Introduction: Regular dialysis, is not able to maintain phosphorus in the normal range. Therefore, using phosphate chelators to keep serum level of phosphorus in the normal range is essential. Sevelamer is a chelator for phosphate. Objectives: The purpose of this investigation was to compare the therapeutic impact of sevelamer carbonate versus sevelamer hydrochloride on electrolytes and metabolic acidosis and gastrointestinal symptoms in a group of hemodialysis patients. Patients and Methods: In this randomized clinical trial, patients were divided into two treatment groups; sevelamer carbonate and sevelamer hydrochloride. Sevelamer carbonate and sevelamer hydrochloride were prescribed as daily 800 mg tablets three times daily with their meals. Patients were evaluated for serum calcium, phosphorus, plasma bicarbonate and pH levels after one month. Results: Around 44 patients were enrolled, of which 22 patients were treated with sevelamer hydrochloride and 22 patients in the intervention group with sevelamer carbonate. There was no significant difference between the effects of sevelamer carbonate and sevelamer hydrochloride on serum calcium and phosphorus levels at the end of the study (P>0.05). There was a significant difference between the effects of sevelamer carbonate versus sevelamer hydrochloride on plasma bicarbonate and pH levels (P=0.036 and P=0.012 respectively). In terms of gastrointestinal complications, two drugs did not differ significantly. Conclusion: To prevent acidosis, along with increasing plasma bicarbonate and blood pH in patients undergoing hemodialysis, sevelamer carbonate is better than sevelamer hydrochloride. Therefore, the administration of sevelamer hydrochloride is preferable. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT20141016019554N13, https:// en.irct.ir/trial/28916, ethical code#IR.ZUMS.REC.1397.352).
Sexual dysfunction is a common complication among male patients with chronic kidney disease. Common disturbances include erectile dysfunction, decreased libido, and infertility. Sexual dysfunction is a multifactorial problem, and the treatment options are limited, it associated with lower quality of life scores in patients. Chronic kidney disease also has a critically impairing effect on the quality of life. To investigate the efficacy of bupropion on sexual dysfunction and quality of life in men with chronic kidney disease, a single-blind placebo-controlled trial was conducted. A total of 40 male patients with chronic kidney disease suffering from erectile dysfunction (Mean age 41/25±8/8) were randomly assigned to receive 10 weeks of treatment with either bupropion or placebo. Sexual function and quality of life were assessed by IIEF5 and WHOQOL-BREF questionnaires, respectively. Baseline demographic and clinical features were similar in both groups. The results showed a significant difference between the intervention and control groups in sexual function (P=0/005) and total quality of life (P=0/001); also the difference was significant in physical health (P=0/012), psychological health (P<0/001) and social relationship (P<0/001) domains. Our findings suggest that Bupropion is effective and safe for treating sexual dysfunction in men with chronic kidney disease and also could positively affect the quality of life among the patients. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(5):320-327.
In this study on a group of hemodialysis patients, we found that plasma renin activity in the intradialytic hypertension group increased during dialysis and after dialysis compared to pre-dialysis, while in the control group it decreased after dialysis compared to pre-dialysis. Please cite this paper as:Abbasi M, Hajisalimi B. The main determinants of intradialysis hypertension during dialysis in chronic hemodialysis patients; a single-center study. J Renal Inj Prev. 2018;7(3):152-159.Introduction: Raising or lowering blood pressure and muscle cramps are the main barriers for dialysis. Meanwhile, lowering blood pressure is more common and its mechanism is somewhat clear. But the mechanism for increasing blood pressure is not yet clear fully. Objectives: In this study, we examined the prevalence of intradialytic hypertension (IDH) and its related factors, especially changes in plasma renin activity, hematocrit, heart rate, and electrolytes in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis. Patients and Methods:In a cross-sectional study, patients with chronic end-stage renal disease under chronic hemodialysis were included to the study in the absence of a specific infection, as well as in lack of intravenous fluid providing during dialysis due to hypotension. Blood pressure and heart rate before and after hemodialysis were measured in four consecutive dialysis sessions. Elevating mean arterial blood pressure by 15 mm Hg between beginning and end of dialysis or raising blood pressure within four consecutive dialysis sessions were considered as IDH. Results: Around 17 of the 88 (19.3%) patients with hemodialysis had IDH. These subjects were compared with non-IDH patients who were similar in age and gender. The most common underlying disease in both groups was diabetes mellitus followed by hypertension. Comparison of measured parameters before and after dialysis showed that serum potassium level was significantly decreased in both groups. Serum sodium level increased in both groups, but this increase was significant only in the control group. There were no significant changes in renin plasma activity, heart rate and hematocrit levels in both groups. Conclusion: In this study, plasma renin activity in IDH group increased after dialysis compared to pre-dialysis. This finding requires to more test with larger sample size.
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