Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

BACKGROUND: In peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously. METHODS: This retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk. RESULTS: Using joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as −0.720 (95% confidence interval [CI], −0.971 to −0.472) for diabetic and −0.784 (95% CI, −0.963 to −0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients. CONCLUSION: The results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period.

Effect of allopurinol in decreasing proteinuria in type 2 diabetic patients

Diabetic nephropathy is the most prevalent cause of end-stage renal disease. Besides factors such as angiotensin II, cytokines, and vascular endothelial growth factor, uric acid may play a role as the underlying cause of diabetic nephropathy. We evaluated allopurinol effects on proteinuria in diabetic patients with nephropathy. In a double-blinded randomized controlled trial on 40 patients with type 2 diabetes mellitus and diabetic nephropathy [proteinuria, at least 500 mg/24 h and a serum creatinine level less than 3 mg/dL], allopurinol [100 mg/d] was compared with placebo. Administration of antihypertensive and renoprotective drugs [angiotensin-converting enzyme inhibitors and angiotensin receptor blockers continued for both groups, without changes in dosage. Proteinuria was compared at baseline and 2 and 4 months between the two groups. Each group consisted of 9 men and 11 women. There were no difference between two groups regarding age, body mass index, duration of diabetes mellitus, systolic and diastolic blood pressure, fasting blood glucose, blood urea nitrogen, serum creatinine, serum potassium, and urine volume. Serum levels of uric acid [P=.02] and 24-hour urine protein [P=.049] were significantly lower in the patients on allopurinol, after 4 months of receiving allopurinol, compared with the control group. Low-dose allopurinol can reduce severity of proteinuria after 4 months of drug administration, which is probably due to decreasing the serum level of uric acid. Thus, allopurinol can be administered as an adjuvant cost-effective therapy for patients with diabetic nephropathy

Relation between salt intake and blood pressure among Iranians

To determine the mean 24 hr urinary sodium [UNa] and chloride [UCl] excretion, and the association between these variables and blood pressure, since studies on the effect of habitual dietary salt intake and some electrolytes on blood pressure were reported different. Experimental population-based study Urban areas, Isfahan city, Iran Nine hundred and twelve randomly selected patients aged 20-60 years 24-hour urine and food records were collected three times in one month. Systolic [SBP] and diastolic [DBP] blood pressures, heart rate and sodium, potassium, calcium, chloride and creatinine levels in urine samples were measured. Estimated mean daily salt intake based on UNa excretion in Iranian population is 9.9 + 2.9 g/day [men: 11.1 + 3.0 g/day and women: 9.6 + 2.9 g/day; p = 0.001]. The UNa excretion value was 189.7 + 51.4 mmol for men and 164.6 + 49.8 mmol for women, with a significant difference [p = 0.001]. After adjustment for confounding factors and other urinary electrolytes, no relationship was found between UNa and SBP [b = 0.001, p = 0.89] or DBP [b = 0.007, p = 0.34] in the pooled data. Significant relationship was observed between UCl excretion and SBP in hypertensives [b = 0.113, p = 0.001], UNa excretion and DBP in the entire group [r = 0.04, p = 0.004] and in normotensive men [r = 0.036, p = 0.03]. Salt intake is one of the main factors affecting blood pressure among Iranian men but not women