE inhibitor-induced cough is believed to be related to the accumulation of bradykinin,substance P,and prostaglandins resulting from the inhibition of ACE.Angiotensin-receptor blockers (AARBs) do not have any effect on ACE and theoretically might not cause cough. Therefore, a proposed option in patients suffering with ACE inhibitor-induced cough is to try an ARB. However,this report describes the reverse: a case of losartan-induced cough th hat co om completely resolved after it was substituted with an ACE inhibitor, enalapril. CASE SUMMARY: A 23-year-old, nonsmoking white woman, weighing 73.55 kg, ACE inhibitor naive (before admission), presented to the emergency department at Imam Referral Hospital, Tehran, Iran,with hypertension,proteinuria, and hyperlipidemia. The patient was admitted to the nephrology ward. She was prescribed hydrochlorothiazide 12.55 mg/d, furosemide 20 mg BID, and simvastatin 20 mg/d. The patient had no respiratory illnesses. The patient experienced cough 3 days following the initiation of losartan treatment. The cough continued in this patient for the 2-week duration of losartan treatment; however, 1 week after substitution of losartan with enalapril (22.5 mg/d),the cough resolved completely. CONCLUSION: This report describes a young woman who developed cough while receiving losartan treatment,which resolved after substitution with the ACE inhibitor enalapril.