A Randomized Clinical Trial of the Effect of Pentoxifylline on C-Reactive Protein Level and Dialysis Adequacy in End-stage Renal Disease Patients on Maintenance Hemodialysis.

INTRODUCTION:  C-reactive protein (CRP) is increased among patients on maintenance hemodialysis. Such inflammatory markers can result in protein-energy deficit syndromes and low adequacy of dialysis in these patients. This study evaluated the effect of pentoxifylline on serum CRP level and KT/V in end-stage renal disease patients on maintenance hemodialysis. MATERIAL AND METHODS: This 1-month randomized, double-blind, placebo-controlled clinical trial involving 73 patients with end-stage renal disease on maintenance hemodialysis assessed the effectiveness of 400 mg/d of pentoxifylline on serum CRP level decrease and improvement of dialysis adequacy. RESULTS: The difference in mean serum CRP levels of the pentoxifylline and placebo groups was not significant before study. While CRP showed showed a significant increase in the placebo group after completing the interventions (P = .01), the difference was nonsignificant in the pentoxifylline group (P = .53). The difference in the mean adequacy of dialysis was not significant before the interventions between the two groups, while there was a significant increase in the pentoxifylline group (P = .01) and a nonsignificant increase in the placebo group (P = .31) after the interventions. CONCLUSIONS: Among patients on maintenance hemodialysis, a 1-month trial of pentoxifylline was associated with a substantial improvement of adequacy of dialysis and a significant prevention from serum CRP level increase, but not a significant reduction in the mean serum CRP level.

Cold Dialysis Solution for Hemodialysis Patients With Fatigue: a Cross-over Study.

INTRODUCTION: The purpose of this study was to explore the effect of cold dialysis on fatigue in hemodialysis patients. MATERIALS AND METHODS: In a double-blinded cross-over clinical trial, 46 participants were recruited from a hemodialysis unit in Iran. The participants were allocated into 2 groups through simple random sampling method. Each group received 3 sessions of hemodialysis with a dialysis solution temperature of either 37°C 3 or 35.5°C during the first week and then with for another week with the other temperature.  The self-report Piper Fatigue Scale questionnaire was filled out by the participants. RESULTS: The Piper Fatigue Scale scores in the cold dialysis groups were significantly lower than those in the conventional dialysis solution temperature (P < .001). Reducing the temperature of hemodialysis solution brought a 31.3% reduction in the fatigue score. CONCLUSIONS: Cold dialysis can be used for all hemodialysis patients as a routine intervention, and in particular, it is recommended dialysis patients who have severe fatigue as a convenient and inexpensive therapeutic option.

Effects of group sexual counseling on the traditional perceptions and attitudes of Iranian pregnant women.

BACKGROUND: Marital relationships may fluctuate due to physical and psychological changes during pregnancy. This study aimed to investigate the effect of group sexual counseling on the traditional perceptions and attitudes of pregnant women. METHODS: This was a quasiexperimental intervention study. Among the pregnant women who were referred to health care centers in Zahedan, Iran, in 2015 for routine care during pregnancy, 100 individuals were chosen and randomly categorized into two groups: intervention (n=50) and control (n=50). Variables were the participant's attitudes and beliefs on sexual activity during pregnancy. The data were collected during pregnancy using the Sexual Activities and Attitudes Questionnaire. The questionnaire was completed before and 6 weeks after five sessions of group sexual counseling. Data were analyzed using SPSS software (Version 20) with descriptive and analytical statistics. RESULTS: The mean of score changes for sexual attitudes and traditional perceptions in the intervention group was significantly higher than that in the control group (P<0.0001). Analysis of covariance also showed that the mean score of the participant's traditional perceptions and sexual attitudes in both groups was significantly different after the group sexual counseling. DISCUSSION: Due to the positive effect of group sexual counseling on improving the attitudes of pregnant women about sexual issues and reframing the traditional perceptions over sexual activities during pregnancy, it is recommended that this educational intervention should be integrated into counseling and prenatal care for pregnant women.

Effect of raloxifene on parathyroid hormone in osteopenic and osteoporotic postmenopausal women with chronic kidney disease stage 5.

INTRODUCTION: This study was aimed to investigate the effects of raloxifene on intact parathyroid hormone (PTH) level and bone mineral density (BMD) for 8 months in women on hemodialysis and women with chronic kidney disease stage 5 not dependent on dialysis to determine its effect on secondary hyperparathyroidism and osteoporosis. MATERIALS AND METHODS: Fifty-one women on hemodialysis and 9 with chronic kidney disease stage 5 were randomly assigned to receive oral raloxifene, 60 mg/d, or placebo for 8 months. Baseline blood determinations and BMD were done and repeated after 8 months. Serum levels of total calcium, phosphorus, alkaline phosphatase, and intact PTH were measured. RESULTS: Serum levels of intact PTH significantly decreased in both groups, and there was no difference between the two groups after 8 months (P = .37). Serum phosphorus levels also decreased by 1.8% in the two groups. After 8 months of treatment, the BMD of the lumbar spine and femural neck decreased by 1.9% in the control group, while an increase in BMD was observed in the raloxifene group,with an average increase in both BMDs of the lumbar spine and the femural neck by 2% (significant in the lumbar spine; P = .01). CONCLUSIONS: Raloxifene has proven to be an effective medication in terms of improving BMD, with no adverse effects. However, it had no effect on controlling hyperparathyroidism in our patients. Long-term studies should be done to investigate the effects of raloxifene in chronic kidney disease and dialysis patients.

Acute renal failure in a patient with Sheehan syndrome and rhabdomyolysis.

We report a case of acute renal failure related to rhabdomyolysis in a patient with Sheehan syndrome, while other diseases that could cause rhabdomyolysis were excluded. The patient's kidney function completely recovered with 3 sessions of intermittent hemodialysis. After thyroxine replacement therapy, musculoskeletal symptoms disappeared and creatine kinase concentrations decreased. Steroid replacement therapy was also administered. The present case suggests that rhabdomyolysis could occur in a patient with Sheehan syndrome without other precipitating factors.

Lipid profile cutoff values for predicting hypertension in an Iranian population (ROC curve analysis).

BACKGROUND: Hypertension is a common condition that affects many people in the world. Although several risk factors for the development of hypertension have been identified, its etiology is still not fully understood. In this study the prevalence of dyslipidemia in a hypertensive and a control group was compared and the cutoff points of the lipid profile to predict hypertension were determined. MATERIAL/METHOD: In this cross-sectional population-based study, the lipid profiles of 250 people who had hypertension were compared with those of 750 healthy subjects (control group). Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff values. RESULTS: There were significant differences in mean TC, TG, and LDL-C between the hypertensive and control groups (p<0.001). ROC curves for predicting hypertension were plotted and the best cutoff values were 185 mg/dl for TC, 125 mg/dl for TG, 110 mg/dl for LDL-C, and 45 mg/dl for HDL-C. CONCLUSION: The significantly higher prevalence of dyslipidemia in hypertensive patients may necessitate special attention to its detection and treatment. Also, plasma lipid cutoff points in hypertension seem to be different from ATP III cutoff points (for a patient with a 2+ risk factor). Further studies are needed to confirm standard values of the lipid profile as a predictive factor in hypertensive patients.