Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses

Background/Aims: This retrospective study analysed hypertension management and adherence to blood pressure (BP) targets among renal transplant recipients (RTRs) under specialized care in the Outpatient Transplantation Unit in the Department of Nephrology, Transplantology and Internal Medicine at Gdansk University Hospital. Methods: Medical records of 101, 316, 639 and 818 RTRs diagnosed with hypertension, who received outpatient care in 2001, 2006, 2011 and 2014, respectively were analysed in four independent cross-sectional surveys. All RTRs received antihypertensive regimens. Results: The overall most commonly used antihypertensive agents were beta-blockers (BB) (range 66.3-82.5%) followed by calcium channel blockers (CCB) (range 52.8-64.2%). Whilst a significant, upward tendency of BB usage (p<0.01) was observed, CCB usage (p<0.001) displayed a downward tendency as a first line therapy in the subsequent years. The average number of antihypertensive agents used per patient increased significantly from 2.24±1.03 in 2001 to 2.55±1.25 in 2014 (p<0.05). The most frequently used combination of hypotensive therapy consisted of two or three antihypertensive drugs depending on the survey. The most common two drug combination consisted of BB and CCB followed by BB accompanied by angiotensin converting enzyme inhibitors. A significant, upward tendency in the use of four (p<0.001) and five (p<0.05) antihypertensive drugs simultaneously, was observed in subsequent years. The target values of BP i.e. <140/90 mmHg were accomplished in 47, 58, 60 and 46% of RTRs in subsequent years. In a secondary - stratified analysis of data from 2014, younger patients (p<0.05), patients with better graft function (p<0.001), patients treated with a higher number of antihypertensive agents (p<0.001) and those not treated with BB (p<0.01) were shown to reach the BP target of below 140/90 mmHg more often. Conclusion: The study showed intensification of hypertension treatment in RTRs in subsequent years with BB assuming a dominant role

The use of over-the-counter analgesics in patients with chronic kidney disease

Background: Analgesics can be sold following medical prescription, but also as over-the-counter (OTC) medications. In patients with chronic kidney disease (CKD), their use could potentially be associated with increased risk of side-effects, due to impaired renal elimination. The aim was to evaluate the epidemiology and indications for the use of OTC analgesics, and the knowledge of their side-effects in patients with CKD. Material and methods: A cross-sectional, controlled survey on the use of OTC analgesic drugs was conducted among 180 CKD patients (stage 1-5, dialysis, kidney transplant), compared to 60 controls. Results: The proportion of patients using OTC analgesics on a regular basis was higher in the CKD group, compared to controls (18.9% vs. 10.0%, p<0.02). The major indications included musculoskeletal issues, followed by headaches and other. Subgroup analysis revealed that analgesic use was lowest among transplanted patients, in comparison to CKD stage 1-5, and dialysis subjects (10%, 20%, 26%, respectively, p=0.06). Less than half of CKD patients and controls declared any knowledge on potential side-effects of analgesic drugs (45.6% vs. 40.0%, NS). Conclusions: The use of OTC analgesics among patients with CKD is higher than in subjects without CKD, with the exception of transplanted patients. The knowledge on the potential side-effect of analgesics is limited

Importance of dental care to maintain oral health of children and youth with type 1 diabetes

Background Dental care for children and youth with type 1 diabetes should rely on reliable examination of the oral cavity, early treatment of dental caries and maintenance of the treatment results. This can be achieved through regular control visits consistent with the standards, and also through following the recommendations for prevention of dental caries and periodontal disease. The aim of the study was to investigate whether dental care allows to preserve good oral health of children and youth with type 1 diabetes. Material and Methods The study included 60 patients with type 1 diabetes, aged 7–17 years, and 30 healthy children and youth within the same age range. There were evaluated intensity of caries, the effectiveness of conservative treatment, periodontal health and oral hygiene. Results The results of examinations showed significantly lower caries prevalence and better periodontal health in the children and youth with type 1 diabetes. The effectiveness of conservative treatment was significantly higher among patients with mixed dentition. There was no significant difference in oral hygiene between the compared groups. Conclusions Diabetes is a risk factor for oral diseases, so children and youth with type 1 diabetes should be provided with special preventive care and curative measures. The main goal of the insulin-dependent diabetes care program is to early classify them to highrisk groups to improve general oral health and thus improve the quality of life. Proper dental care for children and yuoth with type 1 diabetes is a condition to maintain oral health. Med Pr 2018;69(1):37–4

Dietary supplement use among patients with chronic kidney disease

Background. Dietary supplements (DS) are available over the counter, but patients with impaired renal function are specifically at risk for toxicity when consuming certain DS. The aim of this study was to evaluate the prevalence and characteristics of DS use in patients with chronic kidney disease (CKD). Material and methods. A cross-sectional, controlled DS use survey (22 questions) was conducted among 180 CKD patients (stage 1-5, dialysis, kidney transplant), with 60 patients without CKD serving as controls. Results. DS use did not differ significantly between subjects with and without CKD, unless the CKD patients were on dialysis. In the CKD group, 20% admitted to use DS regularly and 22% did not take the mat all. In the controls, DS consumption was 17% and 13%, respectively (NS). The DS use was higher among women ascompared to men (89% vs. 70%; p < 0.005), and people living in cities versus those living in the country side (81% vs. 63%; p < 0.05). DS most commonly used were: vitamins, minerals, and herbs. Major indications for DS use included: musculoskeletal issues, general health improvement and prevention of urinary tract infections. Subgroup analyses revealed that dialysis patients were characterized by a significantly higher DS use in comparison to CKD stage 1-5 subjects and renal transplant recipients. The decision to introduce DS was made by the physician in 54% of cases; by a pharmacist in 9% of cases, and by the patients themselves in 37%. Only 21% of patients with CKD, and 27% of subjects without CKD, declared knowledge of any possible side-effects associated with DS (NS). Conclusions. The use of DS among patients with CKD is similar to patients without CKD, with the exception of those on dialysis. Vitamins and minerals were the most commonly reported DS consumed. The knowledge on potential side-effectof DS was limited to approximately one-fourth of those surveyed