The effects of nebivolol and irbesartan on postdialysis and ambulatory blood pressure in patients with intradialytic hypertension: a randomized cross-over study.

OBJECTIVES: Intradialytic hypertension is estimated at 5-15% of hemodialysis patients and is associated with poor prognosis. Studies on therapeutic interventions for this entity are extremely few. We aimed to evaluate the effects of nebivolol and irbesartan on peridialytic, intradialytic, and ambulatory BP in patients with intradialytic hypertension. METHODS: This is a pilot randomized-cross-over study in 38 hemodialysis patients (age: 60.4 ±â€Š11.1 years, men: 65.8%) with intradialytic hypertension (intradialytic SBP rise ≥10 mmHg at ≥4 over six consecutive sessions]. After baseline evaluation, patients were randomly assigned to nebivolol 5 mg and subsequently irbesartan 150 mg, or vice versa. Nineteen patients received a single drug-dose 1 h before hemodialysis and 19 received the drug for a week before evaluation. A 2-week wash-out period took place before the initiation of the second drug. Patients had three respective 24-h ambulatory BP measurements starting before a midweek session. RESULTS: In total, 20 (52.6%) patients received nebivolol first and 18 (47.4%) received irbesartan. Patients receiving a single dose of either drug had lower postdialysis BP (baseline: 160.2 ±â€Š17.8/93.2 ±â€Š13.6 mmHg; nebivolol: 148.0 ±â€Š20.8/84.5 ±â€Š13.1 mmHg, P = 0.013/P = 0.027; irbesartan 142.9 ±â€Š29.9/87.2 ±â€Š18.1 mmHg, P = 0.003/P = 0.104 for SBP and DBP, respectively). The 24-h BP presented a trend towards reduction, but was significant only for 24-h DBP in the nebivolol arm. Patients on weekly administration of either drug had lower postdialysis BP (baseline: 162.5 ±â€Š16.8/95.4 ±â€Š12.7 mmHg; nebivolol: 146.7 ±â€Š16.3/91.8 ±â€Š12.2 mmHg, P = 0.001/P = 0.235; irbesartan: 146.0 ±â€Š23.9/85.8 ±â€Š12.9 mmHg, P = 0.004/ P = 0.007, respectively), lower intradialytic BP and lower 24-h BP (baseline: 148.3 ±â€Š12.6/90.2 ±â€Š9.0 mmHg; nebivolol: 139.2 ±â€Š10.6/85.0 ±â€Š7.7 mmHg, P < 0.001/P = 0.001; irbesartan: 142.4 ±â€Š16.4/85.1 ±â€Š9.9 mmHg, P = 0.156/P = 0.030). No significant differences were observed in comparisons between the two drugs, with the exception of heart rate, being lower with nebivolol. CONCLUSION: Both nebivolol and irbesartan reduced postdialysis and 24-h BP in patients with intradialytic hypertension. Weekly administration had greater effect and nebivolol was numerically slightly more potent than irbesartan.

Ulcerative uremic stomatitis associated with untreated chronic renal failure: report of a case and review of the literature.

Uremic stomatitis represents a relatively uncommon intraoral complication seen, mostly, in cases of end-stage renal disease or undiagnosed/untreated chronic renal failure. Its incidence has decreased due to the advent of renal dialysis. Clinically uremic stomatitis is characterized by the presence of painful plaques and crusts that are usually distributed on the buccal mucosa, dorsal or ventral surface of the tongue, gingiva, lips, and floor of the mouth. Treatment consists of improvement of urea blood concentration and the underlying renal failure, supported by increased oral hygiene with antiseptic mouthwashes and antimicrobial/antifungal agents if necessary. Although uremic stomatitis occurs in patients with end-stage renal disease, we report a case of a patient who exhibited an ulcerative form of uremic stomatitis related to the sudden relapse of uremia, although not in an advanced stage of her renal disease. A description of the clinical and microscopic appearance is given along with our hypothesis for the pathogenesis of the disease.