Nastaran Khoshhal; Ashkan Torshizian; Masoud Mohebbi; Abbas Ali Zeraraati; Ali Teimouri; Zahra Lotfi
Abstract
Introduction: Various studies have assessed the link between the thyroid and kidney and concluded that dysfunction in one organ can disrupt the other. Thyroid dysfunction is more prevalent in individuals with end-stage renal disease (ESRD) compared to the general population. Hypothyroid ESRD patients ...
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Introduction: Various studies have assessed the link between the thyroid and kidney and concluded that dysfunction in one organ can disrupt the other. Thyroid dysfunction is more prevalent in individuals with end-stage renal disease (ESRD) compared to the general population. Hypothyroid ESRD patients have higher mortality than euthyroid patients. In this study, we evaluated the prevalence of hypothyroidism in dialysis-dependent ESRD patients and assessed the association of possible prognostic factors with mortality.Methods: Patients who were undergoing dialysis in centers affiliated with the Mashhad University of Medical Sciences were enrolled and followed for a year to obtain survival rates. Lab parameters including thyroid stimulating hormone (TSH), parathyroid hormone (PTH), and magnesium (Mg) were recorded at baseline, and the relationship between these values and mortality was assessed.Results: The prevalence of hypothyroidism was 23% and 32.5% in hemodialysis and peritoneal dialysis patients, respectively. Blood urea was meaningfully higher in hemodialysis patients, while hypocalcemia and hyponatremia were more common in peritoneal dialysis patients. Higher ages (P=0.006), lower baseline Mg (P=0.044) and PTH (P=0.01), and diabetes (P=0.037) were all linked to a higher risk of mortality.Conclusion: Hypothyroidism was notably prevalent in our study population. As hypothyroidism is associated with higher mortality, proper screening and intervention in this group are essential. We recommend the prescription of supplementary Mg in dialysis patients as baseline Mg and PTH levels are associated with better outcomes in this group. Diabetes was also associated with higher mortality. Maintaining glycated hemoglobin between 6%-8% is therefore suggested to increase the survival of diabetic patients.
Yalda Ravanshad; Abbasali Zeraati; Mohadese Golsorkhi; Sahar Ravanshad; Anoush Azarfar; Hanieh Jafari
Abstract
Introduction: To date, several randomized trials have compared calcineurin inhibitors, especially tacrolimus, with cyclosporine in patients with steroid-resistant nephrotic syndrome, proposing conflicting results. Use of immunosuppressive therapy for the treatment of resistant nephrotic syndrome ...
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Introduction: To date, several randomized trials have compared calcineurin inhibitors, especially tacrolimus, with cyclosporine in patients with steroid-resistant nephrotic syndrome, proposing conflicting results. Use of immunosuppressive therapy for the treatment of resistant nephrotic syndrome remains a matter of debate, and the evidence on its efficacy and safety is inconclusive.The present study aimed to compare the benefits and limitations of tacrolimus and cyclosporine in the treatment of steroid-resistant nephrotic syndrome. Methods: This systematic review and meta-analysis was conducted via searching for the relevant trials performed until January 2018 in electronic databases such as PubMed, Scopus, ScienceDirect, Cochrane Library, and Web of Science. In total, 285 potentially relevant articles were identified, and four articles were selected for the review. A random effects model was used to analyze data, and the heterogeneity of the articles was assessed using Chi-square-based Cochran’s Q and I2 statistics, and heterogeneity was considered statistically significant with I2>50%. The outcomes were presented as relative risk with 95% confidence interval, and P-value of less than 0.05 was considered statistically significant. In addition, meta-analysis was used for further data analysis. Result: Four eligible randomized controlled trials were evaluated in this systematic review. In terms of partial and complete remission, no significant differences were observed between tacrolimus and cyclosporine. However, lack of response to therapy was significantly lower with tacrolimus (RR=0.289; P=0.02) compared to cyclosporine. No significant differences were observed between the drugs in terms of the infection rate, hypertension, ALT/AST elevation, and gastrointestinal symptoms, while nephrotoxicity (RR=0.395; P=0.004) and hypertrichosis (RR=0.018; P<0.001) were significantly lower with tacrolimus. Conclusions: In conclusion, Tacrolimus is superior to Cyclosporine in treating in patients with steroid resistance nephrotic syndrome in terms of no response to therapy, nephrotoxicity and hypertrichosis