Omega-3 Supplementation Improves Pruritus in Continuous Ambulatory Peritoneal Dialysis Patients: A Crossover Randomized Pilot Clinical Trial.

OBJECTIVE: Pruritus is a prevalent skin condition in end-stage renal disease patients. Omega-3 fatty acids have been shown to reduce pruritus in hemodialysis patients. Our objective was to assess the effect of 3 g/day omega-3 supplementation on pruritus among continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: In this two-period, two-sequence crossover randomized clinical trial, 40 eligible subjects (CAPD patients who complained of pruritus for more than 8 weeks) were randomized to 3 g of omega-3 (n = 20) or identical placebo capsules (n = 20) for 4 weeks. After a wash-out period of 6 weeks, patients were crossed over to the alternate treatment option. Pruritus intensity was assessed using the visual analog scale (VAS) at baseline, 2-and 4-weeks post-intervention in each study period. Both patients and investigators were blinded to the study protocol. FINDINGS: No significant carry-over effect was detected. The mean pruritus score (VAS) in the omega-3 group compared with placebo group after the first (-3.02 vs. -0.48, P < 0.001) and second (-4.09 vs. -0.43, P < 0.001) intervention periods showed higher significant decrease. CONCLUSION: In summary, omega-3 supplementation is an effective treatment for pruritus alleviation in CAPD patients. Further studies are needed to determine the mechanisms underlying antipruritic effects of omega-3.

The effect of vitamin D administration on serum leptin and adiponectin levels in end-stage renal disease patients on hemodialysis with vitamin D deficiency: A placebo-controlled double-blind clinical trial.

BACKGROUND: The prevalence of vitamin D deficiency is higher in end-stage renal disease (ESRD) patients compared to healthy populations. This deficiency could lead to several complications with different mechanisms and might result in reduced survival in patients. Leptin and adiponectin are messenger proteins with endocrine secretion from adipocytes and various effects in cellular mechanisms. The goal of this study was to find the effect of vitamin D administration on serum levels of leptin and adiponectin in ESRD patients. MATERIALS AND METHODS: This double-blind randomized placebo-controlled clinical trial was carried out on 64 ESRD patients on hemodialysis in the Amin and Noor hospitals of Isfahan, Iran. Patients were categorized into two groups, on control and intervention; serum levels of vitamin D, leptin, and adiponectin were measured in both groups before and after the study. The intervention group was treated with vitamin D pearls, while the control group received placebo in the same manner. RESULTS: The mean [standard deviation (SD)] ages of the patients were 62 (21) years and 60 (19) years in the control and treated groups, respectively. CONCLUSION: The change in serum level of vitamin D was statistically significant in the treatment group but not in the control group. The serum level of leptin was reduced in the treatment group, while the serum level of adiponectin increased significantly, but none of these changes were statistically significant in the control group. This study showed that vitamin D administration is associated with an increase in adiponectin and a decrease in leptin level in ESRD patients.

Comparison of malnutrition in hemodialysis and peritoneal dialysis patients and its relationship with echocardiographic findings.

BACKGROUND: Malnutrition is common in patients with end-stage renal disease (ESRD) who on peritoneal dialysis (PD) or hemodialysis (HD). This study aimed to compare the frequency distribution of malnutrition in HD and PD patients and its relationship with echocardiographic findings. MATERIALS AND METHODS: This is a case-control study. Using the simple random sampling, 109 patients were selected among HD and PD patients based on the inclusion criteria. HD and PD groups included 55 and 54 patients, respectively. The malnutrition-inflammation score (MIS) index was used to assess malnutrition. Echocardiography was performed by a cardiologist. All the data were analyzed by SPSS version 18. RESULTS: In this study, 79.6% (43 patients) were in the PD group with MIS <9 (no malnutrition to mild malnutrition) and 20.4% (11 patients) with 9 ≤ MIS ≤ 18 suffered from moderate malnutrition. In the HD group, 72.7% (forty patients) had MIS < 9, 25.5% (14) had 9 ≤ MIS ≤ 18, and 1.8% (one patient) with MIS > 18 suffered from severe malnutrition (P = 0.74). There was no significant relationship between MIS and echocardiographic findings in PD patients (P > 0.05). In the HD group, there was no significant relationship between MIS and echocardiographic findings (P > 0.05), except for aortic and mitral valve insufficiencies (P < 0.05). CONCLUSION: The findings of this study show 27.3% of HD patients had moderate to severe malnutrition. There was a statistically significant relationship between MIS index and aortic and mitral valve insufficiencies in HD patients.

The effect of Vitamin D administration on treatment of anemia in end-stage renal disease patients with Vitamin D deficiency on hemodialysis: A placebo-controlled, double-blind clinical trial.

BACKGROUND: Chronic kidney disease is a progressive and irreversible loss of renal function. Anemia is one of the main complications of end-stage renal disease (ESRD) which is linked closely with other complications of the disease. The primary therapy for anemia in these patients is erythropoietin (EPO). The goal of this study was to find the effect of Vitamin D administration in addition to the appropriate dose of EPO in ESRD patients with Vitamin D deficiency. MATERIALS AND METHODS: This was a double-blind clinical trial on 64 ESRD patients undergoing hemodialysis in Amin and Noor Hospitals of Isfahan, Iran. The patients were divided into two groups of control and intervention. The intervention group was given Vitamin D supplements and the control group received placebo. The required dose of EPO to reach the target hemoglobin (Hb) was measured and statistically analyzed. RESULTS: A total number of 32 females and 32 males were included in this study. All the patients in the treatment group were aged between 18 and 76 and the patients in the control group were aged between 21 and 76 years old. There was a significant statistical relationship between Vitamin D administration and the required dose of EPO in both groups (P = 0.013). However, there was no correlation between the concentration of Hb and serum Vitamin D levels. CONCLUSION: Based on the main finding of this study, the relationship between Vitamin D administration and required dose of EPO seems that the predicted dose of Vitamin D prescribing strategy in Kidney Disease Outcomes Quality Initiative guidelines is not adequate to achieve normal serum Vitamin D in ESRD patients.

Sleep apnea syndrome and restless legs syndrome in kidney transplant recipients.

BACKGROUND: This study was aimed to evaluate the prevalence of obstructive sleep apnea (OSA) and restless legs syndrome (RLS) in patients with end-stage renal disease (ESRD) after kidney transplantation. MATERIALS AND METHODS: Two hundred kidney transplant recipients were enrolled in this cross-sectional study. Data on age, gender, etiology of ESRD, history of previous kidney transplantation, serum creatinine, and the presence or absence of OSA and RLS were collected. Symptoms of RLS were identified using the RLS questionnaire which was completed by the patients. The Berlin questionnaire and polysomnography were used for diagnosing OSA. RESULTS: The mean age of the studied patients was 45.86 ± 10.24 years. The prevalence of OSA was 26% (52 of 200 studied patients) and of RLS was 51.5% (103 of 200 studied patients). Majority of the patients with high-risk OSA were male and significantly older than the patients with low-risk OSA (P < 0.05). The prevalence of RLS was higher in patients with high-risk OSA and a higher level of creatinine compared to that in those with a low risk of OSA (P < 0.0001). Level of creatinine in patients with positive RLS was significantly higher than in those with negative RLS (P < 0.0001). OSA was observed in almost 42% of patients with positive RLS, compared to 9% of patients with negative RLS (P < 0.0001). CONCLUSION: In summary, our results indicate that the prevalence of OSA and RLS in kidney transplant recipients was higher than in the general population. Also, there was a significant association between OSA and RLS in these patients.

Effect of omega-3 supplementation on inflammatory parameters in patients on chronic ambulatory peritoneal dialysis.

BACKGROUND: End stage renal disease (ESRD) is a state of micro inflammation that attenuates patient's life span and quality of life. Inflammatory markers like interlukin 6 (IL-6) and C- reactive protein (CRP) can predict inflammatory state in ESRD patients. Dietary limitations are risk factors for omega-3 deficiency in these patients. Omega-3 supplementation is an attractive material that proposed in inflammation modulation. The aim of this study is evaluation of effect of omega-3 supplementation on IL-6 and CRP level in chronic ambulatory peritoneal dialysis (CAPD) patients. MATERIALS AND METHODS: This randomized controlled double-blind clinical trial is performed in 40 CAPD patients in two academic hospitals in Isfahan, Iran. One group received 1000 mg omega-3 capsule (each capsule contains 180 mg Eicosapentanoic and 120 mg Dosahexanoic acid) three times a day orally for 8 weeks (n = 20) and the other matched group by placebo (n = 20). Serum level of IL-6 and quantitative CRP (Q-CRP) were measured in beginning and the end of the study. Finally all data were analyzed by SPSS version 18. RESULTS: Mean age of patients was 53 years old in omega-3 group patients and 54 years old in placebo group. There were not any differences in CRP and IL-6 level in the beginning and the end of study between two groups (P: 0.81 and 0.10 for CRP and 0.26 and 0.23 for IL-6, respectively). CONCLUSION: Omega-3 supplementation did not effect on inflammatory markers (Q-CRP and IL-6) in CAPD patients after 8 weeks.

Effect of Omega-3 fatty acids on blood pressure and serum lipids in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: Hypertension and hyperlipidemia are two major risk factors for cardiovascular disease in continuous ambulatory peritoneal dialysis (CAPD) patients. This study was designed to investigate the effect of omega-3 fatty acids on blood pressure (BP) and serum lipids in CAPD patients. METHODS: This study was a randomized double-blind clinical trial in which 90 CAPD patients were randomly assigned to either the omega-3 or the placebo group. Patients in omega-3 group received 3 g/day omega-3 for 8 weeks, whereas patients in the control group received placebo. At baseline and at the end of 8 weeks, the patients' BP was controlled, and serum biochemistry was measured. FINDINGS: Mean systolic BP decreased (-22.2 ± 14.2 mmHg) in the omega-3 group at the end of the study while in the placebo group increased (+0.5 ± 30.2 mmHg) (P < 0.0001). Mean diastolic BP of the omega-3 group decreased more (-11.95 ± 11.9 mmHg) comparing with the placebo group (-1.1 ± 17.3 mmHg) (P = 0.001). There were no significant differences between the two groups in mean changes in serum triglyceride, and total, high-density lipoprotein, and low-density lipoprotein cholesterol. CONCLUSION: The results of this study indicate that omega-3 reduced BP significantly but had no effect on lipid profile in our CAPD patients.

The effect of omega-3 fatty acid supplementation on oxidative stress in continuous ambulatory peritoneal dialysis patients.

BACKGROUND: End stage renal disease (ESRD) is a condition that inflammation and oxidative stress plays an important role in damaging to tissues, especially, in the vascular system. The effect of omega-3 fatty acids is well-documented in some inflammatory diseases via eicosapentanoic acid and docosahexanoic acid components of fish oil. The aim of this study was to investigate the effects of dietary omega-3 fatty acid supplementation on levels of lipid peroxidation and oxidative sttress in ESRD patients. MATERIALS AND METHODS: This randomized controlled double-blind clinical trial consisted of 90 patients on chronic ambulatory peritoneal dialysis (CAPD). One group was treated orally with 3000 mg omega-3, per day for 8 weeks (n = 45) and the other matched group by placebo (n = 45). Serum levels of lipids, iron, ferritin, Protrombin Time, Partial thromboplastin time, superoxide dismutase (SOD), and reduced glutathione (GH) were measured at the beginning and at 8 weeks. RESULTS: Our results showed that SOD and reduced GH were not significantly changed in omega-3 group where lipid profile showed no significant changes too. Erythropoietin requirements also had no significant differences. CONCLUSION: Incorporation of omega-3 fatty acids to CAPD patients had no beneficial effects on oxidative stress but should evaluate more.

Sleep quality in patients on maintenance hemodialysis and peritoneal dialysis.

BACKGROUND: Sleep disturbances are common among uremic patients; however, limited data are available on predictors of sleep quality in this population. We assessed sleep quality in patients on hemodialysis (HD) and peritoneal dialysis (PD) and investigated predictors related to sleep quality. METHODS: Patients on maintenance HD and PD were consecutively included from two medical centers in Isfahan city (Iran). They completed the Pittsburgh sleep quality index (PSQI) and hospital anxiety and depression scale. Laboratory tests were done for iron state, kidney function, and electrolytes. Univariate and multivariate analyses were performed to find predictors of sleep quality. RESULTS: About 90 patients were evaluated (53 males, age = 54.2 ± 15.2 years, disease duration = 5.3 ± 4.5 years). Poor sleep quality was frequent in 86.6% of the cases in each group of HD and PD patients. Patients on HD had poorer sleep quality in terms of total PSQI scores and two dimensions of sleep latency and sleep efficiency (P < 0.05). Anxiety (ß = 0.232, P = 0.027), depression (ß = 0.317, P = 0.004), and being on HD (ß = 2.095, P = 0.009) were independent predictors of overall poor sleep quality. CONCLUSIONS: Poor sleep quality is highly frequent in patients on maintenance dialysis and mood disorders and being on HD are predictive factors. Further studies are required for better understanding of risk factors associated with poor sleep quality and thus possible treatments in these patients.

Pulmonary hypertension among patients on dialysis and kidney transplant recipients.

Pulmonary arterial hypertension (PAH) is a serious cardiac complication among patients with end-stage renal disease (ESRD). We investigated pulmonary hypertension and its associated factors among patients who were on chronic dialysis and kidney transplant recipients. One hundred-eighty patients in three groups of hemodialysis (HD), peritoneal dialysis (PD), and kidney transplant were studied. Demographic and clinical characteristics and echocardiographic findings were evaluated. A multivariable linear regression model was used to find factors associated with pulmonary artery pressure. The mean age of participants was 50.3 ± 15.5 years and 63.9% were male. We found pulmonary hypertension (mean pulmonary artery pressure >25 mmHg) in 31.6%, 8.3%, and 5% of the patients on HD, PD, and transplant recipients, respectively (p < 0.001). In multivariate analyses, being on HD (B = 5.276, confidence interval [CI] 95%: 1.211-9.341), age (B = -0.319, CI 95%: -0.501 to -0.138), smoking (B = 11.631, CI 95%: 1.847-21.416), systolic cardiac dysfunction (B = 6.313, CI 95%: 3.073-9.554), and diastolic cardiac dysfunction (B = 5.227, CI 95%: 1.176-9.277) were associated with systolic pulmonary artery pressure. These results showed that pulmonary hypertension is a frequent cardiac complication among patients with ESRD, and the type of renal replacement therapy (HD), systolic and diastolic cardiac dysfunction, and smoking are associated with increased pulmonary artery pressure. Further studies with larger sample sizes and also prospective studies are recommended in this regard.

Oral carnitine supplementation for dyslipidemia in chronic hemodialysis patients.

Carnitine deficiency is a commonly observed problem in maintenance hemodialysis (MHD) patients, which results in altered metabolism of fatty acids and subsequently development of dyslipidemia. To evaluate the effect of oral L-carnitine (LC) supplementation on lipid profile of adult MHD patients, we studied 30 of them (19 males, 11 females) who received LC supplementation of 250 mg tablets three times a day for eight weeks. They were compared with 30 matched patients as a control group. Serum lipid profiles were compared before and after the intervention between the two groups. There was a significant decrease of the values of the lipid profile in the intervention group before and after carnitine supplementation including the mean values of total cholesterol (190 ± 36.8 vs. 177 ± 31.2 mg/dL), triglyceride (210 ± 64.7 vs. 190 ± 54.1 mg/dL) and LDL-cholesterol (117 ± 30.1 vs. 106 ± 26.3 mg/dL), while the values did not change siginificantly from base line in the control group. However, the difference for HDL-cholesterol in intervention group was not statistically significant. None of the patients dropped out of the study due to drug side effects. Oral LC supplementation (750 mg/day) is able to improve lipid profile in patients on MHD. Further long-term studies with adequate sample size are needed to define the population of patients who would benefit more from carnitine therapy and the optimal dose and the most efficient route for administration of the drug.

Role of pentoxifylline in treatment of anemic patients suffering chronic hemodialysis: a randomized clinical trial.

BACKGROUND: Anemia is a major problem in patients with end-stage renal disease on chronic hemodialysis. rh-EPO is used mostly to elevate serum hemoglobin level and improve complaints caused by anemia, although in some patients it may not be totally effective for treating the disease. In this study, we aimed to evaluate pentoxifylline as a drug for treating anemia. METHODS AND MATERIAL: Fifty patients were enrolled in the study and divided into 2 groups. The case group took 400 mg of pentoxifylline daily for 6 months, while the control group took placebo for the same time. The levels of hemoglobin and serum albumin, TIBC, iron, ferritin, and PTH, and use of rh-EPO were estimated. The data were analyzed using SPSS-18 software. RESULTS: Of the 50 patients, 33 (66%) were male and 17 (34%) were female. Student paired t tests showed no significant difference in hemoglobin and serum albumin, TIBC, ferritin, and PTH levels, or use of rh-EPO between the case and control groups. However, iron level was significantly different in the 2 groups. CONCLUSION: In contrast to previous studies, our data do not support the concept that pentoxifylline elevates hemoglobin level and improves anemia, Further studies on a larger number of patients are required to assess whether or not pentoxifylline is useful in these patients.

The comparative evaluation of patients' body dry weight under hemodialysis using two methods: Bioelectrical impedance analysis and conventional method.

BACKGROUND: Dry weight (DW) is an important concept related to patients undergoing hemodialysis. Conventional method seems to be time consuming and operator dependent. Bio impedance analysis (BIA) is a new and simple method reported to be an accurate way for estimating DW. In this study, we aimed to compare the conventional estimation of DW with measuring DW by BIA. MATERIALS AND METHODS: This study involved 130 uremic patients, performed in Isfahan, Iran. DW was calculated by both conventional (CDW) and BIA (BIADW) method and results were compared based on different grouping factors including sex, underlying cause of renal failure (RF) (diabetic RF and non-diabetic RF), body mass index (BMI) status, and sessions of hemodialysis. We also calculated the difference between DWs of 2 methods (DW diff = CDW-BIADW). RESULTS: The mean of BIADW was significantly lower than CDW (57.20 ± 1.82 vs 59.36 ± 1.77, P value < 0.001). After grouping cases according to the underlying cause, BMI, sex, and dialysis sessions BIADW was significantly lower than CDW. CONCLUSION: Based on the combination of problems with CDW measurement which are corrected by BIA, and more clinical reliability of CDW, we concluded that although conventional method is a time-consuming and operator-dependent way to assess DW, DW could be estimated by combining both of these methods by finding the mathematic correlation between these methods.

The effects of hypotension on differences between the results of simultaneous venous and arterial blood gas analysis.

BACKGROUND: Analysis of venous blood gas (VBG) can represent arterial blood gas (ABG) analysis in patients with various diseases. The effects of hypotension on differences between the results of simultaneous venous and arterial blood gas analyses were reviewed. METHODS: This observational, cross-sectional study was conducted from March to October 2010 in emergency departments of two university hospitals in Tehran (Iran) on consecutive adult patients for whom ABG had been indicated for diagnosis/treatment. Arterial and peripheral venous bloods were simultaneously sampled with blood pressure measurement. The VBG-ABG amount of difference regarding pH, HCO(3), PCO(2), PO(2), SO(2), and Base Excess (BE) was compared between those with and without hypotension. RESULTS: During the study, 192 patients (51.6 ± 23.6 years, 67.7% males) were entered into the hypotension (n = 78) and normotensive groups (n = 114). The average VBG-ABG amount of difference (95% limits of agreement) in the hypotension versus normotensive group were -0.030 (-0.09 to 0.03) vs. -0.016 (-0.1 to 0.068) for pH (p = 0.01), 1.79 (-1.91 to 5.49) vs. 1.32 (-1.94 to 4.58) mEq/L for HCO(3) (p = 0.032), 2.69 (-20.43 to 25.81) vs. 2.03 (-7.75 to 11.81) mmHg for PCO(2) (p = 0.295), -35.97 (-130.17 to 58.23) vs. -32.65 (-104.79 to 39.49) mmHg for PO(2) (p = 0.293), -18.58 (-14.66 to 51.82) vs. -9.06 (-31.28 to 13.16) percent (p < 0.001) for SO(2), and 0.25 (-3.73 to 4.23) vs. 0.79 (-2.51 to 4.09) for BE (p = 0.036). CONCLUSIONS: Hypotensive status is associated with an increase in the amount of difference between VBG and ABG analysis regarding pH, HCO(3), and BE, though the amount of increase does not seem to be clinically important. Studying the precise effects of replacing ABG with VBG on the clinical decision-making and the following outcomes is worth-while.

Trend of indications for therapeutic plasma exchange at an Iranian university hospital.

BACKGROUND: There is neither a registry system nor center-by-center reports on therapeutic plasma exchange in Iran. We evaluated the trend of indications as well as techniques and safety of plasma exchange in a single center in Iran. METHODS: All registered cases in the plasma exchange unit of Al-Zahra hospital between 1996 and 2005 accounting for 560 patients (260 men, 300 women; median age 29, range 1-95 years) who underwent a total of 3985 procedures were included. Data collection was performed using the official questionnaire of the International Apheresis Registry System. RESULTS: The total number of procedures per year has remained stable corresponding to a median of 9 treatments per 100,000 inhabitants. Of the 560 patients, the majority had neurologic (62.8%), followed by hematologic disorders (16.9%). The three most common indications were: Guillain-Barré syndrome (27.8%), myasthenia gravis (23.0%) and thrombotic thrombocytopenic purpura (11.4%). Three hundred and seventy-nine patients (67.7%) belonged to category I of the ASFA indication classification, 28 (5%) to category II, 104 (18.5%) to category III, and five (0.9%) to category IV. Forty-four cases (7.8%) were unclassified. All plasma exchanges were performed with a discontinuous flow centrifugation method. Normal saline+albumin (5%) was the main liquid of replacement (77.9%). CONCLUSION: The trend of indications in our center is comparable to international data. However, the average number of procedures in our population is lower than world statistics and the method of plasma exchange has not been modified.

Effect of shift work on patient-doctor relationship in emergency department.

BACKGROUND: This study aimed to find effect of shift work on patient-doctor relationship in Emergency Department. METHODS: In a prospective cross-sectional study, 352 patients (mean age of 44 ± 17 years, 131 females and 221 males) referred to the emergency department of Rasoul-Akram hospital were enrolled in the study. The patient-doctor relationship questionnaire (PDRQ) was asked to be filled by patients. The questionnaires contained 9 items and the appropriateness of the statements was simplified to a scale of 1 (not at all) through 5 (totally). RESULTS: Comparing three shift works, the highest PDRQ score was for morning (27.1 ± 5.5) and the lowest value was for afternoon shift (23.8 ± 5.3). PDRQ score for night shift was 25.1 ± 6.9 (p = 0.002). CONCLUSIONS: The results of this study encouraged that patients' satisfaction of relationship with doctors was the lowest in the afternoon and it may be better to implement some strategies to reduce residents' workloads and increase quality of works in the afternoon shifts.

Outcome of patients without any immunosuppressive therapy after renal allograft failure.

Continuation of low-dose maintenance immunosuppressive therapy in end-stage renal allografts (ESRAs) that are left in situ is controversial. We studied the outcome of 85 patients (mean age 33.3 +/- 13.4 and range of 12-56 years) on hemodialysis with ESRAs, and without immunosuppressive therapy in our center from July 1991 to July 2003. Twelve (14.1%) study patients underwent allograft nephrectomy within a mean interval of 44.5 months after graft failure. The rest of the patients remained stable without fever, hematuria, graft tenderness, or localized edema during a mean interval of 46.5 +/- 45.2 months of follow-up. These results are promising and suggest that maintenance immuno-suppressive therapy in patients with ESRAs and on dialysis may not be necessary to avoid allograft nephrectomy. Prospective studies are warranted to substantiate these results.

Prevalence and clinical findings of biopsy-proven glomerulonephritidis in Iran.

Epidemiological data of renal diseases is population-based and have great geographic variability. Due to the lack of a national renal data registry system, there is no information on the prevalence rate, and clinical and laboratory features of various glomerulo-nephritidis (GNs) in Iran. In a retrospective cross sectional study, we analyzed 462 adult renal biopsies in Tehran, Iran. We determined the prevalence rate and the frequency of different clinical and laboratory findings in patients with different GNs. We also compared our results with the reports from other countries. There were 267 (57.8%) males and 195 (42.2%) females. The mean (+/- SD) age was 33.6 +/- 15.7 (range, 13-75) years. A total of 55 biopsies, which had revealed pathologies other than GNs, were excluded. Among the remaining 407 biopsies, membranous glomerulopathy (MGN) was the most common GN (23.6%), followed by IgAN (13.5%), membranoproliferative GN (MPGN) (11.5%), systemic lupus nephritis (SLE-GN) (10.6%), focal and segmental glomerulosclerosis (FSGS) (10.3%), and minimal change disease (MCD) (9.8%). Our study shows that MGN is the most common form of GN, followed by IgAN, MPGN, SLE-GN, FSGS and MCD in adult patients in Iran. A multi-center study with a larger sample size is needed for more comprehensive data in Iranian population.

Gabapentin: a promising drug for the treatment of uremic pruritus.

Despite advances made in treatment, uremic pruritus remains a common and distressing symptom in patients on hemodialysis (HD). Gabapentin is an effective drug in the management of neuropathic pain. Considering that neuropathic pain and pruritus share similar pathogenic mechanisms, we conducted this study to evaluate the efficacy of gabapentin in controlling uremic itch. In a double blind, placebo-controlled trial, 34 adult patients on maintenance HD were enrolled. The patients were assigned to receive four weeks of treatment with either gabapentin (400 mg) or placebo administered twice weekly after HD sessions. Pruritus scores were measured using a visual analogue scale and compared between the two groups.After four weeks of treatment, the mean decrease in pruritus score in gabapentin and placebo groups was 6.7 +/- 2.6 and 1.5 +/- 1.8, respectively (p< 0.001). None of the patients was forced to drop out of the study due to side effects of the treatment. Our study suggests that gabapentin is a safe and effective treatment for uremic itch.

Doxycycline: a pilot study to reduce diabetic proteinuria.

BACKGROUND: Activity of matrix metalloproteinases (MMPs), the enzymes primarily responsible for the deposition of extracellular matrix proteins, contributes to the pathogenesis of diabetic proteinuria. We evaluated the effect of doxycycline, a potent nonselective MMPs inhibitor, on reduction of proteinuria in diabetic patients. MATERIAL AND METHODS: In a self-control clinical trial, 35 patients with overt diabetic nephropathy (proteinuria >300 mg/24 h) received oral doxycycline 100 mg/day for 2 months. Twenty-four-hour urine volume, Cr and protein excretion were measured at baseline, after 1 and 2 months of treatment, and after 4 months of its discontinuation. Treatment-related side effects were closely monitored and documented. RESULTS: Mean (+/-SD) 24-hour urine protein was 888 +/- 419 mg at baseline, 884 +/- 368 mg after 1 month, and 643 +/- 386 mg after the 2 months of doxycycline treatment. There was statistically significant reduction in proteinuria at 2 months of treatment vs. at the baseline (p < 0.001). Mean 24-hour urine protein excretion increased to 1,021 +/- 422 mg 4 months after doxycycline was discontinued. The changes in serum sodium, potassium, BUN and Cr concentrations, and blood pressure measurements during the 2 months of treatment and follow-up period were not statistically significant. CONCLUSION: Proteinuria in patients with diabetic nephropathy can be reduced with low dose doxycycline therapy over a 2-month period of drug administration. Further studies are necessary to determine the long-term effect, the optimal dose, and the optimal duration of this potentially novel therapy.