[The effects of trimetazidine on QT-interval prolongation in patients with chronic kidney disease stage III-IV (predialysis CRD)]. / Ucinak trimetazidina na produljeni QT interval u bolesnika s kronicnom bubreznom bolesti III.-IV. stupnja (predijalizna kronicna bubrezna bolest).

Prolonged QT interval is a predictor of cardiovascular mortality. It indicates delayed repolarization of ventricular myocardium and is considered a precursor of malignant cardiac arrhythmias and sudden cardiac death. Increased cardiovascular risk (CVR) in the presence of prolonged QT interval, corrected by heart rate (QTc), is attributed to ventricular electrical instability. Patients with chronic renal disease (CRD) usually die from sudden cardiac death before reaching the final stage, final chronic kidney disease (CRD stage V). We investigated whether patients with CRD stage III-V have prolonged QT interval, what are the possible causes of this extension, and whether in this patient population trimetazidine application may affect the reduction in QT prolongation. Our study showed one quarter of predialysis patients, mostly asymptomatic, to have QT prolongation, thus being at a higher risk of CV events. Introducing trimetazidine along with standard therapy can reduce the incidence of sudden cardiac death, and calculation of the QTc index would be a useful and economical method of screening and monitoring high risk patients.

Inadequate use of preventive strategies in patients receiving NSAIDs.

OBJECTIVE: Little is known about the factors that influence the decision to use NSAIDs in combination with gastroprotective drugs. The aims of this observational study were to evaluate the extent to which NSAID users are prescribed concomitant gastroprotective drug regimens ('preventive strategies'), and to determine how patient risk factors for NSAID-associated gastrointestinal toxicity and physician prescribing preferences influenced the decision to prescribe a gastroprotective drug in combination with an NSAID. DESIGN AND PATIENTS: The study was conducted on 29 June 2004 and comprised 109 eligible adult patients hospitalised at the Clinical Hospital Center, Zagreb. Use of NSAIDs and gastroprotective drugs, risk factors for NSAID-associated gastrointestinal toxicity, and physician prescribing preferences were monitored throughout the study. RESULTS: Sixty-six percent of patients receiving proton pump inhibitors or histamine H(2)-receptor antagonists with NSAIDs had no risk factors for gastrointestinal toxicity. Furthermore, 29% of patients who used NSAIDs had risk factors for gastrointestinal toxicity but were not receiving gastroprotective drugs. Even though patients at risk of NSAID-associated gastrointestinal complications had higher odds of receiving preventive strategies (odds ratio 1.25), the absolute rate of utilisation of these therapies in at-risk populations was unacceptably low (69%). However, the strongest independent correlation for gastroprotective drug use was the prescribing physician, with an odds ratio of 6.40. CONCLUSION: This study demonstrates that an individual physician's prescribing style largely determines the odds of receiving preventive strategies with NSAID treatment and is more important than the patient's risk factors for gastrointestinal toxicity.