Ouppatham Supasyndh

Effect of Oral Anabolic Steroid on Muscle Strength and Muscle Growth in Hemodialysis Patients

BACKGROUND AND OBJECTIVES Sarcopenia is common in hemodialysis patients. This study examined whether the anabolic steroid oxymetholone improves muscle mass and handgrip strength in hemodialysis patients and possible mechanisms that might engender such changes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Forty-three eligible hemodialysis patients were randomly assigned to ingest oxymetholone or placebo for 24 weeks. Body composition, handgrip strength, and quality of life were measured during the study. Muscle biopsies were performed and analyzed for mRNA levels for myostatin, IGF-I, IGF binding proteins, and myosin heavy chains and protein expression. Muscle fiber types and diameter were assessed by reduced nicotinamide-adenine dinucleotide staining. RESULTS There was a significantly greater increase in fat-free mass and handgrip strength and decrease in fat mass in the oxymetholone compared with the placebo group. Moreover, compared with baseline values, patients given oxymetholone exhibited an increase in fat-free mass, handgrip strength, physical functioning scores, and type I muscle fiber cross-sectional area and a decrease in fat mass, whereas patients receiving placebo did not undergo changes. There was a significantly greater increase in muscle mRNA levels for myosin heavy chain 2×, IGF-I, and IGF-II receptor with oxymetholone treatment than placebo. Liver enzyme rose significantly in the oxymetholone group, but the number of values greater than three times the upper limit of normal were not different between these groups. CONCLUSIONS In hemodialysis patients, ingesting oxymetholone was associated with an increase in fat-free mass, handgrip strength, and muscle mRNA levels for several growth factors and a decrease in fat mass, but it also induced liver injury.

Sericin cream reduces pruritus in hemodialysis patients: a randomized, double-blind, placebo-controlled experimental study

BackgroundUremic pruritus (UP) is a significant complication in ESRD patients and substantially impairs their quality of life. UP is considered to be a skin manifestation of chronic inflammation. Because sericin can suppress the release of pro-inflammatory cytokines, the purpose of this study was to investigate the short-term safety and efficacy of sericin cream for treating UP in hemodialysis patients.MethodsThis study used a double-blind design to investigate the effects of random topical administration of sericin cream and cream base (placebo) on either the right or left extremities of hemodialysis patients for 6 weeks. Skin hydration, irritation and pigmentation were evaluated every 2 weeks using Skin Diagnostic SD27. The visual analog scale for itching was also evaluated every 2 weeks, and the Kidney Disease Quality of Life Short Form was performed on the day of each patient’s enrollment and after 6 weeks of treatment.ResultsFifty dialysis patients were enrolled, 47 of which completed the study. The hydration of the skin of the patients’ extremities increased significantly after administration of sericin cream; significant differences were found between sericin treatment and control after 6 weeks of treatment (p = 0.041 for arms and p = 0.022 for legs, respectively). Moreover, a significant difference was also found in skin irritation between the two treatments (p = 0.013 for arms and p = 0.027 for legs, respectively). At the end of the study, the skin pigmentation level was significantly reduced on both the arms (p = 0.032) and legs (p = 0.021) of the sericin-treated side compared with the side treated with cream base. The mean itching score decreased significantly from moderate to severe at the time of enrollment to mild pruritus after 6 weeks of treatment (p = 0.002). A better quality of life was found in all domains tested although statistically significant differences before and after treatment was found only in the patients’ pain scores, the effect of kidney disease on daily life, sleep quality and symptoms or problems related to kidney disease.ConclusionsWe conclude that sericin cream has a high potential for reducing UP in hemodialysis patients.The trial registration number of this study is ISRCTN16019033; its public title is “sericin cream reduces pruritus in hemodialysis patients”.

Obesity and its relation to chronic kidney disease: a population-based, cross-sectional study of a Thai army population and relatives.

Obesity represents a significant problem in patients with cardiovascular disease and chronic kidney disease (CKD). The aim of the present study was to investigate the association between body mass index (BMI) and CKD in Thai individuals.

Relationship between serum uric acid levels with chronic kidney disease in a Southeast Asian population

Aim:  Elevated serum uric level has been suggested as a risk factor for chronic kidney disease (CKD). The relationship between serum uric acid level, and CKD in a Southeast Asian population was examined.

Periostin as a Tissue and Urinary Biomarker of Renal Injury in Type 2 Diabetes Mellitus

Background Improving the early detection of diabetic nephropathy remains a great challenge in disease management. Periostin is a marker of renal tubular injury and related to progressive kidney injury in animal models of chronic kidney disease. The clinical implications of urinary periostin activities in patients with type 2 diabetes have not been evaluated. Methods Urine samples were obtained from 30 healthy volunteers and 328 type 2 diabetic patients with normoalbuminuria (n=114), microalbuminuria (n=100) and macroalbuminuria (n=114). The excretion levels of urinary periostin were quantified with enzyme-linked immunosorbent assay. Immunohistochemical periostin expression was determined in kidney tissues from overt diabetic nephropathy. Results Increased periostin expression in glomeruli and tubular epithelium in diabetic renal pathology was observed. Urinary periostin levels were significantly elevated in the patients of the normoalbuminuria [3.06 (IQR: 1.12, 6.77) ng/mgCr], microalbuminuria [8.71 (IQR: 5.09, 19.29) ng/mgCr] and macroalbuminuria [13.58 (IQR: 3.99, 16.19) ng/mgCr] compared with healthy controls [1.15 (IQR: 0.60, 1.63) ng/mgCr] (P<0.01).Increased urine periostin level significantly correlated with aging, high albuminuria and decline of GFR. Urine periostin ELISA also demonstrated high performance for the diagnosis of established normoalbuminuric, microalbuminuric and macroalbuminuric type 2 diabetes (AUC 0.78 (95%CI, 0.71 to 0.86), 0.99 (95%CI, 0.98 to 1.00) and 0.95 (95%CI, 0.91 to 0.98), respectively). Conclusion The study indicates that increased urine periostin levels can be detected in patients with type 2 diabetes before the onset of significant albuminuria. Urinary periostin is an associated renal derangement in patients with established diabetic nephropathy and it may be used as an early marker of diabetic renal injury.

Vitamin D insufficiency and deficiency with stages of chronic kidney disease in an Asian population.

BackgroundVitamin D insufficiency is associated with proteinuria and could be a risk factor for end-stage renal disease (ESRD). However, few studies have examined the significance of vitamin D insufficiency as a contributing factor for the development of ESRD in the Asian chronic kidney disease (CKD) population.MethodsAuthors examined the relationship between vitamin D status and the staging of CKD using data from an outpatient clinic-based screening in 2,895 Thai CKD patients. Serum levels of 25-hydroxyvitamin D were analyzed according to CKD stages. Vitamin D deficiency and insufficiency were defined as a serum 25-hydroxyvitamin D concentration < 10 ng/mL and 10–30 ng/mL, respectively.ResultsThe mean (SD) 25-hydroxyvitamin D levels were significantly lower according to severity of renal impairment (CKD stage 3a: 27.84±14.03 ng/mL, CKD stage 3b: 25.86±11.14 ng/mL, CKD stage 4: 24.09±11.65 and CKD stage 5: 20.82±9.86 ng/mL, p<0.001). The prevalence of vitamin D deficiency/insufficiency was from CKD stage 3a, 3b, 4 to 5, 66.6%, 70.9%, 74.6%, and 84.7% (p<0.001). The odds ratio (95% CI) of vitamin D insufficiency/deficiency (serum 25-hydroxyvitamin D ≤ 30 ng/mL) and vitamin D deficiency (serum 25-hydroxyvitamin D < 10 ng/mL) for developing ESRD, after adjustment for age, gender, hemoglobin, serum albumin, calcium, phosphate and alkaline phosphatase were 2.19 (95% CI 1.07 to 4.48) and 16.76 (95% CI 4.89 to 57.49), respectively.ConclusionThis study demonstrates that 25-hydroxyvitamin D insufficiency and deficiency are more common and associated with the level of kidney function in the Thai CKD population especially advanced stage of CKD.

Efficacy of mulberry leaf tablets in patients with mild dyslipidemia.

Mulberry leaf is well known for its several biological effects. The purpose of this study was to evaluate the hypolipidemic effect of mulberry leaf in non‐diabetic patients with mild dyslipidemia. A within‐subjects research design was conducted at the out‐patient clinic in Thailand. Twenty‐three patients who met the NCEP ATP III criteria guideline for dyslipidemia and failed a 4 week diet therapy were enrolled and assigned to receive three tablets of 280 mg mulberry leaf tablet three times a day before meals for a period of 12 weeks. Routine blood analyses including lipid parameters and liver function tests were performed every 4 weeks. At 4 and 8 weeks of mulberry leaf tablet therapy, triglyceride was significantly decreased by 10.2% (p < 0.05) and 12.5% (p < 0.05), respectively, from baseline. At the end of the study, total cholesterol, triglyceride and LDL were significantly decreased by 4.9% (p < 0.05), 14.1% (p < 0.05) and 5.6% (p < 0.05), respectively, from baseline, whereas HDL was significantly increased by 19.7% (p < 0.05). Even though some patients experienced side effects such as mild diarrhea (26%), dizziness (8.7%) or constipation and bloating (4.3%), mulberry leaf tablet therapy is still capable and safe in reducing cholesterol levels and enhancing HDL in patients with mild dyslipidemia. Copyright

Urinary angiotensinogen as a potential biomarker of diabetic nephropathy.

Background Activation of the renin–angiotensin–aldosterone system (RAAS) is an important mediator of diabetic nephropathy. Urinary angiotensinogen, a novel biomarker of the intrarenal RAAS, is associated with progressive kidney injury. In this study, the authors investigated the determinants of urinary angiotensinogen and its associations with staging of diabetic nephropathy. Methods Random urine samples were collected from the patients with type 2 diabetes with normoalbuminuria (n = 52), microalbuminuria (n = 52) and macroalbuminuria (n = 51) for the measurement of angiotensinogen by sensitive and specific ELISAs. Control samples were collected from healthy volunteers (n = 20) who had normal albuminuria and renal function. Results Urinary angiotensinogen was higher in microalbuminuric and macroalbuminuric diabetes than in controls [63.44 (interquartile range, IQR: 22.08, 174.8) versus 398.38 (IQR: 205.03, 673.68) versus 9.12 (IQR: 3.76, 23.82) ng/mg creatinine, respectively, P < 0.001]. In diabetes with normoalbuminuria, urinary angiotensinogen was also higher than in controls [16.42 (IQR: 7.69, 34.71) versus 9.12 (IQR: 3.76, 23.82) ng/mg creatinine, P = 0.047]. The performance of the biomarker in differentiating each stage of type 2 diabetes from controls was illustrated by receiver-operating characteristic curves. The areas under the curve for the diagnosis of established normoalbuminuric, microalbuminuric and macroalbuminuric type 2 diabetes using urine angiotensinogen (ng/mg creatinine) were 0.62 (95% CI: 0.48–0.77), 0.85 (95% CI: 0.76–0.94) and 0.96 (95% CI: 0.92–1.00), respectively. In addition, the cut-off levels were 9.30 ng/mg (sensitivity 65.4%, specificity 55.0%), 12.32 ng/mg (sensitivity 55.8%, specificity 65.0%) and 17.44 ng/mg (sensitivity 44.2%, specificity 70.0%), respectively, for distinguishing normoalbuminuric type 2 diabetes from healthy controls. Conclusions The authors propose that angiotensinogen could be one of the potential urinary biomarkers for diagnosis in established diabetic nephropathy. It appeared even before the significant albuminuria in diabetic nephropathy. It might be useful as an early biomarker of activation of the renin–angiotensin system in diabetic nephropathy.

Pharmacokinetics of single-dose rosiglitazone in chronic ambulatory peritoneal dialysis patients.

Background:  End‐stage renal disease (ESRD) is associated with marked alterations in the pharmacokinetics of many drugs, not only from reduction in renal clearance but also from changes in metabolic activity, bioavailability, volume of distribution and plasma protein binding.

Effectiveness and safety of extended-release nicotinic acid for reducing serum phosphorus in hemodialysis patients.

BACKGROUND Hyperphosphatemia is commonly found in dialysis patients, which can lead to fatal cardiovascular diseases. The objective of this study was to evaluate the effectiveness and safety of extended-release nicotinic acid for reducing serum phosphorus in hemodialysis patients. METHODS A randomized placebo-controlled trial was conducted, and 28 hemodialysis patients with hyperphosphatemia after 4 weeks of diet control were randomized to receive extended-release nicotinic acid (treatment group) once daily for 12 weeks. The initial daily dose was 375 mg, which was then titrated once weekly to 500, 750 and 1,000 mg, as tolerated. The control group received placebo. All patients in each group still received their phosphate-binding medication as standard treatment. RESULTS At the 12th week, mean serum phosphorus of the treatment group significantly decreased from 7.13 ± 1.09 mg/dL to 5.65 ± 1.22 mg/dL (p<0.001). However, there was no statistically significant difference between the control and treatment groups. Nine out of the 14 patients (64.29%) in the treatment group achieved the K/DOQI serum phosphorus goal. Serum high-density lipoprotein cholesterol of patients in the treatment group increased by 30.22% from baseline (p=0.037). There were no significant changes in serum calcium or parathyroid hormone level in any of the patients. Hot flushes were observed in all patients of the treatment group. There were no significant changes in the fasting blood glucose level, uric acid or liver function enzymes in any of the patients. CONCLUSIONS Extended-release nicotinic acid is effective and safe in reducing serum phosphorus as an add-on standard therapy in hemodialysis patients.