relationship between arteriovenous fistula competence and hemodialysis adequacy in hemodialysis patients

Background: A Functional vascular access is the lifeline, for hemodialysis patients. Having an effective vascular access is a major supporter for dialysis adequacy and patient well-being; it is a vital determinant of dialysis ampleness and has critical implications for mortality rates and morbidity outcomes. A working arteriovenous fistula [AVF] is a significant determinant of adequacy of hemodialysis; yet nonfunctional AVF scontributing for hospitalization in hemodialysis patients. Learning about the probable complications of AVFs should add to their time detection and allow measures to be taken that may avoid harmful outcomes. This study was to assess AVF abnormalities by duplex U.S and to evaluate the impact of these abnormalities on dialysis adequacy

Patients and methods:78 patients with end stage renal disease [ESRD] on regular HD had their AVF assessed by duplex U.S and were studied as regard dialysis adequacy [Kt/v]and residual renal function [RRF] and also subjected to full history taking, clinical examination with focusing on AVF physical examination

Results: There was a significant positive correlation between access blood flow [Qa] and Kt/v, this confirms the importance of well-functioning non stenotic AVF in delivering adequate dialysis. Our data confirm a significant positive correlation between diabetes mellitus, hypertension, hyperlipidemia and hyperphosphatemia and AVF dysfunction.Thoug hour results showed no significant positive correlation between RRF decline and AVF dysfunction, the dual causal relationship between RRF decline and AVF stenosis might be existed

Pharmacokinetics interaction of dapoxetine with different doses of green tea extract in male healthy volunteers using midazolam as CYP3A4 enzyme probe.

Objective: This study aimed to investigate the pharmacokinetics interaction of dapoxetine with different doses of green tea extract in healthy volunteers using midazolam (CYP3A4 probe).Method and materials: Twelve healthy males were included in a random three-way crossover study. Each volunteer received dapoxetine 60 mg and midazolam 7.5 mg concurrently after drinking 250 ml of water, 250 ml of fresh extract of 2 gram of green tea or 250 ml of fresh extract of 4 gram of green tea with one week washout period. Plasma samples were analyzed for dapoxetine and midazolam using HPLC.Results: The co-administration of dapoxetine with 4 gm green tea extract significantly increased dapoxetine AUC∞ (from 3218.74 μg.hr/L to 4207.65 μg.hr/L, P< 0.05) and dapoxetine Cmax (from 433.1 μg/L to 601.1 μg/L,P< 0.05) with a decrease in CL and t1/2 only after administration of 4 gm green tea extract. There was a significant increase in midazolam AUC∞ (from 41.123 μg.hr/L to 58.55 μg.hr/L, P< 0.05) and midazolam Cmax (from 36.07 μg/L to 53.53 μg/L,P< 0.05) with a decrease in CL and t1/2only after administration of 4 gm green tea extract. However, the intake of 2 gram green tea extract showed no significant change in either dapoxetine or midazolam AUC or Cmax (p≥0.05). Conclusion: High dose of green tea intake increases dapoxetine bioavailability by the inhibiting CYP3A4 enzyme as indicated by the change in midazolam pharmacokinetic. Taking high dose of green tea with dapoxetine should be avoided. However, normal dose of green tea is safe for dapoxetine co-administration.