comparison between hybrid therapy and standard triple therapy for helicobacter pylori eradication in patients with uremia: a randomized clinical trial

Background: The prevalence of peptic ulcer disease in hemodialysis patients is more than the general population. They are also more prone to complications including upper gastrointestinal bleeding. The aim of this study was to compare the efficacy of 14 days hybrid regimen with 14 days triple therapy for Helicobacter pylori [H. pylori] eradication in hemodialysis patients

Methods: Forty hemodialysis patients with naïve H.pylori infection were randomized to receive either hybrid regimen [pantoprazole 40 mg + amoxicillin 500 mg, both twice a day during the first 7 days, followed by pantoprazole 40 mg + amoxicillin 500 mg + clarithromycin 500 mg + tinidazole 500 mg, all twice a day, for the second 7 days, or standard triple therapy including pantoprazole 40 mg, clarithromycin 500 mg, and amoxicillin 500 mg, all twice a day for 14 days. H.pylori eradication was assessed by fecal H.pylori antigen test 8 weeks after the treatment

Results: All the patients completed the study. According to both intention to treat and per-protocol analyses, H.pylori eradication rates were 100% [95% confidence interval [CI]: 100] in those who received hybrid therapy and 70% [95% CI: 69.4 - 70.8] in those who were treated by standard triple therapy [p=0.02]. Severe adverse effects were not reported by any patient; however, mild adverse effects were more frequent in those who received standard triple therapy [p<0.05]

Conclusion: Hybrid regimen could achieve ideal H.pylori eradication rates with low rates of adverse effects

Comparative analysis of serum levels of aluminum and lead in dialysis patients, pre and post dialysis

Accumulation or deficiency of trace elements can occur in hemodialysis patients and it increases risk of cardiovascular or other organs disorders. Special ions levels such as sodium and bicarbonate in dialysis fluid are accurately regulated but the remaining elements are not regularly measured. Aluminum and lead belong to the biologic performance free heavy metals .They also has a tendency to accumulate in hemodialysis patients. This study aims to compare serum aluminum and lead levels in hemodialysis patients before and after dialysis during 6 months period. This comparative longitudinal research has been a comparative longitudinal research conducted to 86 hemodialysis patients in Imam Khomeini and Fatima Zahra in Sari. Sampling was done on patients for three times [two times before dialysis with 6 months interval and one time after dialysis in the sixth month]. It has been measured by spectrophotometer method. In order to compare the metal mean and standard deviation, ANOVA analysis method and also evaluating intra group difference with paired test has been used. In the 100 hemodialysis patients, the mean age and duration of hemodialysis were 57.0 +/- 7.3 years and 15.28 +/- 5.73 months, respectively. Aluminum level in patient's serum was 30.7 +/- 6.2 and 37.5 +/- 6.8 mg/dl before and after dialysis, respectively. The post-dialysis aluminum level became statistically significant [p<0.05]. There was no significant difference between pre dialysis aluminum concentrations during 6 months interval. We weren't finding significant difference in lead level between the three samples taken. Trace elements status in chronic kidney diseases patients is influenced by a renal function residual, size and dialyzer membrane surface. The water nature also is used for dialysis fluid preparation and composition. Trace elements in ESRD patients differed from healthy individuals. So this issue requires accurate studies on trace elements clinical aspects in ESRD patients

effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients: a randomized controlled trial

This study was conducted to determine the impact of an 8-week intradialytic exercise program [consisting of 15 minutes low-intensity exercise during the first 2 hours of dialysis] on dialysis efficacy. In an open randomized controlled trial, a total of 50 clinically stable hemodialysis patients were enrolled into the study and randomly allocated into two groups: the aerobic exercise group [n=25] and the control group [n=25]. Aerobic exercises were done in the intervention group for 15 min/day, three times a week for 2 months. The dialysis efficacy was assessed prior to and at the end of each month of the program. The efficacy of dialysis increased at the end of the first month and remained elevated for the duration of the program in the exercise group [p<0.05]. A simplified aerobic exercise program has increased the efficacy of dialysis and may be considered as a safe, complementary and effective modality for hemodialysis patients.

Relationship between serum parathyroid hormone and hypertension in hemodialysis patients

Prevalence of hypertension is high in hemodialysis patients. Increase of intracellular calcium due to hyperparathyroidism is one of probable factors for hypertension in hemodialysis patients. In this study, the relationship between serum parathyroid hormone [PTH] level and severity of hypertension in hemodialysis patients was investigated. In a case-control study, 50 hemodialysis patients with hypertension were compared with 50 hemodialysis patients without hypertension. The two groups were comparable in age, sex, body mass index, hemodialysis duration, KT/V, serum calcium, hemoglobin, and erythropoietin dose. Serum PTH level was measured in the two groups. The mean age was 57.0 +/- 7.7 years in the hypertensive group and 56.4 +/- 6.0 years in the control group [P = .61]. The mean hemodialysis duration was 15.28 +/- 5.74 months in the hypertensive group and 14.98 +/- 6.35 months in the control group. The mean serum PTH was 487.18 +/- 408.85 pg/mL in hypertensives [445.12 +/- 447.92 pg/mL in stage 1 of hypertension and 561.94 +/- 326.67 pg/mL in stage 2 of hypertension, P = .003] and 170.64 +/- 122.09 pg/mL in the case group [P = .001]. According to this study, there is a positive relationship between serum PTH and severity of hypertension in hemodialysis patients. We conclude that control of secondary hyperparathyroidism might be helpful in controlling hypertension in hemodialysis patients

Topical capsaicin therapy for uremic pruritus in patients on hemodialysis

Pruritus is one of the common problems in patients on hemodialysis. There are several causes for pruritus, and different treatment modalities are applied to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in patients on hemodialysis. This randomized double-blinded cross-over clinical trial was performed on 34 patients on hemodialysis with uremic pruritus. The patients were divided into 2 groups, one group received capsaicin 0.03% and the other, placebo, for 4 weeks. Treatment was stopped for 2 weeks as washout period and continued as a cross-over technique. Pruritus scores were analyzed and compared. Thirty-four patients on long-term hemodialysis, 14 men and 20 women with a mean age of 57.0 +/- 18.6 years were studied. The mean of pruritus score before capsaicin treatment was 15.9 +/- 6.3, which was reduced to 6.4 +/- 3.9, 4.7 +/- 3.1, 3.2 +/- 2.9, and 2.5 +/- 2.5 on weeks 1 to 4, respectively [P < .001]. In the placebo group, pruritus score before treatment was 15.0 +/- 6.0 on average, and it was 11.7 +/- 5.8, 9.4 +/- 5.9, 7.9 +/- 5.5, and 7.2 +/- 5.5, respectively, on weeks 1 to 4 [P < .001]. There was no significant difference in pruritus scores before the treatment between the two groups, but after each week, the difference was significant [P < .001]. Repeated measurement test showed that decreasing in pruritus severity in the capsaicin group was more than that in the placebo group during treatment period [P < .001]. Capsaicin is a new safe and effective topical treatment for hemodialysis-induced pruritus in patients with end-stage renal disease

Correlation between amputation of diabetic foot and nephropathy

A diabetic foot lesion remains a major cause of morbidity in diabetic patients with chronic kidney disease. We studied the relation between kidney function and the risk of amputation in patients with diabetic foot. We reviewed retrospectively the charts of 244 patients admitted to Imam Khomeini Hospital of Sari, Iran, for diabetic foot from 1996 to 2005. Their clinical characteristics and kidney function indicators, including urine protein excretion and serum creatinine were analyzed and compared between amputees and nonamputees. There were 244 patients with diabetic foot who were admitted to our center during the studied period. The duration of being affected by DM was between 3 months and 34 years [mean, 11.80 +/- 6.81 years]. Sixty-six patients [27.0%] underwent amputation. The amputees were older than the nonamputees [61.1 +/- 11.5 years versus 55.6 +/- 12.5 years, P < .001]. There were 20 patients [30.3%] in the amputee group and 44 [24.7%] in the nonamputee group who had proteinuria [P = .38]. The mean creatinine level was significantly higher in the amputees compared to the nonamputees [1.78 +/- 1.36 mg/dL versus 1.28 +/- 1.23 mg/dL, P - .03]. Lower extremity amputations in our patients with diabetic foot were strongly associated with elevated serum creatinine levels. The presence of this complication necessitates intensifying actions in order to prevent amputations

Frequency of nasal carriage of staphylococcus aureus and its antimicrobial resistance pattern in patients on hemodialysis

Staphylococcus aureus is currently the most common cause of infection in hospitalized patients. Patients on hemodialysis are at increased risk due to their immunocompromised state. The present study was designed to determine the frequency of S aureus nasal carriage in patients on hemodialysis. This study was undertaken in 2 dialysis centers to establish the frequency of S aureus nasal carriage at teaching hospitals of Mazandaran University of Medical Sciences, in the north of Iran. Standardized nose swabs were rotated into the anterior nares of the patients, and the samples were cultured on a blood-agar medium. Having grown the colony, gram stain, catalase, manitol, DNAase, and coagulase tests were all performed. Pattern of antibacterial sensitivity was determined by using the disc diffusion method. Also, agar dilution method was used to determine minimal inhibitory concentration of oxacillin and vancomycin. Of 84 patients on hemodialysis, 31 [36.9%] were nasal carriers of S aureus, of whom 23 [74.2%] were resistant to methicillin. Of the methicillin-resistant S aureus isolates, 3 [13.0%] were resistant to vancomycin and 7 [56.5%] had reduced susceptibility to vancomycin in agar dilution method. Resistance frequencies to clindamycin, ciprofloxacin, and trimethoprim-sulfamethoxsazole were 12.9%, 9.7%, and 19.3%, respectively. However, all microorganisms were sensitive to rifampicin. Patients on hemodialysis are at an increased risk of S aureus infections; thus, screening of these susceptible patients should be considered as a health priority. Meanwhile, microbial sensitivity tests should be ordered for all cases in order to optimize treatment options

[Evaluation of therapeutic effect of capsaicin pomade [Caspian 0.03%] in hemodialysis related pruritus]

Pruritus is one of the common problems in hemodialysis patients with end stage renal disease. Approximately, 60% of these patients suffer from this condition. There are several causes for pruritus, thus, various treatments are applied in order to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in hemodialysis patients. This randomized double blind cross over clinical trial study, was performed on 34 hemodialysis patients with uremic pruritus in 1386. All patients were divided in two groups. One group received Caspian 0.03%, while the other, placebo for four weeks. Treatment was stopped for two weeks and continued as cross over technique. Pruritus scores were analyzed with Paired t-test and Repeated measurement ANOVA. In this study, the difference between Mean of pruritus score before capsian treatment and in weeks following 1 to 4 was statistically significant [P=0.0001]. In placebo group, the difference between pruritus score before treatment and in weeks 1 to 4 was statistically significant [P=0.0001]. There was no significant difference before treatment in two groups, however, after each week, the difference was significant [P=0.0001]. Repeated measurement test showed that reduction in pruritus severity in capsian group was more than placebo group, during treatment period [P=0.0001]. Although our study indicated the appropriate effects of Capsian in pruritus, the placebo also has a good effect in controlling hemodialysis related pruritus. Our placebo had emollient property; therefore, we can apply it to control the pruritus in these patients

Posttransplant lymphoproliferative disorders in kidney transplant recipients. An Iranian multicenter experience

Limited data with adequate sample size exist on the development of posttransplant lymphoproliferative disorder [PTLD] in living donor kidney recipients. We conducted a retrospective cohort study on the data of 10 transplant centers to identify the incidence of PTLD in Iran. Data of 9917 kidney transplant recipients who received their kidneys between 1984 and 2008 were reviewed. Fifty-one recipients [0.5%] who developed PTLD were evaluated with a median follow-up of 47.5 months [range, 1 to 211] months. Patients with PTLD represented 24% of all posttransplant malignancies [51 out of 211 cases]. There was no relationship between PTLD and sex [P = .20]. There were no statistically significance differences considering the age at transplantation between patients with and without PTLD. The late-onset PTLD [70.6%] occurred more frequently compared to the early form. There was no signification relationship between early-onset and late-onset groups in terms of clinical course and outcome. In patients who received azathioprine, PTLD was more frequent when compared to those who received mycophenolate mofetil [P < .001]. The lymph nodes were the predominantly involved site [35.3%], followed by the gastrointestinal tract, brain, kidney allograft, lung, ovary, vertebrae, and palatine. Age at diagnosis and the time from transplantation to diagnosis were comparable for various involvement sites of PTLDs. The overall mortality in this series of patients was 51.0%. Posttransplant lymphoproliferative disorder is a rare but devastating complication and long-term prognosis can be improved with early recognition and appropriate therapy

Prophylactic Effect of Theophylline in Renal Contrast Nephropathy after Coronary Angiography

Contrast nephropathy will increase mortality up to 30% following angiographic procedures. Adenosine is a crucial mediator of contrast-induced nephropathy. The purpose of this study was to investigate whether the adenosine antagonist Theophylline reduces the incidence of CN after coronary angiography. In this randomized, double-blind, placebo-controlled clinical trial study, carried out from February 2004 to September 2005 at the Fatemeh Zahra Hospital, 70 patients who were undergoing coronary angiography were divided into two groups. Case group [n=35] received oral Theophylline 200 mg bid. 24 h before and for 48 h after angiography. The control group [n=35] received placebo. Serum Na+, K+, blood urea nitrogen [BUN], creatinine, glomerular filtration rate [GFR] were measured before and after angiography. In the case group there were no significant change in serum creatinine [0.90 +/- 0.7 vs. 0.92 +/- 0.3 mg/dl], BUN [17.76 +/- 7.8 vs. 19.35 +/- 9.6mg/dl], GFR [83.01 +/- 26.7 vs. 81.36 +/- 24.9 ml/min] Na+ [139.08 +/- 3.6 vs. 138.54 +/- 2.7 mEq/l] and K+ [4.30 +/- 0.4 vs. 4.19 +/- 0.3 mEq/l]. In the control group, there was a significant fall in GFR after angiography [86.10 +/- 34.8 vs. 80.7 +/- 30.4 ml/min, P=0.03]. Following angiography, there were no significant difference in serum creatinine, BUN, GFR, Na+ and K+ level between the two groups. None of the patients in either group faced contrast induced nephropathy. Theophylline does not appear to add a protective role in preventing against contrast induced nephropathy in patients undergoing angiographic procedures