ABSTRACT
Background: Hypothyroidism is common throughout the world and the prevalence of hypothyroidism is high in India. Ailment of thyroid function has been documented to occur at a higher rate in patients with chronic kidney disease (CKD), including those undergoing dialysis than in general population.Methods: A prospective cross-sectional observational clinical study in real time was carried out to assess the thyroid status in eighty-nine adult patients undergoing a 4 h three times weekly haemodialysis schedule in a rural tertiary referral hospital in South India. The status of the thyroid was monitored via Free T3 Free T4 and Thyroid Stimulating Hormone levels.Results: Subclinical hypothyroidism was common in patients undergoing haemodialysis. Although there was a negative correlation between the levels of thyroid hormones and other variables, it was clinically insignificant.Conclusions: The present study showed that abnormalities in thyroid function are high in patients undergoing haemodialysis and that there were no clinically significant correlation between the levels of thyroid hormones and clinical or biochemical characteristics.
ABSTRACT
Background: The prevalence of chronic kidney disease is increasing with diabetic nephropathy as the common underlying cause. Although numerous drugs are being used to improve glycaemic control, evidence in patients with diabetic nephropathy is sparse. The aim of the present was to evaluate the effectiveness of sitagliptin or vildagliptin addition on glycaemic control in patients with T2DM undergoing haemodialysis as part of their routine care in a rural tertiary care setting.Methods: Type 2 diabetic patients on maintenance haemodialysis as part of routine care and whose glycaemia was not controlled adequately and prescribed one of the oral gliptins once daily in addition to existing therapy for a period of 24 weeks were included in the present study. Effectiveness was assessed in terms of glycaemic control as measured by the change over time in glycated haemoglobin. Data analysis included glycated haemoglobin, body weight, serum creatinine, urine albumin creatinine ratio and the occurrence of hypoglycaemia.Results: Significant reduction in glycated haemoglobin values were noted after 24 weeks of therapy with gliptins similar to insulin glargine with a small weight loss. There was an insignificant decrease in the serum creatinine and urine albumin excretion levels after treatment with vildagliptin with Vildagliptin producing a slightly higher decrease but there was no correlation with changes in A1c levels. The overall incidence of adverse experiences was low and generally mild in both groups.Conclusions: In a group of Asian Indian patients with diabetic nephropathy due to T2DM undergoing haemodialysis in whom glycaemia was not controlled adequately, addition of gliptins helped to achieve glycaemic control to a similar extent as insulin glargine but with a marginal weight advantage.