Evaluation of knowledge and behavior of and attitudes towards smoking cigarettes and using smokeless tobacco in patients with chronic renal failure.

BACKGROUND: Smoking can have negative effects on renal function in healthy individuals, which may result in kidney disease. To determine knowledge, behavior, and attitudes toward smoking cigarettes and using smokeless tobacco among patients with chronic renal failure, we sought to provide evidence for appropriate precautions and guidance for further research. METHODS: The study included 86.7% of 390 patients undergoing treatment for chronic renal failure who completed a 30-question instrument. RESULTS: Of the participants, 7.9% were smokers and 12.6% ex-smokers. Among the smokers, 61% said they wanted to quit and 45% said they needed help to quit. Of the participants, 9.5% were using Maras powder, a type of smokeless tobacco. Of the smokeless tobacco users, 55.6% noted that they wanted to give it up. The rate of the participants smoking cigarettes and/or using smokeless tobacco was 17.4%. In addition, 38.9% of the participants said that they started to use smokeless tobacco to quit smoking cigarettes. Of the participants, 62.6% thought smoking was harmful to the kidneys. The rate of the passive smokers was 30.2%. Of the participants, 66.3% explained that they were exposed to smoke at home. CONCLUSIONS: Appropriate interventions should begin to help patients with chronic renal failure stop smoking and to prevent them from exposure to cigarette smoke. Smokers should be informed that using smokeless tobacco is not a way to stop smoking cigarettes. Education programs should be conducted to prevent people from using smokeless tobacco and to help smokeless tobacco users to quit their habit.

Effect of valsartan on erythropoietin and hemoglobin levels in stage III-IV chronic kidney disease patients.

Angiotensin-converting enzyme inhibitors (ACEIs) were accepted as a potential cause of inadequate epoetin response in chronic kidney disease (CKD) patients. We aimed to determine the effects of valsartan, an angiotensin receptor blocker (ARB), on serum ertyhropoietin levels and on certain biochemical and haematological parameters in hypertensive CKD patients. Twenty-two stage III-IV CKD patients (mean age; 56.8 +/- 8.9 years, 12 male 10 female) were included in the study. Before initiating the treatment, current anti-hypertensive treatments (if any) were discontinued, and blood samples were collected after a washout period of 3 weeks. Valsartan 80 mg/day was started, and additional anti-hypertensive agents were given according to study protocol if needed. One way Anova and paired t-tests were used for statistical comparisons. Serum blood urea nitrogen (BUN), creatinine, uric acid, potassium, haemoglobin and erythropoietin values were measured, and glomerular filtration rates were calculated before and 3, 6 and 90 days after valsartan treatment, a significant reduction in EPO level was observed at 3rd (19.6 +/- 24.0 vs. 13.8 +/- 8.5, p = 0.010), 6th (12.1 +/- 7.6, p = 0.009), and 90th days (8.3 +/- 5.4, p = 0.007). When pre-treatment values were compared with 90th day results, no significant change was observed in terms of hgb, htc, serum BUN, creatinine, uric acid, potassium, and GFR values. In conclusion, valsartan, an ARB, did not decrease haemoglobin levels in stage III-IV CKD patients despite significant reduction in serum erythropoietinlevels, so ARBs may be preferred to ACEIs in CKD patients when indicated.

Tuberculosis in dialysis patients, single centre experience from an endemic area.

Because of immunity defect, patients with end-stage renal disease are at increased risk of developing infections, tuberculosis (TB) in particular. The incidence of TB is higher in dialysis patients than in general population. We retrospectively reviewed the charts of dialysis patients with TB in our facility. A total of 287 dialysis patients (153 male, 134 female, 223 haemodialysis (HD), 64 continuous ambulatory peritoneal dialysis (CAPD) patients, mean age 46 +/- 15) were reviewed from October 1997 to January 2002. TB developed in 30 patients (17 male, 13 female, 24 HD and six CAPD). Thirteen patients with TB presented with fever of unknown origin (FUO) and four of them subsequently developed military lesions on chest X-ray. Nine patients had pulmonary TB (four with pleural effusions), five patients had TB lymphadenits, two patients had TB peritonitis and one patient had vertebral TB. TB was presented mostly as FUO among dialysis patients in a region under poor socio-economic conditions. In such areas with endemic TB, dialysis patients who present with FUO should be carefully evaluated for the presence of TB, and test therapy for TB should be performed in otherwise unexplained FUO.