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Prevalence of hypertension is high in hemodialysis patients. Increase of intracellular calcium due to hyperparathyroidism is one of probable factors for hypertension in hemodialysis patients. In this study, the relationship between serum parathyroid hormone (PTH) level and severity of hypertension in hemodialysis patients was investigated.In a case-control study, 50 hemodialysis patients with hypertension were compared with 50 hemodialysis patients without hypertension. The two groups were comparable in age, sex, body mass index, hemodialysis duration, KT/V, serum calcium, hemoglobin, and erythropoietin dose. Serum PTH level was measured in the two groups.The mean age was 57.0 ± 7.7 years in the hypertensive group and 56.4 ± 6.0 years in the control group (P = .61). The mean hemodialysis duration was 15.28 ± 5.74 months in the hypertensive group and 14.98 ± 6.35 months in the control group. The mean serum PTH was 487.18 ± 408.85 pg/mL in hypertensives (445.12 ± 447.92 pg/mL in stage 1 of hypertension and 561.94 ± 326.67 pg/mL in stage 2 of hypertension, P = .003) and 170.64 ± 122.09 pg/mL in the case group (P = .001).According to this study, there is a positive relationship between serum PTH and severity of hypertension in hemodialysis patients. We conclude that control of secondary hyperparathyroidism might be helpful in controlling hypertension in hemodialysis patients.

Pruritus is one of the common problems in patients on hemodialysis. There are several causes for pruritus, and different treatment modalities are applied to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in patients on hemodialysis.This randomized double-blinded cross-over clinical trial was performed on 34 patients on hemodialysis with uremic pruritus. The patients were divided into 2 groups, one group received capsaicin 0.03% and the other, placebo, for 4 weeks. Treatment was stopped for 2 weeks as washout period and continued as a cross-over technique. Pruritus scores were analyzed and compared.Thirty-four patients on long-term hemodialysis, 14 men and 20 women with a mean age of 57.0 +/- 18.6 years were studied. The mean of pruritus score before capsaicin treatment was 15.9 +/- 6.3, which was reduced to 6.4 +/- 3.9, 4.7 +/- 3.1, 3.2 +/- 2.9, and 2.5 +/- 2.5 on weeks 1 to 4, respectively (P.001). In the placebo group, pruritus score before treatment was 15.0 +/- 6.0 on average, and it was 11.7 +/- 5.8, 9.4 +/- 5.9, 7.9 +/- 5.5, and 7.2 +/- 5.5, respectively, on weeks 1 to 4 (P.001). There was no significant difference in pruritus scores before the treatment between the two groups, but after each week, the difference was significant (P.001). Repeated measurement test showed that decreasing in pruritus severity in the capsaicin group was more than that in the placebo group during treatment period (P.001).Capsaicin is a new safe and effective topical treatment for hemodialysis-induced pruritus in patients with end-stage renal disease.

INTRODUCTION. After kidney transplantation, patients appear to have vitamin D deficiency due to the use of immunosuppressive treatment and prevention of sunlight. This study was designed to determine vitamin D serum levels in kidney transplant patients in comparison with healthy individuals. MATERIALS AND METHODS. Forty-six kidney transplant patients with a creatinine clearance greater than 60 mL/min and 46 healthy individuals with normal kidney function were tested for serum levels of calcium, phosphorus, 25-hydroxyvitamin D, and parathyroid hormone at the end of the summer. RESULTS. Thirty-one participants were men and 15 were women in each group. The mean age was 41.0 ± 14.2 years in kidney transplant recipients and 41.4 ± 13.7 years in the control group. Inadequate serum 25-hydroxyvitamin D was seen in 93.5% of the transplant patients and in 89.1% of the controls. There was a 26.1% [corrected] vitamin D insufficiency (20 ng/mL to 30 ng/mL) and a 67.4% [corrected] deficiency (lower than 20 ng/mL) in the patients, and these rates were 21.7% [corrected] and 67.4% [corrected] in the control group, respectively. There was no significant difference between the two groups. CONCLUSIONS. Vitamin D deficiency is prevalent in kidney transplant patients. Lack of a significant difference between our two groups may be attributable to the high prevalence of vitamin D deficiency in general population and the use of vitamin D supplementation in transplant patients. Indeed, adequate doses of vitamin D in these patients are undetermined. They may need higher doses for normalization of serum vitamin D and metabolic requirements.

A diabetic foot lesion remains a major cause of morbidity in diabetic patients with chronic kidney disease. We studied the relation between kidney function and the risk of amputation in patients with diabetic foot.We reviewed retrospectively the charts of 244 patients admitted to Imam Khomeini Hospital of Sari, Iran, for diabetic foot from 1996 to 2005. Their clinical characteristics and kidney function indicators, including urine protein excretion and serum creatinine were analyzed and compared between amputees and nonamputees.There were 244 patients with diabetic foot who were admitted to our center during the studied period. The duration of being affected by DM was between 3 months and 34 years (mean, 11.80 +/- 6.81 years). Sixty-six patients (27.0%) underwent amputation. The amputees were older than the nonamputees (61.1 +/- 11.5 years versus 55.6 +/- 12.5 years, P.001). There were 20 patients (30.3%) in the amputee group and 44 (24.7%) in the nonamputee group who had proteinuria (P = .38). The mean creatinine level was significantly higher in the amputees compared to the nonamputees (1.78 +/- 1.36 mg/dL versus 1.28 +/- 1.23 mg/dL, P = .03).Lower extremity amputations in our patients with diabetic foot were strongly associated with elevated serum creatinine levels. The presence of this complication necessitates intensifying actions in order to prevent amputations.