Impact of sertraline on serum concentration of CRP in hemodialysis patients with depression.

Introduction: Depression is the most prevalent psychological problem among hemodialysis (HD) patients. Inflammatory factors have been reported to play an important role in the pathogenesis of depression. The association between depression and inflammatory factors was established in chronic kidney disease (CKD) patients. Sertraline, a selective serotonin reuptake inhibitor (SSRI) antidepressant, decreases serum levels of inflammatory factors in patients with depression. Objectives: This study was designed to assess the effect of sertraline on serum concentration of C-reactive protein (CRP), hemoglobin and albumin of depressed hemodialysis (HD) patients. Patients and Methods: During a clinical trail, 35 depressed HD patients, and CRP >5 were allocated to receive sertraline for 12 weeks. Patients' depression was assessed using Beck depression inventory second edition (BDI-II) biochemical parameters (hemoglobin, serum albumin, etc) and CRP levels were measured at baseline and at weeks 4, 8 and 12 of the study. BDI-II score was evaluated before and after 12 weeks treatment with sertraline. Results: Sertraline significantly improved depression symptoms in HD patients. At the end of the study, BDI-II scores significantly changed from baseline (P=0.001) and serum levels of CRP significantly decreased at week 12 of initiation of the study (P=0.001). However, the concentration of hemoglobin and serum albumin concentration and weight was not changed significantly (P=0.995 and P=0.328, respectively). Conclusion: Sertraline significantly decreases CRP levels and can be a promising strategy to reduce the systemic inflammation and to treat depression in HD patients.

The evaluation of relationship between blood pressure and dialysate Na concentration in chronic hemodialysis patients.

INTRODUCTION: Hypertension is one of the traditional risk factors of cardiovascular disease (CVD). Extra cellular volume expansion and Na retention remain the main cause of hypertension. OBJECTIVES: The aim of this study was to investigate the relation between concentration of Na dialysate and blood pressure (BP) in chronic hemodialysis (HD) patient. PATIENTS AND METHODS: This cross-sectional study was performed on 266 adult patients undergoing HD for at least three months. Pre-HD systolic BP (SBP) and post-HD SBP during 4 weeks were measured in relation to Na dialysate concentration. The other main factors affecting the post-dialysis BP, such as body mass index (BMI), pump speed, dialysis solution temperature, duration of dialysis and intradialysis weight gain (IDWG) were also considered. Mean of ΔSBP (post-HD SBP - pre-HD SBP) in each patient in 12 session of HD was measured and statistically analyzed in relation to dialysate Na with SPSS 21. Backward multivariable linear regression analysis and Pearson's correlation coefficients were used to evaluate the correlation between sodium gradient and ΔSBP. RESULTS: SBP was significantly changed before and after dialysis in relation to dialysate Na (P<0.001). The Pearson's correlation between ΔSBP with dialysate sodium and blood flow rate (pump speed) were statistically significant(P<0.05). CONCLUSION: We found that changes in SBP before and after dialysis is significantly associated with dialysate sodium concentration.

Effects of coenzyme Q10 supplementation on C-reactive protein and homocysteine as the inflammatory markers in hemodialysis patients; a randomized clinical trial.

BACKGROUND: The most leading cause of death in end-stage renal disease (ESRD) patients are cardiovascular disease and inflammatory markers are related to coronary events. CO-Q10 (coenzyme Q10) is a protective supplement from free radical oxidative damage. In addition, hyperhomocysteinemia is an independent coronary artery disease (CAD) risk factor. OBJECTIVES: Due to increasing oxidative stress in dialysis patients, and the effect of CO-Q10 in decrease oxidative stress, in this work, we assessed the effect of CO-Q10 on C-reactive protein (CRP) level as an inflammatory marker and homocysteine in dialysis patients. PATIENTS AND METHODS: This was a single-blind, randomized cross over clinical trial. Patients with ESRD were randomly allotted to two groups. All patients received placebo and C0- Q10 100mg/d during the three months in each stage, with two week washout period. Plasma level of CRP and homocysteine from the start of the work and at the conclusion of each menses, are evaluated. RESULTS: Thirty-four patients randomized, but 26 patients complete study protocol. The treatment effect of CO-Q10 on CRP level is significant (P < 0.001) (95% CI = -20.1 to -10.5) and it was also significant for the increasing albumin level. (P = 0.044) (95% CI = 0. 0-0.6), But there was not any substantial effect on serum homocysteine level (P = 0.630). CONCLUSIONS: CO-Q10 could significantly decrease CRP level as an inflammatory marker and can protect cardiovascular events.

Central venous pressure catheter for large-volume paracentesis in refractory ascites.

BACKGROUND AND AIMS: About 10 % of cirrhotic patients are unresponsive to sodium restriction and diuretics and develop refractory ascites. Such patients usually require recurrent large-volume paracentesis and lots of hospital admissions. Hereby, we introduce a method applying a central vein (CV) catheter for large-volume paracentesis in patients with refractory ascites in up to 4 days associated with sodium restriction and high dose of diuretics. METHODS: Non-tunneled triple lumen CV catheter was used to drain the ascites fluid of 30 cirrhotic patients. After precise percussion, the point of highest fluid accumulation was marked for puncture. Then, the skin and subcutaneous tissue were anesthetized. CV catheter set guide wire was entered into the peritoneal cavity and the dilator of the CV catheter set was passed through the guide wire and extracted after some rotations around its insertion site on the skin. The catheter was passed over the guide wire and the guide wire was extracted gradually from one of the lumens and fixed to the skin. RESULTS: Nineteen males and 11 females with mean (±SD) age of 59.4 ± 11.7 years old underwent the procedure. A minimum of 9 and maximum of 29 L (12 ± 6.6 L) ascites fluid drained during a minimum of 2 and maximum of 5 days of hospital stay. All catheters were patent during the drainage. None of the patients developed hemodynamic instability. Number of re-hospitalizations for paracentesis was 1.9 times during the following year. No complication occurred. CONCLUSIONS: This technique is a simple noninvasive method that can be performed in the endoscopy unit or even at the patient's bedside and may reduce the need for repeated admissions.

Cumin extract for symptom control in patients with irritable bowel syndrome: a case series.

BACKGROUND: Irritable bowel syndrome is one of the most common gastrointestinal disordersCharacterized by chronic abdominal pain, altered bowel habits or changesin stool consistency. Unfortunately, no specific treatments for relieving IBSsymptoms have been suggested yet. This pilot study was conducted to evaluatethe efficacy of the Cumin extract, a kind of herbal used in the treatment of gastrointestinaldisorders like bloating, and other symptoms of IBS. METHODS: Fifty seven patients with IBS (according to the ROME II diagnostic criteria)with no nay other accompanying illness enrolled in study. Patients wereadvised to discontinue their other treatments during the study course, then 20drops per day of Cumin essential oil was administered for included patients.IBS-associated symptoms including abdominal pain, nausea, painful defection,presence of mucosa in stool, changes in stool consistency and defecationfrequency were evaluated using a questionnairebefore treatment, 2 and4 weeks after beginning treatment and 2 and 4 weeks after stopping treatment. RESULTS: Abdominal pain, bloating, incomplete defecation, fecal urgency and presenceof mucus discharge in stool were statistically significant decreased duringand after treatment with Cumin extract. Stool consistency and defecation frequencywere also both statistically significant improved in patients with constipationdominant pattern of IBS. CONCLUSION: Cumin extract can be effective in improving all IBS symptoms. Consideringits low cost and easy availability Cumin administration in patients with IBSmay have economic benefits.