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1.
BMC Nephrol ; 22(1): 363, 2021 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732171

RESUMO

BACKGROUND: Patients on haemodialysis (HD) are often constipated. This study aimed to assess the relationship between constipation and mortality in such patients. In this study, constipation was defined as receiving prescription laxatives, based on the investigation results of "a need to take laxatives is the most common conception of constipation" reported by the World Gastroenterology Organization Global Guidelines. METHODS: This cohort study included 12,217 adult patients on HD enrolled in the Japan-Dialysis Outcomes and Practice Patterns study phases 1 to 5 (1998 to 2015). The participants were grouped into two based on whether they were prescribed laxatives during enrolment at baseline. The primary endpoint was all-cause mortality in 3 years, and the secondary endpoint was cause-specific death. Missing values were imputed using multiple imputation methods. All estimations were calculated using a Cox proportional hazards model with an inverse probability of treatment weighting using the propensity score. RESULTS: Laxatives were prescribed in 30.5% of the patients, and there were 1240 all-cause deaths. There was a significant association between laxative prescription and all-cause mortality [adjusted hazard ratio (AHR), 1.12; 95% confidence interval (CI): 1.03 to 1.21]. Because the Kaplan-Meier curves of the two groups crossed over, we examined 8345 patients observed for more than 1.5 years. Laxative prescription was significantly associated with all-cause mortality (AHR, 1.35; 95% CI: 1.17 to 1.55). The AHR of infectious death was 1.62 (95% CI: 1.14 to 2.29), and that of cancerous death was 1.60 (95% CI: 1.08 to 2.36). However, cardiovascular death did not show a significant inter-group difference. CONCLUSIONS: Constipation requiring use of laxatives was associated with an increased risk of death in patients on HD. It is important to prevent patients receiving HD from developing constipation and to reduce the number of patients requiring laxatives.


Assuntos
Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/mortalidade , Laxantes/uso terapêutico , Diálise Renal , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
2.
J Pediatr ; 214: 227-230, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31351682

RESUMO

Compared with a 5% intravenous immunoglobulin, a 10% intravenous immunoglobulin as the first-line treatment of Kawasaki disease significantly reduced the fever duration (10 vs 13 hours, P = .022) among the responders, and the interval to adjunctive therapy for nonresponders (47 vs 49 hours, P = .035). There were no severe adverse events.


Assuntos
Imunoglobulinas Intravenosas/administração & dosagem , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Fatores Imunológicos/administração & dosagem , Infusões Intravenosas/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
3.
Clin Exp Nephrol ; 19(3): 465-73, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25135635

RESUMO

BACKGROUND: Combination drugs containing an angiotensin receptor blocker and a calcium channel blocker have been widely commercialized in recent years, and their advantages, such as improvements in adherence, and reductions in medication costs, have been greatly emphasized. However, the actual situations and the impact of switching to combination drugs in clinical practice of nephrology are not fully understood. METHODS: This study was conducted in outpatients of nephrology who received antihypertensive medicines, and who switched to combination drugs. Changes in the potency of the antihypertensive drugs, and blood pressure were examined retrospectively before and after changing treatments. In addition, the study also involved patients' questionnaire, which examined changes in blood pressure at home, the presence or absence of missed doses, the impact on medication-related expenses, and the level of patients' satisfaction with regard to combination drugs. RESULTS: Survey results from 90 participants revealed that changing to combination drugs resulted in a reduction of missed doses, a decrease in blood pressure measured in an outpatient setting, and a reduction in medication-related expenses in total patients, non-chronic kidney disease (CKD) patients, and CKD patients. CONCLUSION: Our study shows that switching to combination antihypertensive drugs resulted in an improvement in adherence and a reduction in medication-related expenses, and revealed that patient satisfaction was high. Combination drugs for hypertensive patients may be beneficial in both medical and economical viewpoints.


Assuntos
Antagonistas de Receptores de Angiotensina/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/administração & dosagem , Hipertensão/tratamento farmacológico , Nefrologia , Insuficiência Renal Crônica/complicações , Idoso , Anlodipino/administração & dosagem , Antagonistas de Receptores de Angiotensina/economia , Ácido Azetidinocarboxílico/administração & dosagem , Ácido Azetidinocarboxílico/análogos & derivados , Benzimidazóis/administração & dosagem , Benzoatos/administração & dosagem , Compostos de Bifenilo , Bloqueadores dos Canais de Cálcio/economia , Di-Hidropiridinas/administração & dosagem , Combinação de Medicamentos , Custos de Medicamentos , Substituição de Medicamentos , Feminino , Humanos , Hipertensão/complicações , Imidazóis/administração & dosagem , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Satisfação do Paciente , Padrões de Prática Médica , Estudos Retrospectivos , Inquéritos e Questionários , Telmisartan , Tetrazóis/administração & dosagem , Valsartana/administração & dosagem
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