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Naghnaghia S, Nazzal Z, Abu Alya L, AL-Ramahi R, Hamdan Z, Samara E. The association between renal impairment and polypharmacy among older Palestinian patients: a multi-center cross-sectional study. BMC PRIMARY CARE 2023; 24:50. [PMID: 36797685 PMCID: PMC9936647 DOI: 10.1186/s12875-023-02005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE This study aimed to examine the association between renal impairment and polypharmacy among older Palestinian patients visiting primary healthcare centers and to examine potentially inappropriate medications among older patients. METHODS A cross-sectional study was conducted among PHC clinic attendees aged 65 and older. We used medical records and an interviewer-administered questionnaire for data collection. Participants with eGFR less than 60mls/min/1.73 m2 were categorized as renal impaired; we then calculated the prevalence of renal impairment and used Poisson multivariable regression model with robust variance to identify associated factors. Beer's criteria and literature reviews were used to evaluate renal impairment patients' medication and to determine the frequency of PIPs. RESULTS The study included 421 participants (224 female, 197 male), and 66.3% were between the ages of 65 and 75. The prevalence of renal impairment was 30.2% (95%CI: 25.8-34.6%). Polypharmacy [aPR = 2.7, 95%CI: 1.7-4.3], stroke [aPR = 2.6, 95%CI: 1.1-2.3], females [aPR = 1.7, 95%CI: 1.2-2.5], and older patients over the age of 80 [aPR = 2.4, 95%CI: 1.6-3.5] were the main factors associated with renal impairment. RAAS (54.3%), metformin (39.3%), and sulfonylurea (20.4%) were the most frequently reported PIP in renal impairment patients. CONCLUSION This study demonstrates a relationship between polypharmacy and renal impairment. Some people with renal impairment receive drugs that those with kidney illness should avoid or use with caution. It is important to prescribe only necessary medication, choose non-nephrotoxic alternatives, and frequently monitor renal function.
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Affiliation(s)
- Shayma Naghnaghia
- grid.11942.3f0000 0004 0631 5695Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, P.O. Box 7, Palestine
| | - Zaher Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, P.O. Box 7, Palestine.
| | - Layan Abu Alya
- grid.11942.3f0000 0004 0631 5695Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, P.O. Box 7, Palestine
| | - Rowa’ AL-Ramahi
- grid.11942.3f0000 0004 0631 5695Department of Pharmacy, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, P.O.Box 7, Palestine
| | - Zakaria Hamdan
- grid.11942.3f0000 0004 0631 5695Internal Medicine Department, An-Najah National University Hospital, Nablus, Palestine
| | - Esra’a Samara
- grid.11942.3f0000 0004 0631 5695Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, P.O. Box 7, Palestine
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Thapa L, Shrestha S, Kandu R, Ghimire MR, Ghimire S, Chaudhary NK, Pahari B, Bhattarai S, Kharel G, Paudel R, Jalan P, Chandra A, Phuyal S, Adhikari B, Aryal N, Kurmi OP. Prevalence of Stroke and Stroke Risk Factors in a South-Western Community of Nepal. J Stroke Cerebrovasc Dis 2021; 30:105716. [PMID: 33725500 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke related studies in Nepal are primarily hospital-based and mainly from the capital city. OBJECTIVES We aimed to estimate the prevalence of stroke and stroke risk factors in the South-Western community of Nepal. METHODS A cross-sectional study was conducted from May to August 2018 among 549 randomly selected Nepalese participants from diverse ethnicity, aged ≥15 years, in a region with the availability of neurological support facilities. Data were collected using a stroke questionnaire designed for the purpose. Stroke was identified by enumerators using the Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale, and a senior neurologist confirmed it. We assessed the presence of major risk factors associated with stroke. RESULTS The crude and age-standardised prevalence of stroke were 2368 and 2967 per 100,000 respectively. Of all the surveyed participants, 61% (n=335) reported consumption of full-fat dairy products >3 days per week, 87.6% (n=481) reported a high intake of salt (>5 g/day), 83.6% (n=459) with a low intake of fruits and vegetables (<400 g/day), 45.2% (n=248) with perceived stress related to work or home, 51.6% (n=283) with financial stress (283, 51.6%), 86.7% (n=457) with low high-density lipoprotein, 96.2% (n=507) with high blood urea nitrogen, 47.1% (n=356) were either overweight or obese 20.4% (n=112) with hypertension and 6.2% (n=34) with diabetes. CONCLUSIONS The prevalence of stroke in the community of the South-Western part of Nepal is relatively higher than that estimated in South-Asia and global context. Our findings suggest an urgent community intervention, particularly with healthy lifestyles changes for future stroke prevention in the high-risk group.
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Affiliation(s)
| | - Shakti Shrestha
- Research Unit, Neuro and Allied Clinic, Bhairahawa, Nepal; School of Pharmacy, The University of Queensland, Queensland, Australia.
| | - Rashmi Kandu
- Department of Nursing, Neuro and Allied Clinic, Bhairahawa, Nepal
| | - Mahesh Raj Ghimire
- Department of Internal Medicine, Devdaha Medical College and Research Centre, Devdaha, Nepal
| | - Sulochana Ghimire
- Department of Nursing, Universal College of Medical Sciences, Bhairahawa, Nepal
| | | | - Bishnu Pahari
- Department of Nephrology and Transplant Medicine, Grande International Hospital, Kathmandu, Nepal
| | | | - Ghanshyam Kharel
- Department of Neurology, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | | | - Pankaj Jalan
- Department of Neurology, Norvic Hospital, Kathmandu, Nepal
| | - Avinash Chandra
- Department of Neurology, Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal
| | - Subash Phuyal
- Department of Radiology and Interventions, Grande International Hospital, Kathmandu, Nepal
| | - Bhojraj Adhikari
- Department of Medicine, Bharatpur District Hospital, Kathmandu, Nepal
| | - Nirmal Aryal
- Faculty of Health and Social Sciences, Bournemouth University, United Kingdom
| | - Om P Kurmi
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada; Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
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Zhao Q, Yan T, Chopp M, Venkat P, Chen J. Brain-kidney interaction: Renal dysfunction following ischemic stroke. J Cereb Blood Flow Metab 2020; 40:246-262. [PMID: 31766979 PMCID: PMC7370616 DOI: 10.1177/0271678x19890931] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Stroke is a leading cause of mortality and morbidity, with long-term debilitating effects. Accumulating evidence from experimental studies as well as observational studies in patients suggests a cross talk between the brain and kidney after stroke. Stroke may lead to kidney dysfunction which can adversely impact patient outcome. In this review article, we discuss the epidemiology and mechanisms of brain–kidney interaction following ischemic stroke. Specifically, we discuss the role of the central autonomic network, autoregulation, inflammatory and immune responses, the role of extracellular vesicles and their cargo microRNA, in mediating brain–kidney interaction following stroke. Understanding the bidirectional nature of interaction between the brain and kidney after cerebral injury would have clinical implications for the treatment of stroke and overall patient outcome.
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Affiliation(s)
- Qiang Zhao
- Tianjin Neurological Institute, Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Yan
- Tianjin Neurological Institute, Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Michael Chopp
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.,Department of Physics, Oakland University, Rochester, MI, USA
| | - Poornima Venkat
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Jieli Chen
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
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