PPIs and Safety Concerns - A Pending Verdict?

Proton pump inhibitors (PPIs) with a high therapeutic index have strong evidence to support their efficacy in the management of common gastrointestinal (GI) conditions such as gastroesophageal reflux (GERD), peptic ulcer diseases, H. pyloriinfection etc. Despite this, the list of adverse effects being cited across literature with chronic use of these drugs is on an upward trend. Studies and published literature have associated PPI use with risk of bone fractures, various micronutrient deficiencies, gastro-intestinal infection, pneumonia, cardiac complications, dementia, kidney disease, intestinal bacterial overgrowth and drug interactions. It is however of clinical interest to note that in most of the studies published, the risk association reported with PPIs is weak. Unfortunately, widespread media publicity around these studies has prompted discontinuation of the drug in patients in whom it is indicated and created generalized anxiety among its users 20 years later since their introduction. The primary objective is to review the literature for an unbiased translation of the knowledge to appropriately guide decision in clinical practice.

Dengue fever in renal allograft recipients: Clinical course and outcome.

BACKGROUND: There are annual outbreaks of dengue infection in tropical and subtropical countries. This retrospective study aimed to assess the clinical manifestation of dengue and outcome in renal transplant recipients. METHODS: Renal transplant recipients diagnosed with dengue in the nephrology department during the outbreak from August 2015 to December 2015 were included in the study. RESULTS: Twenty patients developed dengue presenting during the outbreak. Mean age was 31.9 ± 8.8 years and all were males. Two patients had severe dengue (dengue hemorrhagic fever, dengue shock syndrome). Clinical presentation included febrile illness (95%), myalgia (65%), headache (30%), retro-orbital pain (10%), and mucocutaneous bleeding manifestations (10%). Three (15%) had third space fluid accumulation and 2 (10%) had hypotension. Ninety percent patients had thrombocytopenia, with 4 requiring platelet transfusion. Leucopenia (WBC < 4000/mm3 ) developed in 50% patients. About 60% had transient transaminitis. One patient with severed dengue expired and 1 recovered with IV immunoglobulin therapy. About 40% patients had rise in serum creatinine, with complete recovery in all patients. CONCLUSION: Clinical manifestations of dengue infection in renal transplant recipients were similar to that in general population. However, leucopenia necessitating temporary withdrawal of immunosuppression was common. Renal dysfunction was frequent but completely reversible.

Correction to: Effect of renal transplantation on cognitive function in hemodialysis patients: a longitudinal study.

In the original publication, the second author's affiliation was incorrectly published as "Department of Physiology, RAK College of Medical Sciences, Ras Al Khaimah, UAE". The correct affiliation should read as "Visiting Academic, Basic Medical Sciences Department, College of Medicine, University of Sharjah (UAE)".

Effect of renal transplantation on cognitive function in hemodialysis patients: a longitudinal study.

BACKGROUND: The literature notes high prevalence of cognitive function (CF) impairment among hemodialysis patients. Renal transplantation by reversing metabolic factors should improve cognitive function; however, results in post-transplant patients are inconsistent. Lack of longitudinal studies, variable and small patient population, variable renal function and post-transplantation period and use of non-specific tests make results difficult to interpret. We looked at CF in stable hemodialysis patients just prior to live renal transplantation and approximately 3 months subsequently using well-validated electrophysiological study of P300 cognitive potential obtained by auditory oddball paradigm using multiple scalp electrodes. METHODS: Ten healthy age- and gender-matched controls (group 1) and 20 end-stage kidney disease (ESKD) male patients on maintenance hemodialysis with no other comorbidities that affect CF were studied before (group 2) and 3 months after successful transplantation (group 3). RESULTS: ESKD population had mean age of 29.7 ± 7.5 years, with mean dialysis vintage and post-transplant period being 10.3 ± 6.9 and 3.2 ± 0.4 months, respectively. Mean P300 latencies in groups 1, 2 and 3 were 319 ± 33.6, 348.6 ± 27.8 and 316.4 ± 33.4 ms, respectively (P < 0.001 group 1 vs 2 and group 2 vs 3; group 1 vs 3 NS). Mean P300 amplitude in groups 1, 2 and 3 was 27.9 ± 12.8, 13.4 ± 8.6 and 14.6 ± 9.4 µV, respectively (P < 0.001 group 1 vs 2 and group 1 vs 3; group 2 vs 3 NS). P300 latencies correlated negatively with hemoglobin and serum albumin. CONCLUSIONS: ESKD patients have impaired CF as documented by prolonged P300 latencies. There was normalization of P300 latencies post-transplantation indicating role of uremic toxins in CF impairment.

Cardiovascular disease in patients with chronic kidney disease: a neglected subgroup.

The burden of non-communicable diseases has increased exponentially over the past decade and they account for majority of the health-related morbidity and mortality worldwide. In line with this, the prevalence of chronic kidney disease (CKD) has been increasing over the years. CKD progresses through stages and it is well known that patients are more likely to die than to progress to end-stage renal disease. The presence of multiple classical and novel risk factors predisposes this group of patients to premature cardiovascular mortality. Though being a common entity, prevention, diagnosis and treatment of cardiovascular diseases in CKD are mired with controversies. This is due to the fact that many of the well-established diagnostic modalities and treatment strategies have not been studied in detail in patients with CKD. Moreover, most of the studies have excluded patients with renal dysfunction though they are at a higher risk for adverse outcomes and require specific dose modifications. This has limited the evidence base for optimal decision making. In this review, we aim to cover the risk factors, diagnosis and effectiveness of interventional strategies in patients with CKD.