[Show abstract][Hide abstract] ABSTRACT: Abstract Background: This aim of this multi-centric cross-sectional study was to assess the nutritional status in Indian chronic kidney disease (CKD) patients and to compare the nutritional indicators between stage 5 dialyzed (CKD-D) patients below the poverty line (BPL), and stage 3-4 non-dialyzed (CKD-ND) patients above (APL) and below the poverty line. Methods: Patients were selected from a government medical college hospital, a charity-based outpatient dialysis unit, and a non-profit tertiary care center. The study groups included BPL CKD-ND (n = 100), BPL CKD-D (n = 98), and APL CKD-ND (n = 92) patients, based on a cut-off of per capita income US $1.25 a day. Patients were enquired by a qualified renal dietitian about their pattern of diet, and daily energy and protein intake by 24 h recall method. Anthropometric measurements and biochemical investigations were made and compared. Results: Nutritional indicators were low in all three groups compared to those prescribed by European Best Practice Guidelines (EBPG). BPL CKD-D patients had low serum albumin levels (32.44444 ± 6.279961 g/L; p = 0.017) and 41.83% of them were underweight. The APL CKD-ND group registered the lowest mean daily energy (22.576 ± 6.289 kcal/kg/day) and protein intake (0.71 ± 0.06 g/kg/day), due to dietary restrictions imposed on them by themselves and unqualified renal dietitians. The APL group had better indicators of nutritional status in terms of mid-upper arm circumference (p = 0.001), triceps skin fold thickness (p < 0.001), and serum hemoglobin (p < 0.001). Conclusion: Several nutritional parameters were below the recommended international guidelines for all the three groups, though the high income group had better parameters from several indicators. There is an urgent need for nutritional counseling for CKD-D and CKD-ND patients.
[Show abstract][Hide abstract] ABSTRACT: Diseases of the genitourinary tract in association with the BK virus (BKV) infec-tion are increasing among renal allograft recipients. We herewith report a young, female renal transplant recipient who presented with allograft dysfunction secondary to proximal ureteric stenosis. The allograft function improved dramatically after correction and stenting of the ste-nosis. Our case suggests that screening for BKV infection should be an integral part of evaluation of allograft dysfunction.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 01/2014; 25(1):101-4.
[Show abstract][Hide abstract] ABSTRACT: Background
Contrast induced nephropathy (CIN) is associated with significant morbidity and mortality after percutaneous coronary intervention (PCI). The aim of this study is to evaluate the collective probability of CIN in Indian population by developing a scoring system of several identified risk factors in patients undergoing PCI.
This is a prospective single center study of 1200 consecutive patients who underwent PCI from 2008 to 2011. Patients were randomized in 3:1 ratio into development (n = 900) and validation (n = 300) groups. CIN was defined as an increase of ≥25% and/or ≥0.5 mg/dl in serum creatinine at 48 hours after PCI when compared to baseline value. Seven independent predictors of CIN were identified using logistic regression analysis - amount of contrast, diabetes with microangiopathy, hypotension, peripheral vascular disease, albuminuria, glomerular filtration rate (GFR) and anemia. A formula was then developed to identify the probability of CIN using the logistic regression equation.
The mean (±SD) age was 57.3 (±10.2) years. 83.6% were males. The total incidence of CIN was 9.7% in the development group. The total risk of renal replacement therapy in the study group is 1.1%. Mortality is 0.5%. The risk scoring model correlated well in the validation group (incidence of CIN was 8.7%, sensitivity 92.3%, specificity 82.1%, c statistic 0.95).
A simple risk scoring equation can be employed to predict the probability of CIN following PCI, applying it to each individual. More vigilant preventive measures can be applied to the high risk candidates.
[Show abstract][Hide abstract] ABSTRACT: To study the correlation between Left Ventricular Hypertrophy (LVH) measured by echocardiography and outcomes in Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. A retrospective cross sectional analysis of patients on CAPD being treated in a tertiary care multispecialty hospital in South India. Medical records were screened for echocardiograms which were carried out on 50 patients undergoing CAPD. Cardiac death was assessed. LVH was correlated with outcome. Of the 50 CAPD who were studied, 84% had LVH. Only 26% of the study population had normal Left Ventricular (LV) function, with a majority of patients having moderate (44%) or moderately severe (16%) LV dysfunction. A declining filtration rate was found to correlate significantly with the presence of LVH. And a lower Body Mass Index (BMI) was associated with higher cardiovascular mortality. More than three fourths of the study population had LVH. Residual Renal Function (RRF) was found to be an important determinant of the presence of LVH.
Indian Journal of Peritoneal Dialysis. 08/2013; 25(1):23-26.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION AND AIMS: India, with a population of 1.2 billion is fast catching up with the developed world in science, technology and trade. India, once a hub of infectious diseases is undergoing rapid transition to being a burden for NC D and lifestyle diseases, including diabetes mellitus and hypertension which increases C V and C KD risks. There are a few studies done in India, to estimate the prevalence of chronic kidney disease. Prevention involves awareness and early detection and conducting screening camps. As the Government sponsored screening programmes are unsuccessful in the community a different approach of awareness and screening through religious forums involving church, temple congregation is being done. Priests and other religious heads are more effective in motivating people to take care of their health, as India is still a country with strong religious establishments and belief. METHODS: Awareness: A PowerPoint presentation targeting audience included priests, general public, students and corporate. The presentation included anatomy of kidneys, risk factors of kidney disease and prevention, lasting for 30 minutes. A total of 258 programmes were conducted (since1999 covering 51,532 individuals), 158 programmes in educational institutions addressing 39,819 students, 101 for adults addressing 11,713. Screening: C onducted over 32 screening camps (27 urban and 5 rural) in and around C hennai (2005-2012). This consists of a structured questionnaire to evaluate the risk factors, personal habits followed by the examination of BMI, BP and protein in urine using dipstick. RESULTS: The screened subjects were in the age group of 20years -80years. Mean age was 43.6 yrs. Of 3383 screened 18.2% (617) were from rural, 81.8% (2766) from urban. BMI ≥ 25kg/m2 in 42.5%, 85.6% is from the urban 14.3% from rural. Blood pressure ≥ 120 / 80, in 42.5%, 85.6% from urban, and 8.7% from rural. Known hypertension on drugs was 14.98%. Still, 73.76% had blood pressure ≥ 120/80. Urine glucose ≥ 1+ were detected in 10.46%. 16.1% were diabetic on drugs. 43.95% of the diabetic on treatment had sugar on dipstick. Proteinuria ≥ 1+ was detected in 19.86%. 79.8% of the proteinuric were in urban sector, 21.1% from the rural. Serum C reatinine ≥ 1.2mg/dl was detected in 9.1%. Ultra sound of kidney urinary bladder done in showed presence of stones in 18.5%. CONCLUSIONS: C ommunity awareness programme through NGO, TANKER and MMM Hospital has sensitized and educated varied groups of individuals in the community, which is a proactive way of preventing kidney disease. This screening programme conducted and identified presence of kidney disease unaware to the general population and which has helped them to seek medical attention for treatment. In developing countries such as India, where 40% of the population are below poverty line, such programmes run by NGOs with partnership will achieve significant health care benefits to the community.
World congress of Nephrology 2013, Hong Kong; 06/2013
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION AND AIMS: This study is conducted to know the achievement of cadaveric transplant programme in Tamil nadu in spreading awareness among people about deceased donor transplantation and to put forward a model of organ transplantation which can be an example for other developing countries. METHODS: The Tamil nadu model of deceased donor transplantation was promulgated on October 2008.The main office for this programme is in Madras medical college, C hennai. The structure of this model is comprised of anchor, called the convenor. We retrospectively analysed the data comprises of Age, sex of donors and number of transplant done from October 2008 till November 2012 .we also analysed the number of organ retrieval facilitates by the Tamilnadu cadaver transplant programme. In both government and private institution. All donors are categorized in to two groups comprises of government and private institutes.,. All retrieved organs from the donors are also categorized according to the institutes. RESULTS: Total numbers of donors from October 2008 to November 2012 are 300. Total number of major organ retrieved from 300 donors are 887.Average age of donors is 35±16.Male to female ratio is 4.46:1 and 5 donors are unknown. GOVERENMENT INSTITUTION PRIVATE INSTITUTION DONORS 76 224 KIDNEY 158 395 LIVER 35 239 HEART 4 45 LUNG NIL 11 Table 1 showed the performance report of C adaveric transplant programme including donors and organ retrieval. CONCLUSIONS: This model has facilitated the retrieval of 887 major organs from 300 donors in period of 4 years, which has demonstrated that the deceased donor transplantation program can be successfully exercised in developing countries.Due to huge burden of morbid diseases like diabetes and hypertension in our country ,there are so many people with end stage renal disease,the only hope for them is kidney transplantation .Which can only met by meeting the demand by C adaveric organ transplantation. This model showed very successful public private partnership by achieving highest deceased donor rate in India. This model can save lives and eliminate commercialization, without any moral compulsion on near relative to donate organs and would benefit rich and the poor alike. This model can be a good example for other developing countries to follow and adapt to eliminate commercialization and to bring transparency in organ transplantation.
World Congress of Nephrology 2013, Hong Kong 2013; 06/2013
[Show abstract][Hide abstract] ABSTRACT: The positive impact of a structured deceased-donor program has resulted in a reduction in the number of commercial transplantation operations taking place in India. The engagement of private and government stakeholders has revealed the positive impact of deceased organ donation in India. The best example is the Tamil Nadu state model, where deceased donations have increased to 1.2 per million population compared to the national average of 0.08 per million population. In the last 30 months 994 organs were transplanted. The donation and transplantation in the Government-run hospitals have provided organs to the poor sections of the society free of cost. Immunological surveillance of the prospective recipients remains a challenge, as there is a paucity of immunological laboratories in transplant centers. Generic immunosuppressive drugs manufactured by the local pharmaceutical industry have been shown to be noninferior, and have greatly reduced the cost of achieving immunosuppression
[Show abstract][Hide abstract] ABSTRACT: Hospital-acquired hypernatremia (HAH) is a frequent concern in critical care, which carries high mortality.
To study the risk factors for HAH in settings that practice a preventive protocol.
Two tertiary-care hospitals. Prospective observational study design.
Patients aged >18 years admitted for an acute medical illness with normal serum sodium and need for intensive care >48 h formed the study population. Details of the basic panel of investigations on admission, daily electrolytes and renal function test, sodium content of all intake, free water intake (oral, enteral and intravenous) and fluid balance every 24 h were recorded. Individuals with serum Na 140-142 meq/l received 500 ml of free water every 24 h, and those with 143-145 meq/l received 1000 ml free water every 24 h.
Risk factors associated with HAH was analysed by multiple logistic regression.
Among 670 study participants, 64 (9.5%) developed HAH. The median duration of hypernatremia was 3 days. A total 60 of 64 participants with HAH had features of renal concentrating defect during hypernatremia. Age >60 years (P = 0.02), acute kidney injury (AKI) on admission (P = 0.01), mechanical ventilation (P = 0.01), need for ionotropes (P = 0.03), worsening Sequential Organ Failure Assessment (SOFA) score after admission (P < 0.001), enteral tube feeds (P = 0.002), negative fluid balance (P = 0.02) and mannitol use (P < 0.001) were the risk factors for HAH. Mortality rate was 34.3% among hypernatremic patients.
The study suggests that administration of free water to prevent HAH should be more meticulously complied with in patients who are elderly, present with AKI, suffer multi-organ dysfunction, require mechanical ventilation, receive enteral feeds and drugs like mannitol or ionotropes.
Indian Journal of Critical Care Medicine 01/2013; 17(1):28-33.
[Show abstract][Hide abstract] ABSTRACT: Abdominal aortic calcification (AAC), cardiac valvular calcification (CVC), and atherosclerotic carotid plaque (CP) are known cardiovascular risk factors. The accuracy of the AAC score in predicting CP and CVC in patients with end-stage renal disease (ESRD) is assessed in this study. Twenty-two consecutive prevalent dialysis patients (group 1) and 26 consecutive nondialysis stage V chronic kidney disease patients (group 2) were assessed for their demographic and laboratory variables. Lateral radiograph of the lumbosacral spine was used to assess the AAC score. CP and CVC were assessed using carotid sonography and echocardiogram, respectively. Prevalence of AAC, CP, and CVC in groups 1 and 2 was, respectively, 72.7%, 81.8%, and 72.7% and 76.9%, 80.8%, and 57.7%. AAC was strongly associated with CP and CVC in both groups (P < 0.001). Tests of accuracy for the AAC score as a predictor of CP and CVC showed sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio of a positive test, and likelihood ratio of a negative test, respectively, in group 1: 83%, 75%, 93%, 50%, 3.32, and 0.23 and 85%, 77%, 87%, 70%, 4.5, and 0.29, and in group 2: 90%, 95%, 83%, 69%, 3.9, 0.41, and 82%, 91%, 77%, 71%, 4.1, and 0.21. Reproducibility of the AAC score among observers was acceptable. The AAC score can predict CP and CVC with moderate accuracy in ESRD patients. However, as our study was underpowered, the findings need validation in larger, adequately powered studies.
Indian Journal of Nephrology 11/2012; 22(6):431-7.
[Show abstract][Hide abstract] ABSTRACT: In this report, we discuss a case of a 51-year-old African renal transplant who presented with metastatic Kaposi sarcoma 1 year after transplant. The Kaposi sarcoma was treated with a switch of immunosuppressants and chemotherapy. Six years after transplant, he presented with chronic allograft nephropathy, allograft tuberculosis, BK viremia, and was diagnosed to have contracted HIV infection.
Indian Journal of Nephrology 09/2012; 22(5):388-91.