A prospective, open label, parallel group and randomized study was conducted to see the effect of enalapril and losartan on proteinuria in type 2 diabetic nephropathy patients. 18 patients (proteinuria ≥ 0.5 gm/day and serum creatinine ≤3 mg/dL) were selected and then randomly grouped to receive enalapril (5-40 mg/day, n=10) and losartan (25-200 mg/day, n=8) in increasing dose for 16 weeks. No statistically significant alteration in the urinary total protein, protein creatinine ratio, serum creatinine, estimated glomerular filtration rate, serum potassium and blood pressure was observed in any group. After attaining maximum dose (40 mg and 200 mg respectively), enalapril group showed significant (p<0.04) reduction of protein creatinine ratio in comparison to losartan group. It may be concluded that 40 mg enalapril or 200 mg losartan are not sufficient to reduce proteinuria and blood pressure significantly in type 2 proteinuric diabetics with renal dysfunction although both drugs were well tolerated at high doses.
Background: Anemia is common in patients with end stage renal disease (ESRD) and is associated with impaired quality of life (QOL). This study was done to evaluate the QOL of ESRD patients on maintenance hemodialysis (MHD) with different levels of hemoglobin (Hb).Methods: This cross-sectional study was conducted from January to December 2013 on 135 adult ESRD patients on MHD for ?4 months, at hemodialysis units of three tertiary care hospitals in Dhaka, Bangladesh. The patients were divided into three groups based on Hb levels (Group 1: Hb <9 gm/dl, n=45, 33%; Group 2: Hb 9-11 gm/dl, n=53, 39% and Group 3: Hb >11 gm/dl, n=37, 28%), provided their Hb levels were stable [ie. maintained with erythropoietin (EPO) or blood transfusion (BT) or both] over the previous four months. Subjects were interviewed by principal investigator using Kidney Disease Quality of Life Short Form Tool (KDQOL-SF-36 version 1.3) consisting of two domains with 38 questions with each item put on a 0 to 100 range, higher scores indicating better QOL.Results: The mean age was 50+12 years with male predominance (male:female = 1.5:1). Mean duration of hemodialysis was 12±11.8 months (range 9 to 66 months). The average QOL score was 50. Comparison of QOL parameters between the three groups showed that symptoms/problems, effects of kidney disease, burden of kidney disease, cognitive function, quality of social interaction and sleep in the kidney disease specific domain as well as pain, emotional well-being, social function and energy/fatigue scale scores in the general health related domain were significantly higher in the group 2 and group 3 than group 1 patients (each with p<0.001). Comparison of QOL parameters between anemia correction measures like EPO (n=65, 48.2%), BT (n=42, 31.1%) or both (n=28, 20.7%) showed that the group receiving EPO alone had better QOL [symptom/ problem (p 0.043), burden of kidney disease (p 0.000), sexual function (p 0.000), pain (p 0.008) and energy/ fatigue (p 0.036)] compared to those getting BT or even BT plus EPO.Conclusion: Patients were found to have better QOL with higher Hb levels. The overall QOL can be improved significantly by correction of anemia.Birdem Med J 2017; 7(3): 198-204
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