Iranian Journal of Kidney Diseases
Volume:17 Issue: 4, Jul 2023

Sodium-glucose cotransporter-2 (SGLT2) inhibitors modulate kidney function in diabetic chronic kidney disease trials. Furthermore, recent studies have showed their effect on kidney dysfunction in non-diabetic chronic kidney disease (CKD). Here, we focus on the impact of SGLT2 inhibitors on some renal parameters in nondiabetic CKD by discussing completed and ongoing trials. Different databases and search engines of Web of Science, PubMed, Google Scholar, Scopus, SID, and Magiran were searched until November 2022. We included human studies that evaluated the effect of SGLT2 inhibitors in non-diabetic CKD participants. Two authors independently screened the articles for inclusion, extracted the data, and assessed the quality of the included studies. The primary outcomes were the effect of the SGLT2 inhibitors on proteinuria, GFR and blood pressure. A total of 46 full texts were assessed for eligibility, and further review. After reviewing the full texts, seven eligible articles were entered included in this study. We suggest that SGLT2 inhibitors provide renal protection by modifying predisposing factors in the development of CKD, specifically albuminuria and GFR decrease. Other beneficial effects of these agents on blood pressure and sympathetic nerve activity might be considered as a possible mechanism for improving renal hemodynamics. We believe SGLT2 inhibitors could be considered as an effective add-on therapy in non-diabetic CKD patients.

Early diagnosis and management of preeclampsia are very important to reduce fetal and maternal complications. In this study, we examined the ratio of protein to creatinine in a random urine sample and its relationship to the rate of 24-hour urine protein excretion for quick detection and prompt management of this condition in women with preeclampsia.

In this descriptive-analytical cross-sectional study, 60 pregnant women with preeclampsia referred to the maternity ward of Ali Ebn -e Abitaleb hospital of Zahedan in 2019 were recruited. The 24-hour urine protein excretion and the ratio of protein to creatinine in a random urine sample were compared in these patients.

The results showed that there was a positive correlation between the 24-hour urinary protein excretion and the protein to creatinine ratio of the random urine sample in preeclampsia (P < .001, r = 0.515). Women with a higher 24-hour protein excretion also had a higher urinary protein to creatinine ratio.

In general, based on the results of this study, it can be concluded that the ratio of protein to creatinine in the random urine sample has a good diagnostic efficiency in suspected preeclampsia. It is a quick alternative method for detecting suspicious proteinuria and could be used as a screening test in emergency situations.

This study was conducted to determine the factors affecting the development of sarcopenias in elderly patients with chronic kidney disease (CKD), in order to provide future clinical reference and guidance in preventing the occurrence of sarcopenias in patients with CKD.

We included 116 CKD patients admitted to affiliated Hospital of Hebei University for retrospective analysis between September 2019 and March 2022. Fifty-one CKD patients with sarcopenias were selected as the observation group (OG) and 65 CKD patients without sarcopenias were considered as the control group (CG). Clinical baseline data such as age and sex were recorded, venous blood was collected for routine examination, and a multi-frequency body composition analyzer was applied to measure patients’ body composition. Grip strength, middle arm circumstances (MAC) and triceps skin-foldthickness (TSF) were also measured. Then, patients’ sleep quality, nutritional status and negative psychological status were assessed by using the Pittsburgh Sleep Quality Index (PSQI), Malnutrition inflammation score (MIS), and Self-rating Anxiety/Depression Scale (SAS/SDS), respectively. Differences in test results were compared inter-group, and the factors affecting the occurrence of sarcopenias in CKD patients were analyzed by multiple Logistic regression.

OG patients were older than CG patients, with a higher number of female patients. Their BMI, bone mass, MAC, serum creatinine (Scr), uric acid (UA) and triglyceride (TG) were lower (P < .05). According to multiple Logistic regression analysis, age, as well as PSQI, MIS, SAS, and SDS scores were the risk factors for sarcopenias in CKD, while BMI, bone mass, MAC, Scr, UA and TG were protective factors (P < .05).

Age, poor sleep quality, poor nutritional status and negative emotions are independent risk factors for sarcopenias in CKD patients, while BMI, bone mass, MAC, UA, TG, and Scr are independent protective factors.

Rhabdomyolysis is a clinical syndrome accompanied with biochemical changes that is diagnosed in some patients with acute chemical or drug poisoning. In this regard, the present study aimed to evaluate the effects of Montelukast in the treatment of intoxication-induced rhabdomyolysis.

This single-blind randomized clinical trial study was conducted in Loghman Hakim Hospital from March 2021 to March 2022. The study participants were 60 individuals evenly distributed into experimental and control groups. The experimental group received Montelukast plus routine treatment and the control group Creatine phosphokinase (CPK), urea, creatinine, aspartate aminotransferase (AST) and alanine transaminase (ALT) levels were monitored daily in both groups for seven days. The variables of age, gender and history of diabetes mellitus and kidney diseases were recorded.

The mean age was 39.9 ± 16.87 and 38.2 ± 16.3 years in the control and intervention groups, respectively. Montelukast significantly (P < .05) reduced CPK levels on days five and seven, urea on days three, four, five and seven, and creatinine on days two to seven. The AST and ALT levels, unlike the control group which has a decreasing trend, increased first in the Montelukast group and then decreased on the sixth and seventh days.

The results showed that Montelukast effectively reduced CPK, urea and creatinine levels, as well as the recovery time in patients with poison-induced rhabdomyolysis. In other words, Montelukast is effective in the treatment of rhabdomyolysis.

Contrast-induced nephropathy (CIN) is an important issue in patients with cardiovascular disorders undergoing angiography, especially in patients with kidney failure. The purpose of the present study was to compare the preventive effects of nicorandil and atorvastatin on the incidence of CIN in patients with chronic kidney disease (CKD).

In this clinical trial study, 270 patients with renal insufficiency nominated for angiographic procedures were randomly divided into three groups (each group, n = 90): hydration group (1000 mL saline), hydration + atorvastatin group (80 mg/d for 3 days), and hydration + nicorandil group (10 mg 3 times/d for 3 days). Serum creatinine (Cr) and blood urea nitrogen (BUN) levels as well as glomerular filtration rate (GFR) were evaluated before and 72 hours after the intervention.

At the end of the study, serum Cr and BUN levels in all three groups showed a significant increase compared to the pre-intervention levels, which were significantly higher in the control group than the other two groups. The amount of GFR also significantly decreased following the intervention in all three groups, with the decline being significantly more pronounced in the control group than in other two groups. No significant differences were found in serum concentrations of Cr and BUN as well as GFR levels between nicorandil and atorvastatin groups at the end of the study.

Nicorandil and atorvastatin administration showed preventive effects on CIN in CKD patients undergoing angiography, but there was no significant difference between the two drugs.

Central venous catheters, frequently used in patients undergoing hemodialysis, place the patients at high risk of catheter-related infections. Therefore, it is essential to select the optimal prevention protocol for these infections. This study aims to compare the efficacy of the Taurolock solution and antibiotic lock in preventing tunneled catheter (permcath) related infections.

This multicenter study was conducted between June 2020 and July 2021 on 86 hemodialysis patients with a central venous catheter from four dialysis centers in Tehran, Iran. The patients were randomly assigned into two groups. The first group received Taurolock, and the second group received antibiotic lock(a combination of vancomycin and heparin) at the end of each dialysis session. Peripheral blood and catheter blood samples were collected once before the intervention and monthly thereafter, for up to six months, and blood culture performed for detection of various bacterial strains.

The findings showed no significant difference in the infection rate (positive peripheral blood or catheter cultures) between the Taurolock and vancomycin groups (P > .05). Additionally, there was no significant difference in the duration of catheterimplantation in individuals with positive and negative cultures (P > .05). Furthermore, no significant correlation was found between comorbidities and catheter-related infection in patients of the two groups (P > .05).

There was no significant difference between the two groups in the rate of catheter-related infection. Therefore, vancomycin lock solutions can be good alternatives to Taurolock solution for preventing catheter-related infections.

Hyperhomocysteinemia is an important risk factor for cardiovascular disease in ESKD patients. Homocysteine, as an inflammatory factor, and carotid intima-media thickness (CIMT)could predict atherosclerosis in hemodialysis-treated ESKD patients. In this regard, the present study was conducted to investigate serum homocysteine level and its relationship with internal carotid intima thickness in ESKD patients undergoing routine hemodialysis.

This study comprised 56 ESKD patients, older than 40 years, undergoing hemodialysis for at least 1 year. All participants were taking Nephrovit for at least 6 months. The study participants were patients who underwent ultrasonography for CIMT determination and laboratory test

There was no statistically significant relationship between the mean homocysteine level and hypertension, diabetes mellitus, duration of dialysis, and body mass index (BMI). Among the study participants, the results also showed that the mean value of CMIT homocysteine and C-reactive protein (CRP) were 0.89 millimeters, 30.44 (mcmol/L), and 35.60 mg/L; respectively. Despite hypertension, there was a significant difference between the mean values of CMIT in patients with diabetes mellitus and those who had been on dialysis for a longer period (more than 3 years). Also, the mean value of CMIT was significantly higher in obese patients than those with normal BMI. None of the other variables including homocysteine serum level, C-reactive protein(CRP), and CMIT showed a significant correlation.

The results of the study suggest that there is no relationship between serum homocysteine level and carotid intimamedia thickness in hemodialysis patients.