Effect of the Prophylactic Use of Proton-Pump Inhibitors on the Pattern of Gastrointestinal Symptoms in Patients Late After Kidney Transplant.

OBJECTIVES: Although immunosuppressive drugs have been recognized as leading causes of gastrointestinal symptoms after kidney transplant, other widely used medications such as proton-pump inhibitors recently have been implicated. Our aim was to study the effects of chronic proton-pump inhibitor therapy on gastrointestinal symptoms in clinically stable patients late after kidney transplant. MATERIALS AND METHODS: The study comprised 100 kidney transplant recipients (66 men and 34 women, mean age of 49 ± 12 y, mean time after transplant of 56 ± 46 mo). All patients completed the Gastrointestinal Symptoms Rating Scale and the Quality of Life Questionnaire SF-8 surveys. RESULTS: The most commonly reported symptoms included borborygmus (27%), flatulence (23%), abdominal distension (18%), urgent need of defecation (17%), and heartburn, acid reflux, and eructation (13%). Proton-pump inhibitors were chronically used by 50% of patients and sporadically by 33%. Gastrointestinal Symptoms Rating Scale scores were higher in patients who used proton-pump inhibitors (mean score of 7.8 ± 5.5 vs 4.6 ± 3.0; P = .013). Total score of items representing diarrhea in the Gastrointestinal Symptoms Rating Scale (increased passage of stools, loose stools, urgent need of defecation, incomplete evacuation) was higher in patients treated with proton-pump inhibitors than in those not treated (2.3 ± 2.2 vs 1.3 ± 1.9; P = .04). CONCLUSIONS: Chronic use of proton-pump inhibitors may increase the prevalence of gastrointestinal symptoms, particularly diarrhea, in patients late after kidney transplant.

Dog ownership status and self-assessed health, life-style and habitual physical activity in chronic hemodialysis patients.

Introduction The Statement from the American Heart Association has emphasized a need for novel strategies that can reduce the risk of cardiovascular disease (CVD). Taking a dog for a walk forces its owner to take physical activity. Several studies have explored the relationship between pet ownership and CVD and most reported benefits. This issue has not been investigated in dialysis patients. The aim of the study was to analyze the influence of pet ownership on health and physical activity in hemodialysis patients. Methods 270 chronic hemodialysis patients (172 male, 98 female, mean age 62.7 ± 14.0 years, hemodialysis vintage 4 ± 5 years) took part in the survey focused on their general health and physical activity. Findings Two hundred nineteen (81%) patients were mobile. One hundred sixteen participants had dog at home (43%). An additional physical activity was reported by 46 dog owners (40%) compared with 34 (23%) of nonowners (P = 0.002). Patients who often go for a walk were more often pet owners 49 (57%) than nonowners (n = 37, 43%; P = 0.004). Pet owners were younger (58.3 ± 13.6 vs. 66 ± 13.5 years). Body mass index (BMI) was similar. Patients with BMI from upper tertile (>27.5 kg/m(2) ) and from lower (<23.9) were more often dog owners than from the middle (52.9%, 43.7%, and 31.4%). Dog owners were on dialysis for longer time (5.0 ± 6.5 vs. 3.5 ± 3.7 years; P = 0.02). Discussion Dog ownership appears to positively influence the level of physical activity. Age but not time on dialysis seems to be the most important factor that influences a decision to own a pet and undertake physical activity.

Prevalence of arterial hypertension and the number and classes of antihypertensive drugs prescribed for patients late after kidney transplantation.

BACKGROUND: There are limitations of the use of several classes of antihypertensive drugs in patients after kidney transplantation (KTx), as well as contradictory opinions on their effects on progression of graft dysfunction. In this study we assessed the prevalence of arterial hypertension (HA) and the antihypertensive agents used by the patients long after KTx. MATERIAL/METHODS: This retrospective evaluation of the number and classes of antihypertensive drugs was based on medical records of 348 patients (140 F, 208 M; mean age 49 ± 13 years) late after KTx (mean time after KTx 78 ± 43 months). The data were related to graft function. RESULTS: Ninety-three percent of patients after KTx required antihypertensive therapy. Only 8.7% were treated with 1 agent (mean eGFR 65.1 ± 27.4 ml/min), 26.3% received 2 drugs (eGFR 60.0 ± 25.8 ml/min), 34.2% received 3 drugs (eGFR 55.5 ± 23.4 ml/min), 20.1% received 4 drugs (eGFR 54.9 ± 24.9 ml/min), and 10.5% received ≥ 5 drugs (eGFR 45.9 ± 22.0 ml/min). The number of antihypertensive medications increased along with the deterioration of graft function. Dihydropyridine calcium antagonists (CCB) were the most common class of drugs recommended to the patients after KTx (81%), followed by ß-adrenergic antagonists (74.4%); α-antagonists (40.2%), angiotensin-converting enzyme inhibitors (38.7%), diuretics (34.1%), clonidine (17.8%) and angiotensin II receptor blockers (9.5%). CONCLUSIONS: HA is highly prevalent in KTx patients. Multidrug therapy is usually required for the treatment of HA in this population. Dihydropyridine CCB is the most common class of antihypertensive drugs used by them. Graft function is a determining factor in the number of antihypertensive agents.