Journal of Research in Pharmacy Practice

Abstract  One of the most common diseases with high morbidity and mortality rates is chronic kidney disease. Cardiovascular disease affects most patients with chronic kidney disorders, particularly patients undergoing dialysis; hence, appropriate prevention and management approaches are essential. This study aimed to evaluate the reduction of inflammatory biomarkers, especially homocysteine, by omega-3 fatty acids in peritoneal dialysis patients. Methods: This study enrolled 60 peritoneal dialysis patients who met specified inclusion and exclusion criteria and were randomized to intervention or placebo groups. Omega-3 capsules were given at a dose of 3 g/d for 8 weeks. Inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), homocysteine, albumin, and lipid profile measured before and after the study. Findings: Results of this trial revealed that the levels of homocysteine, hs-CRP, and albumin did not change significantly during the study. Analysis of lipid profiles before and after intervention showed omega-3 has no significant effect on the level of total cholesterol or low-density lipoprotein cholesterol; However, the level of triglyceride reduced remarkably (P = 0.002). In addition, serum levels of high-density lipoprotein cholesterol increased at the end of the study (P < 0.001). Conclusion: Omega-3 does not seem to be able to change the inflammatory markers significantly, particularly homocysteine. More extensive trials must be conducted to better understand the impact of omega-3 on inflammatory and nutritional markers, particularly in peritoneal dialysis patients

Abstract The incidence of cardiovascular events and mortality is higher in patients with chronic kidney disease (CKD) compared to the general population. Homocysteine (Hcy) appears to be an independent risk factor for cardiovascular diseases in general populations and patients with CKD. Further, hyperhomocysteinemia can cause endothelial damage and increase the activity and production of coagulation factors, and its prevalence among patients with end-stage renal disease is approximately 85%–100%. Most treatments, which lower Hcy levels and have been considered in previous studies, include folic acid, B vitamins, omega-3 fatty acids, and N-acetylcysteine. However, the effect of therapies that can decrease Hcy levels and thus cardiovascular events in these patients is still unclear. The results are conflicting and require further investigation. To guide treatment decisions and improve patient outcomes, multiple databases were searched, including Web of Science, PubMed, and Medline to summarize the available evidence (i.e., clinical trial and meta-analyses) on Hcy-lowering interventions and cardiovascular events.

Abstract Protein energy malnutrition is a common problem in patients with chronic kidney disease (CKD). Scattered reports indicate that supplementation of Carnitine may improve patients' clinical symptoms, with significant improvement in nutritional parameters. This systematic review was done to document the evidences of Carnitine effects in nutritional status of CKD patients. Peer-reviewed RCTs on Carnitine administration at any dose in CKD patients with at least four weeks of follow-up were including in the meta-analysis. Online databases (PubMed/Medline, ISI Web of Science, Embase, and Scopus) were searched to October 2017 using selected MeSH terms related to the study topic. Data was extracted independently by two reviewers using a standard form and then cross-checked. Statistical analyses were carried out with Comprehensive Meta-analysis software. Data are presented as standard mean difference (SMD) and 95% confidence interval (CI). According to the predefined criteria, a total of 14 randomized controlled clinical trials were included and screened for data extraction by two reviewers, separately. The preliminary results extracted from meta-analysis have shown that Carnitine can significantly increase the levels of albumin (SMD: -0.861; 95% CI: -1.321, -0.402), total protein (SMD: -0.418; 95% CI: -0.695, -0.141), total cholesterol (SMD: -0.350; 95% CI: -0.564, -0.135), LDL cholesterol (SMD: -0.362; 95% CI: -0.551, -0.173), transferrin (SMD: -1.465; 95% CI: -1.822, -1.108), and hemoglobin (SMD: -0.525; 95% CI: -0.732, -0.318); however there were no conclusive effects of Carnitine on body weight (SMD: -0.057; 95% CI: -0.404, 0.291) and BMI (SMD: -0.567; 95% CI: -1.548, 0.415), in pooled analyses. The results of this meta-analysis showed that there are considerable useful pieces of evidence so far about the effect of Carnitine on nutritional factors; however, there is still doubt about some evidences with this regard. It seems necessary to carry out clinical trials with stronger designs to evaluate the impact of these primary outcomes on the patients' clinical conditions. Having this evidences, the potential role of Carnitine in improving malnutrition consequences in CKD patients would be clearly defined.