Epidemiology of end-stage renal disease in Iran: a review article.

The prevalence and incidence of end-stage renal disease (ESRD) are increasing in developed and developing countries, and this will place an enormous financial burden for health-care systems. The exact reasons of the rising prevalence of ESRD patients are unknown, but it can be attributed to an increase in the prevalence of diabetes mellitus and hypertension as the most common causes of ESRD. However, in contrast to the developed countries, the etiology of ESRD in the significant percent of patients with ESRD in Iran is unknown. In our country, the patients with chronic kidney diseases present themselves to the hospital only when they have severe symptoms of uremia, and, at this time, determining the primary cause of ESRD is often not possible. In addition, although the prevalence and incidence of ESRD are also significantly increasing in Iran in recent years, they are still lower compared with developed countries, which may also be due to poor referral resulting in the under diagnosis of ESRD. The aim of this review is to evaluate the epidemiologic aspects of ESRD in Iran, including demographic data, cause of ESRD, kind of renal replacement therapies implemented and their survival.

The protective effect of theophyline in cisplatin nephrotoxicity.

Cisplatin is a potent and a major anti-neoplastic drug in the treatment of a broad spectrum of malignancies. However, its clinical use is limited by renal tubular dysfunction that occurs in a significant percent of patients. The aim of the present study was to evaluate the possible protective effect of theophyline in the prevention of cisplatin-induced nephrotoxicity. The trial design was prospective, randomized, double-blinded and placebo controlled. Chemotherapeutic patients who received cisplatin at a dosage of at least 50 mg/m 2 alone or in combination with other chemotherapy agent(s) were included in the study. There were a total of 76 patients who were randomly divided into two groups. In group 1 (n = 38), placebo was advised; in group 2 (n = 38), patients received 4 mg/kg aminophyline as an intravenous loading dose, followed by theophyline in a dose of 200 mg three times daily orally for four consecutive days. The placebo group had 22 males and 16 females and the theophyline group had 26 males and 12 females. The mean age was 51 ± 17.6 years and the mean dose of cisplatin was 86.71 ± 43.18 mg. The prevalence of cisplatin nephrotoxicity in groups 1 and 2 was 7.9 and 5.3%, respectively, and the difference was not significant (P = 1). In addition, there was no significant association of cisplatin nephrotoxicity with age (P = 0.1), gender (P = 0.64) and mean dose of cisplatin (P = 0.8). These results indicate that prophy-lactic application of aminophyline and theophyline does not have a protective effect against cisplatin nephrotoxicity.

Efficacy of topical cromolyn sodium 4% on pruritus in uremic nephrogenic patients: a randomized double-blind study in 60 patients.

BACKGROUND: Chronic kidney disease (CKD)-associated pruritus is a significant clinical symptom affecting more than 50% of patients on hemodialysis. The availability of effective therapeutic options for management of CKD-associated pruritus remains a treatment challenge. OBJECTIVE: The aim of this study was to compare cromolyn sodium cream 4% with placebo for the treatment of renal pruritus. METHODS: A randomized, double-blind, prospective, 4-week study was designed. 60 patients with ESRD in our dialysis ward were randomly allocated to cromolyn sodium cream 4% or placebo. All of them completed the study period and their pruritus levels were evaluated 5 times (before the start of the study and at the end of each week for 4 weeks) using a Visual Analogue Scale (VAS). RESULTS: The average pruritus score before administration of the drug in cromolyn sodium 4% and placebo group had been 2.5 ± 1.1 and 2.7 ± 1.3, respectively. In the cromolyn sodium 4% group the average score of pruritus gradually reduced to 0.3 ± 1.3 and in the placebo group it gradually decreased to 1.3 ± 1.4 at the end of Week 4. Method of t-test repeat analytical measurement indicated that there is no significant difference between reduction of pruritus in cromolyn 4% and placebo groups in the first and second week of the study, but in third and fourth week there were significant differences in reducing pruritus in favor of cromolyn sodium 4% (p < 0.04). CONCLUSION: According to our study cromolyn sodium cream 4% was more effective than placebo in reducing pruritus in uremic patients. We suggest to our colleagues to consider this treatment when facing a patient suffering from this symptom.