SummaryChanges in the oral cavity, such as periodontitis and other manifestations of poor oral health, are common in patients with chronic kidney disease (CKD) and may contribute to increased morbidity and mortality because of systemic consequences such as inflammation, infections, protein-energy wasting, and atherosclerotic complications. Poor oral health in CKD patients may thus represent an important, but often overlooked, problem. Several studies show that uremic patients have higher rates of decayed, missing, and filled teeth, loss of attachment, and periapical and mucosal lesions than the general population. The consequences of poor oral health may be more severe in CKD patients because of advanced age, common comorbidities such as diabetes, concurrent medications, and a state of immune dysfunction that may increase the risk for systemic consequences of periodontitis and other oral and dental pathologic conditions. Poor dentition and other signs of poor oral health should be an alarm clock also at early stages of CKD. However, it remains to be determined whether more successful management of poor oral health and periodontitis will reduce the risk of inflammation, infection, protein-energy wasting, and atherosclerotic complications in CKD patients. This review explores etiological factors and potential systemic consequences of poor oral health in CKD patients as well as possible preventive and therapeutic strategies.

No abstract

Objective: To evaluate the efficacy of trimetazidine (TMZ) in the prevention of contrast-induced nephropathy (CIN) in patients with high serum creatinine levels undergoing coronary angiography/angioplasty. Methods: TMZ (20 mg thrice daily) was administered orally for 72 h starting 48 h before the procedure. All patients were given intravenous saline (0.9%) at a rate of 1 ml/kg of body weight per hour for 24 h starting 12 h beforehand. Serum creatinine levels were measured before the procedure, 48 h and 7 days after the procedure. Increase in serum creatinine level exceeding 0.5 mg/day or one quarter of the basal value is considered as CIN. Venous blood samples for serum total antioxidant capacity (TAC) measurement were drawn before and after coronary angiography. Results: Basal serum creatinine levels and TAC were similar in TMZ and control groups. Serum creatinine levels in the control group increased significantly 2 days after the procedure, and returned to the baseline values on the seventh day. However, it did not change significantly on the second day, and even significantly decreased on the seventh day in the TMZ group. CIN developed in 2.5% (1/40) of patients in the TMZ group and in 16.6% (7/42) of patients in the control group (p,0.05). TAC values were not different between treatment groups. Conclusion: TMZ along with isotonic saline infusion is more effective than isotonic saline alone in reducing the risk of CIN in patients with pre-existing renal dysfunction. C ontrast-induced nephropathy (CIN) is a serious complication of coronary angiography that is associated with considerably increased mortality and morbidity, including the need for short-term haemodialysis, extended hospitalisation and permanent impairment of renal function.1 2 CIN after coronary angiography is observed more frequently in patients with chronic renal insufficiency, particularly in patients with diabetes mellitus and/or dehydration and/or congestive heart failure.2-5 Larger doses of contrast medium and intravascular injection of contrast agent are also associated with higher incidence of CIN.6 CIN has been reported to occur in 11-44% of patients with moderate renal insufficiency.2 3 6 7 Pre-existing renal dysfunction is the greatest independent predictor of CIN, and its severity directly correlates with the incidence of CIN. 3 6 8-10 Previous reports suggest that the formation of reactive oxygen radicals, renal medullar ischaemia during reperfusion after contrast-induced vasoconstriction and direct tubular damage secondary to the contrast agent have an important role in the injury mechanisms of CIN.11-14 Many types of prophylaxis regimens have been used in an attempt to prevent CIN. But, to date only hydration with isotonic saline is generally accepted in the prevention of CIN. [14][15][16][17][18] Trimetazidine (TMZ) has been described as a cellular antiischaemic agent. 19 Previous studies demonstrated that TMZ prevents the deleterious effects of ischaemia-reperfusion at both the cellular and the mitochondrial levels, and exert...