Abstract
BackgroundNausea is a major uremic symptom and a frequent indication for starting dialysis. However, preventive medication for uremic nausea has not yet been identified. Vitamin D receptor activators (VDRAs) may prevent uremic nausea via their pleiotropic actions. The objective of this study was to explore whether VDRA administration during the predialysis period is associated with a reduced prevalence of uremic nausea just prior to beginning dialysis.MethodsA multicenter, retrospective, cross-sectional study was performed to identify a medication to prevent uremic nausea. Patients with stage 5 CKD who were followed-up over 3 months were included. The primary outcomes examined were the prevalence of uremic nausea, congestive heart failure (CHF), and intractable edema at dialysis commencement. The predictor variable was VDRA use during the predialysis period.ResultsOne thousand five hundred and thirty six patients who had just begun dialysis in nine Japanese facilities between January 2006 and October 2013 were included. Two hundred and thirty (15.0%) patients had commenced dialysis because of uremic nausea, and three hundred and ninety two (25.5%) patients had been using VDRAs before initiating dialysis. Logistic regression analysis showed that, among the medications examined in this study, only VDRA use was independently associated with a lower frequency of uremic nausea (OR 0.512, 95% CI 0.347–0.738, P = 0.0003). On the other hand, CHF and intractable edema were not associated with VDRA administration.ConclusionUse of VDRAs during the predialysis period was the only factor associated with a lower prevalence of uremic nausea, suggesting that VDRAs may prevent uremic nausea in patients with advanced CKD.
Highlights
Uremic nausea is a common symptom in patients with advanced CKD, it increases in severity with the progression of CKD, especially below a creatinine clearance ofClin Exp Nephrol (2017) 21:825–83425 mL/min, and it may lead to protein-energy wasting, morbidity, and mortality [1, 2]
Logistic regression analysis showed that, among the medications examined in this study, only Vitamin D receptor activators (VDRAs) use was independently associated with a lower frequency of uremic nausea
Use of VDRAs during the predialysis period was the only factor associated with a lower prevalence of uremic nausea, suggesting that VDRAs may prevent uremic nausea in patients with advanced CKD
Summary
Uremic nausea is a common symptom in patients with advanced CKD, it increases in severity with the progression of CKD, especially below a creatinine clearance ofClin Exp Nephrol (2017) 21:825–83425 mL/min, and it may lead to protein-energy wasting, morbidity, and mortality [1, 2]. Predialysis patients with uremic nausea may regain their appetite soon after starting dialysis [4], presumably because of the removal of toxic molecules due to diffusive transport through hemodialysis membranes [5]. In this regard, uremic nausea in non-dialysis patients may differ from anorexia that appears in long-term maintenance dialysis patients. The objective was to explore which medication is associated with a reduced prevalence of dialysis-requiring uremic nausea in predialysis patients with stage 5 CKD. The objective of this study was to explore whether VDRA administration during the predialysis period is associated with a reduced prevalence of uremic nausea just prior to beginning dialysis. Luke’s International Hospital, Tokyo, Japan 9 Division of Nephrology, Division of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan 10 Division of Nephrology and Blood Purification Medicine, Wakayama Medical University, Wakayama, Japan
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
