Factors Affecting the Level of Adherence to Hypertension Medications: A Cross-Sectional Study Using the Hill-Bone Questionnaire.

Background: The adherence to antihypertensive therapy plays a significant role in determining the clinical outcomes of hypertension. We aim to evaluate the level of adherence to antihypertensive medications among patients and to assess the effect of different sociodemographic factors on the level of adherence using the Hill-Bone scale for indirect assessment. Methodology: In this cross-sectional study, we utilized a validated, face-to-face interview questionnaire to collect data on sociodemographic characteristics, participants' attitudes, and disease knowledge. The Hill-Bone questionnaire was employed to assess treatment adherence. The statistical analysis was conducted using SPSS version 28.0, where mean, standard deviation, and range were utilized for variability analysis. Results: A total of 390 patients were included in this study. The sample comprised 56.9% of females and 56.4% of participants aged 60 years or older. Approximately 80% of participants were currently married, and 46.7% had a higher education level. The average Hill-Bone CHBPTS score was 21.23± 4.95 and indicated good adherence in 63.8% of participants. The findings showed that several factors were significantly associated with higher adherence rates, including older age (COR = 3.41, 95% CI = 1.10-10.54, p = 0.03), higher educational level (COR = 1.72, 95% CI = 1.05-2.83, p = 0.03), regular blood pressure monitoring (COR = 1.90, 95% CI = 1.10-3.30, p = 0.03), and knowledge about their medications (COR = 2.12, 95% CI = 1.14-3.94, p = 0.02). Conclusion: The medication adherence within our population falls below the desired level. Enhanced counselling and further research are necessary to identify additional factors influencing adherence and develop effective strategies for promoting adherence to antihypertensive medications.

Comparison and evaluation of the 2009 and 2021 chronic kidney disease-epidemiological collaboration equations among Jordanian patients with type 2 diabetes mellitus.

AIMS: This study compared the 2009 versus 2021 chronic kidney disease (CKD) Epidemiological Collaboration (CKD-EPI) equations to calculate estimated glomerular filtration rate (eGFR) among Jordanian patients with T2DM to assess their agreement and impact on CKD staging. METHODS: This cross-sectional study included 2382 adult Jordanian patients with T2DM. The 2009 and 2021 CKD-EPI equations were used to calculate eGFR. Patients were reclassified according to kidney disease-Improving Global Outcomes (KDIGO) categories. Agreement between the equations was assessed using Bland-Altman plots and Lin's concordance correlation. RESULTS: The 2021 equation significantly increased eGFR by a median of 2.1 mL/min/1.73 m2 (interquartile range: 0.6-3.6 mL/min/1.73 m2). However, there was significant agreement between equations (Kappa: 0.99; 95% confidence interval: 0.95-1.00), independent of age, sex, and the presence of hypertension. In total, 202 patients (8.5%) were reclassified to higher KDIGO categories using the 2021 equation, with category G3 being most affected. The overall prevalence of patients in the high to highest risk categories decreased (28.0% vs. 26.5%). CONCLUSIONS: Although there was significant agreement with the 2009 equation, the 2021 equation increased eGFR and resulted in the reclassification of a subset of subjects according to KDIGO criteria. The uncertain impact of reducing high-risk category patients raises concerns about potential delays in referral and intervention, while holding the potential to enhance high-risk patient categorization, thus alleviating healthcare burden.

Clinical outcomes in patients with type 2 diabetes mellitus-related kidney disease: A Jordanian population cohort study.

BACKGROUND: Diabetic kidney disease (DKD) increases the risk of cardiovascular (CV) complications, kidney disease progression, and mortality. We aimed to determine the incidence and risk of these outcomes according to DKD phenotype among the Jordanian population. METHODS: A total of 1172 type 2 diabetes mellitus patients with estimated glomerular filtration rates (eGFRs) of >30 ml/min/1.73 m2 were followed-up from 2019 to 2022. At baseline, patients were classified according to the presence of albuminuria (>30 mg/g creatinine) and reduced eGFR (<60 ml/min/1.73 m2) into four phenotypes: non-DKD (reference category), albuminuric DKD without decreased eGFR, non-albuminuric DKD with decreased eGFR, and albuminuric DKD with decreased eGFR. RESULTS: Mean follow-up was 2.9 ± 0.4 years. Overall, 147 patients (12.5 %) experienced CV events, while 61 (5.2 %) demonstrated kidney disease progression (eGFR: <30 ml/min/1.73 m2). The mortality rate was 4.0 %. Multivariable-adjusted risk for CV events and mortality was greatest for the albuminuric DKD with decreased eGFR group (hazard ratio [HR]: 1.45, 95 % confidence interval [CI]: 1.02-2.33 and HR: 6.36, 95 % CI: 2.98-13.59, respectively), with the risk increasing when adjusted for prior CV history (HR: 1.47, 95 % CI: 1.06-3.42 and HR: 6.70, 95 % CI: 2.70-16.60, respectively). Risk of a ≥40 % decline in eGFR was greatest for the albuminuric DKD with decreased eGFR group (HR: 3.45, 95 % CI: 1.74-6.85), followed by the albuminuric DKD without decreased eGFR group (HR: 1.6, 95 % CI: 1.06-2.75). CONCLUSION: Thus, patients with albuminuric DKD and decreased eGFR were at greater risk for poor CV, renal, and mortality outcomes compared to other phenotypes.

Isolated Persistent Left Superior Vena Cava Associated With Autosomal Dominant Polycystic Kidney Disease (ADPKD): Challenges and Clinical Significance.

Persistent left superior vena cava (PLSVC) is the most common venous anomaly of the thorax that usually coexists with the right superior vena cava. However, in a minority of cases, there is only a PLSVC without a right superior vena cava which is called an isolated PLSVC. There are some reported anomalies that can co-occur with PLSVC; yet, none have reported an association with autosomal dominant polycystic kidney disease (ADPKD). In this case report, we describe a 41-year-old man with end-stage renal disease from ADPKD who underwent central venous catheterization (permacath) to initiate hemodialysis. Upon catheterization, a complete right internal jugular vein septum (bicuspid valve) was found, along with an isolated PLSVC that drained directly in the coronary sinus. We demonstrate the multiple challenges encountered during the catheterization procedure and we illustrate the anomaly with detailed images and supplementary videos. Furthermore, we discuss the coexistence of PLSVC with renal anomalies in the context of previous literature. To conclude, interventional radiologists should keep the possibility of PLSVC in mind, especially when difficulties are encountered during catheterization where proper characterization of the PLSVC type and associated anomalies is crucial for tailoring the best management approach. Moreover, an association between venous anomalies including left superior vena cava and renal anomalies may co-exist, and further studies are needed to explore this possible association.

Accuracy and feasibility of portable blood pressure monitoring in the detection of atrial fibrillation in hemodialysis patients.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in clinical practice and is a common comorbidity in hemodialysis patients. AF contributes to cardiovascular complications; therefore, it is recommended to screen for AF in high-risk patients to prevent serious complications. As we currently lack a handy AF screening tool, the aim of this study was to assess the accuracy of a modified BP monitor (Omron M6), in detecting AF in hemodialysis patients. In a cross-sectional analysis conducted from October 2018 to February 2019, we enrolled all the hemodialysis patients, older than 18 years and maintained on hemodialysis for at least 3 months in four hemodialysis centers in Jordan. Logistic regression was used to predict the accuracy, while the R package (epiR) was used to determine the sensitivity and specificity of the Omron M6 in screening AF. A total of 227 patients participated in the study, with a median age of 57 years (42.8-67.3); among these, 44.5% were female. Of all the participants, 18 were detected with AF, which was confirmed by a 12-lead ECG. The prevalence of AF in our study was 7.9%, while the sensitivity, specificity and accuracy of the Omron M6 in detecting AF were calculated as 83.0% (95% CI, 59.0-96.0), 94.0% (95% CI, 90.0-97.0) and 93.4% (95% CI, 88.0-95.0) respectively. We concluded that Omron M6 has high sensitivity, specificity, and accuracy in screening AF among hemodialysis patients. However, further studies are required to ascertain and firmly establish this preliminary finding.

Comparison of pre- and post-hemodialysis PHQ-9 depression scores in patients with end-stage renal disease: A cross-sectional study.

OBJECTIVES: An overlap between the somatic symptoms of depression and those of uremia seen in end-stage renal disease (ESRD) patients may affect the diagnosis of depression. This study aims to evaluate the effect of hemodialysis on the diagnosis of depression among patients on maintenance hemodialysis as dialysis diminishes the uremic symptoms, and to compare depression scores before and after dialysis. METHODS: This was a cross-sectional analytic study conducted from November 2018 through April 2019, in three tertiary hospitals. Consenting participants aged 18 years or older, who had received hemodialysis for at least three months were included. The Patient Health Questionnaire (PHQ-9) tool was used to collect patients' data and to identify symptoms of depression Pre- and post-hemodialysis. Depression scores were compared using the paired sample Wilcoxon rank test or the McNemar test, where appropriate. RESULTS: Overall, 163 participants were enrolled in the study. The average age of the participants was 56.5 years old, whereas 44.8% were females. The prevalence of depressive symptoms before hemodialysis was 48.5%, with prevalence of mild, moderate and moderately severe of 34.4%, 11.7% and 2.5%, respectively. On the other hand, the prevalence of depressive symptoms after hemodialysis was 46.6% with 36.8%, 9.2% and 0.6% of the participants reporting mild, moderate and moderately severe symptoms, respectively. We found no significant difference in depression scores before and after dialysis (p-values > 0.05). CONCLUSION: Our study supports the fact that the prevalence of depression is high among patients with ESRD on maintenance hemodialysis. We didn't find a significant difference in depression scores among hemodialysis patients before and after dialysis, with negligible effect of uremic symptoms on the diagnosis of depression. We suggest adopting routine screening of depression among this high-risk group of patients.

Prevalence and associated factors of undiagnosed atrial fibrillation among end-stage renal disease patients on maintenance haemodialysis: a cross-sectional study.

BACKGROUND: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia worldwide and it aggravates cardiovascular morbidity and mortality; however, this is largely under-diagnosed. Moreover, among end-stage renal disease patients on haemodialysis, AF is substantially more common and serious. The researchers conducted this study to assess the prevalence of, and the factors correlated with AF in Jordanian haemodialysis patients. METHODS: In a cross-sectional analysis conducted from October 2018 to February 2019 in four tertiary hospitals, the researchers enrolled all consenting patients aged 18 years or older who were on haemodialysis for at least three months prior to the study. We screened for AF clinically by pulse palpation, precordial auscultation, by an automated blood pressure monitor and an electrocardiogram. The researchers reported qualitative variables as counts and frequencies, while continuous variables were summarised using the mean or median where necessary. We used multiple logistic regression with backward selection to identify independent risk factors of AF. RESULTS: A total of 231 patients were enrolled; mean age was 54.8 ± 15.6 years (from 20 to 86), and 44.3% of them were women. The prevalence of AF was found to be 7.8% (95% CI, 4.8-12.2), with no gender disparity. Age (adjusted odds ratio [AOR] = 1.05; 95% CI, 1.01-1.10; p = 0.031), history of ischaemic heart disease (AOR = 3.74; 95% CI, 1.09-12.34; p = 0.033), history of smoking (AOR = 0.15; 95% CI, 0.02-0.60; p = 0.019), and low interdialytic weight gain (AOR = 0.50: 95% CI, 0.25-0.91; p = 0.031) were independently correlated to AF. CONCLUSIONS: The prevalence of AF among patients on maintenance haemodialysis is high, but largely undiagnosed. AF is generally associated with advancing age, history of ischaemic heart disease, lower interdialytic weight gain, and history of smoking. We suggest routine check-up of AF in this high-risk group of patients as anticoagulant therapy if indicated may prevent serious complications. However, there is a need for large-scale cohort studies and for the creation of regional chronic kidney disease and dialysis registries in the Middle East region.

Effect of Hydrocortisone on Intradialytic Hypotension: A Preliminary Investigational Study.

INTRODUCTION: Approximately 15 to 33% of all dialysis treatments are complicated by intradialytic hypotension (IDH). In this study, we tested the hypothesis that the intravenous administration of hydrocortisone prior to HD treatment could prevent IDH or at least decrease the drop in the blood pressure resulting from IDH. METHODS: This study was approved by our local ethics committee/IRB (2017/87) and by the Jordan Food and Drug Administration (7/clinical/18). Additionally, it is registered on ClinicalTrials.gov (NCT03465007). In this preliminary investigational study, we screened all chronic hemodialysis patients at our clinic who were 18 years of age or older (n = 82) for IDH. There were 14 patients included in the interventional part of this study; patients were given IV hydrocortisone for 3 consecutive HD sessions, followed or preceded by 3 intervention-free sessions where they were given 5 ml of saline as a placebo. RESULTS: The initial total sample size was 82 patients. The frequency of IDH at our clinic was 24.4%. Fourteen out of the 20 patients who were diagnosed with IDH agreed to enroll in the interventional part of our study. The mean age of the patients in the interventional part of our study was 53.5 years (±10.3). These patients included 5 (35.7%) men and 9 (64.3%) women. Upon comparing the number of hypotensive attacks with and without the hydrocortisone administration, we found a significant difference (p = 0.003) between the hydrocortisone and placebo treatments in which 12 (85.7%) patients had fewer IDH episodes with the hydrocortisone treatment than with placebo. CONCLUSION: This preliminary investigational study found that the administration of a stress dose of hydrocortisone prior to hemodialysis could be an effective measure for preventing or minimizing the risk of IDH episodes. Additional prospective studies on this subject are needed. Ruling out adrenal insufficiency in patients diagnosed with IDH is also crucial.

Prevalence of metabolic syndrome in dialysis and transplant patients.

Background: Several epidemiological studies have assessed various components of Metabolic Syndrome (MS) in different populations, but only a few compared the prevalence of metabolic syndrome in dialysis and transplant patients. Aim: The aim of this study is to compare the prevalence of MS in dialysis and transplant patients. Two groups of patients were included; hemodialysis patients and patients with transplanted kidneys. Methods: Demographic and clinical history, and lab data were collected. A total of 108 patients were included in this study with a mean age of 52.3 (±16.29) years. Study groups included 61 (56.5%) dialysis patients, and 47 (43.5%) patients with transplanted kidneys. Results: Upon comparing the prevalence of metabolic syndrome between the two study groups, transplant patients had significantly lower prevalence of metabolic syndrome (34%) compared to that of metabolic syndrome in patients on dialysis (55.7%; P=0.016). Conclusion: As metabolic syndrome plays an important role in the pathology of elderly patients, especially those with transplanted kidneys, such findings indicate the need for close monitoring of kidney transplant patients for the manifestations of metabolic syndrome.

Prevalence of previously unrecognized peripheral arterial disease in patients undergoing coronary angiography.

Coronary artery disease (CAD) and peripheral arterial disease (PAD) are serious manifestations of systemic atherosclerosis. A considerable proportion of patients with CAD have associated PAD; however, many are asymptomatic and this condition remains underdiagnosed. Little is known about the prevalence and clinical implication of PAD in patients undergoing coronary angiography in the Middle East with no history of the disease.To study the prevalence of previously unrecognized PAD of the lower limbs in patients undergoing coronary angiography, and to determine the correlation with CAD.This is a prospective study conducted at a university tertiary referral hospital. A total of 2120 patients referred for coronary angiography without a prior diagnosis of PAD, between January 1, 2014 and December 31, 2014, were included. Patients were evaluated through detailed medical history taking, a questionnaire survey to assess symptoms and functional status, ankle-brachial index (ABI) measurement, and coronary angiography. PAD was considered present if the ABI was <0.90 in either leg.In all patients, the prevalence of previously unrecognized PAD was 12.8%. There was no significant difference between men and women (13.4% vs 11.7%, P = .485). Abnormal angiographic results were seen in 82% (1739 of 2120). The prevalence of PAD was 14.7% in patients with abnormal coronary angiographic result, significantly higher than that in patients with normal results (4.5%, P < .0001). The prevalence of abnormal angiographic results among patients with and without PAD was 96% and 80%, respectively (P = .001). Factors independently related to PAD were age (odds ratio [OR] 1.081, 95% confidence interval [CI] 1.053-1.109; P < .001), hypertension (OR 3.122, 95% CI: 1.474-5.678; P < .004), diabetes (OR 1.827, 95% CI: 0.975-2.171; P = .04), smoking (OR 1.301, 95% CI: 0.725-2.076; P < .001), previous coronary artery bypass grafting (OR 2.939, 95% CI: 1.385-5.219; P = .004), previous cerebrovascular accident (OR 3.212, 95% CI: 1.872-9.658; P = .003), left main CAD (OR 9.535, 95% CI: 3.978-20.230; P = .002), and multivessel CAD (OR 1.869, 95% CI: 1.018-2.798; P = .03). Patients with CAD and PAD were associated with a higher prevalence of multivessel CAD (58.2% vs 42.6%, P < .005) and left main disease (3% vs 0.3%, P < .0001).The prevalence of undiagnosed PAD in patients undergoing coronary angiography was 12.8% (14.7% in patients with CAD) and associated with a higher incidence of cardiovascular risk factors, multivessel disease, and left main disease. The high prevalence of PAD in patients with CAD confirms the importance of active screening for PAD by using ABI. Routine determination of ABI in the clinical evaluation of all patients with CAD may help identify high-risk patients.

Dietary salt consumption and the knowledge, attitudes and behavior of healthy adults: a cross-sectional study from Jordan.

High dietary sodium is recognized as a silent killer responsible for 2.3 million deaths worldwide in 2010 predominantly secondary to hypertension and its complications. Although high salt consumption is considered a worldwide public health problem, its magnitude is highly variable among different communities; therefore, it is important to study locally. This study aimed to evaluate habitual salt consumption, its important correlations, as well as the knowledge, attitude, and behavior of healthy Jordanian citizens. As potassium consumption is highly correlated and important we aimed to study both jointly. In this descriptive cross-sectional study we enrolled 103 healthy adult Jordanian citizens. All participants were interviewed for questionnaire filling, physical examination, and instructed on proper 24-hour urine collection procedure. We measured sodium and potassium concentration in the provided controlled 24-hour urine collection samples, as it is presently considered the gold standard for evaluating daily intake. The results showed an average sodium intake of 179 mmol (4.1 g) per day [higher in males at 186 mmol (4.3 g) vs. 173 mmol (4.0 g) for females], significantly above the current WHO recommendations, though only 8% regularly add salt to food. Ironically, most participants (82%) believe their salt consumption was appropriate and only 29% thought they may benefit from reducing salt intake. On the other hand, potassium intake is far below the current WHO recommendations. High sodium and low potassium intake have synergistic adverse effects on public health that is not currently addressed in Jordan. We conclude that Jordanian citizens currently consume high sodium and low potassium diet and are mostly unaware of its negative impact on their health. Hence, it is crucial for healthcare providers to intervene and adopt long-term strategies to control salt intake to reduce its negative effects in Jordan and elsewhere.

Congenital insensitivity to pain and anhydrosis due to a rare mutation and that is complicated by inflammatory bowel disease and amyloidosis: a case report.

Patients with congenital insensitivity to pain and anhydrosis syndrome are at risk for renal amyloidosis and inflammatory bowel disease. Physicians caring for such patients should be aware of these complications.

Outcome of upper limb vascular access for hemodialysis.

The aim of this study was to investigate the outcome of vascular access procedures for hemodialysis and factors affecting access survival and complication rates. A retrospective review was carried out on 276 patients who underwent 404 consecutive vascular access operations performed over seven-years. The overall primary failure rate was 9.2%, while the oneand five-year cumulative access patency rates were 63.8% and 40.6%, respectively. Diabetes mellitus status significantly influenced access survival (P = 0.022). Autogenous arteriovenous fistulas (AVFs) are reliable procedures with access sites often available in the upper limb proximally and distally. Patients with diabetes mellitus have significantly worse patency rates of upper limb AVFs.

Evaluation of the impact of pharmaceutical care service on hospitalized patients with chronic kidney disease in Jordan.

OBJECTIVES: The primary goal of the present study was to implement and evaluate the impact of pharmaceutical care service for hospitalized chronic kidney disease (CKD) patients in Jordan. SETTING: Nephrology wards of one of the largest general hospitals in Jordan. METHODS: All patients who were previously diagnosed with CKD by their physician were eligible for inclusion in the study. Recruited patients were fully assessed for treatment related problems (TRPs) by a clinical pharmacist. Pharmaceutical care service was assessed through a systematic, prospective before-after design. Chi Square test was used to investigate association between categorical variables. P value <0.05 was considered to be statistically significant. MAIN OUTCOME MEASURES: Study outcomes included: Process outcomes (prevalence and nature of identified TRPs, clinical significance of TRPs, associated diseases and drugs), General clinical outcomes (Therapeutic outcomes of TRPs) and CKD specific clinical outcomes (Change from baseline in the number of patients receiving appropriate progression modifying therapy and appropriate management of complications). RESULTS: 130 patients were included in the study. The average number of the identified TRPs was 5.31. Eighty-six percent of the recommendations were accepted by physicians. Efficacy related problems were the most common TRP category. Seventeen percent of all TRPs were resolved, 5.5 % were improved, and 37.4 % were prevented through the clinical pharmacist interventions. CONCLUSIONS: The current study indicated that hospitalized patients with CKD suffer from multiple TRPs mostly related to efficacy of medications and patients monitoring. Clinical pharmacists substantially contributed towards the care of hospitalized CKD patients through optimizing progression modifying therapies, medications safety and management of CKD complications. Based on this study it is strongly recommended to implement pharmaceutical care services for hospitalized CKD patients.

Benign pheochromocytoma presented 6 years after kidney transplantation.

Hypertension is very common in kidney transplant patients; however, severe and resistant cases should raise suspicion of secondary causes. Pheochromocytomas are rare but serious tumors because of their lethal hypertensive and possible malignant nature. The diagnosis is occasionally elusive, but prompt diagnosis and localization is essential for definitive surgical management. We report a case of a patient with benign pheochromocytoma presenting largely asymptomatically, but with severe resistant hypertension, 6 years after kidney transplantation. To the best of our knowledge, this is the first case report of this type of tumor after kidney transplantation.

Complementary and alternative medicine (CAM) use among Jordanian patients with chronic diseases.

PURPOSE: This study explores the prevalence of herbal medicine use in a cohort of patients with chronic kidney disease (CKD), dyslipidemia and hypertension (HTN) in Jordan. METHODS: The study took the form of a cross-sectional survey of patients attending the outpatient departments at The Jordan University Hospital (JUH), in Amman. The method was based on semi-structured questionnaire. RESULTS: A total of 700 CKD, dyslipidemia and hypertension patients were interviewed. Of the participants, 7.6% (n = 53) reported using herbs. Most of complementary and alternative medicine (CAM) users were older than 50 years of age (n = 42; 79.3%) and predominantly female (54.1%, n = 29). The majority of patients in this group had hypertension (n = 44, 83.0%), followed by dyslipidemia (n = 32, 60.4%). The most common herbal product to be used was Hibiscus sabdariffa (22.5%). CONCLUSION: This study confirmed that there is an appreciable prevalence of herbal use among patients with CKD, dyslipidemia and hypertension in Jordan.

Comprehensive assessment of treatment related problems in hospitalized medicine patients in Jordan.

OBJECTIVES: The aim of this study was to identify the prevalence and characteristics of treatment related problems (TRPs) in hospitalized internal medicine patients in Jordan as well as to identify diseases and drugs associated with each specific TRP. We have also aimed at investigating physicians' acceptance of recommendations made by clinical pharmacist and to identify the outcomes of pharmacist interventions. SETTING: Internal medicine department of a general hospital in Jordan. METHODS: We have utilized a systematic, prospective, bedside, comprehensive clinical assessment approach that allowed us to effectively identify, communicate and follow up TRPs. MAIN OUTCOME MEASURES: prevalence and nature of identified TRPs, clinical significance of TRPs, associated diseases and drugs and clinical outcomes of clinical pharmacist interventions. RESULTS: 402 patients were included in the study. The average number of the identified TRPs was 9.35. Fifty-three percent of identified TRPs were classified as major and 28% were classified as moderate. Ninety-one percent of the recommendations were accepted by physicians. Efficacy related problems were the most common TRP category followed by safety related problems and indication related problems. Sixty-four percent of the TRPs were resolved or prevented through the clinical pharmacist intervention. CONCLUSIONS: We have found that prevalence of TRPs is substantially high among patients hospitalized at the internal medicine department. TRPs related to Dosage regimens, untreated conditions, patient monitoring, drug interactions, and drug choices were the most common. Most of TRPs identified by pharmacists were clinically significant. Pharmacists' interventions contributed substantially to the resolving of many of the identified TRPs. Patients suffering from higher number of medical conditions and receiving higher number of medications should be given the priority for clinical pharmacy service in hospitalized internal medicine patients.

A placebo-controlled trial of the effects of hydrochlorothiazide on nocturnal enuresis.

OBJECTIVE: To assess the efficacy, tolerability and side effects of the diuretic hydrochlorothiazide (HCTZ) in the management of monosymptomatic nocturnal enuresis by a placebo-controlled double-blind crossover trial. PATIENTS AND METHODS: Forty patients suffering from nocturnal enuresis were blindly randomized into 2 groups of equal numbers. Group 1 first received placebo for 3 months, and group 2 received oral HCTZ once daily for the same period. Both groups, after a 2-week wash-out period, were crossed over in their medication and continued treatment for another 3 months. The main outcome measure (variable) for the assessment of drug efficacy was taken to represent the average reduction in the percentage of wet nights as compared to the baseline enuresis pattern. Statistical analysis was based on a t test (p