BMC Nephrology最新文献

Background: End-stage renal disease (ESRD) patients receiving hemodialysis are experiencing a considerable increase in the burden of cardiovascular diseases (CVDs). In this patient population, hypertension is a prevalent modifiable cardiovascular risk factor that is associated with poor prognosis. Resistant hypertension in dialysis patients is challenging to manage since some individuals do not respond to antihypertensive medications or volume control. Hyperhomocysteinemia is common among ESRD patients. "H-type hypertension" or hyperhomocysteinemia-associated hypertension refers to resistant hypertension with elevated cardiovascular risk. The current study examined the efficacy of methylfolate and methylcobalamin supplementation in reducing serum homocysteine levels and improving blood pressure (BP) control in ESRD patients with resistant hypertension on regular hemodialysis.

Methods: Throughout the study, 51 ESRD patients with resistant hypertension were randomly allocated to receive either daily doses of L-methylfolate 800 mcg and methylcobalamin 1000 mcg capsule (intervention group) or no medication (control group). Serum homocysteine levels were measured twice: at baseline and three months later. In addition, average pre- and post-dialysis blood pressure readings were obtained at baseline, one month, two months, and three months.

Results: After three months, mean serum homocysteine levels were significantly lower than at the commencement of therapy (p = 0.035), nonetheless, control patients showed no significant difference. Between-group analysis found a statistically significant difference in the change in homocysteine levels among the two groups (p = 0.006). Furthermore, the treatment group had statistically significant lower pre- and post-dialysis blood pressure readings.

Conclusions: A three-month supplementation with a combination of 800 mcg methylfolate and 1000 mcg methylcobalamin showed promise in lowering blood pressure and serum homocysteine levels in ESRD patients with resistant hypertension. These findings require additional exploration in larger studies.

Trial registration: ClinicalTrials.gov Identifier NCT05807711 registered on 20,230,329.

Background: There is no gold standard for assessment of medication adherence. This study aimed to systematically review the literature to identify validated medication adherence measurement tools and methods used in clinical practice and research settings in the context of patients with chronic kidney disease (CKD) and to synthesize key features of the identified medication adherence tools.

Methods: We systematically reviewed MEDLINE via Ovid, Embase via Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL (via EBSCO) from inception to September 25, 2025. All abstracts were screened by pairs of reviewers independently, followed by a full-text review identifying the tool/method used for measuring medication adherence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this systematic review. General study and medication adherence method/tool-specific characteristics were summarized. The quality criteria for measurement properties were applied across the included studies to synthesize and assess the strength of the evidence.

Results: The 43 included articles originated from 25 countries. The most common measures used for evaluating medication adherence were the Eight-Item Morisky Medication Adherence Scale (MMAS-8) (n = 11 [25.6%]), Medication Possession Ratio (MPR) (n = 10 [23.3%]), Proportion of Days Covered (PDC) (n = 8 [18.6%]), and Medication Events Monitoring System (MEMS) (n = 6 [14.0%]). Five (15.6%) studies used multiple methods to measure medication adherence.

Conclusion: No accepted reference tool is available to measure CKD patients' medication adherence. Some tools, however, were used more frequently in the context of patients with CKD. Choosing an appropriate method/tool or a combination of methods depends on the clinician/researcher's goals, study setting, availability of data and other resources, and patients' characteristics.