Georgi Abraham

Pondicherry Institute of Medical Sciences, Pondichéry, Pondicherry, India

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Publications (138)173.57 Total impact

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    ABSTRACT: Abstract There is an enormous increase in the burden of chronic kidney disease both in developing and developed countries. There is a paucity of data on obstructive sleep apnea (OSA) in chronic kidney disease (CKD) patients in India. We used a cross-sectional prospective observational study to determine the prevalence of OSA in non-dialysis CKD patients. Of the 647 CKD patients 302 patients were in stage II, III and IV. The study population was screened using the Berlin questionnaire and 87 patients were positive for OSA (28%). Among the 87, 37 patients were excluded based on the exclusion criteria. Fifty patients underwent a split night sleep study. Stage II, III CKD patients were clubbed as early CKD or group one and stage IV CKD patients were clubbed as late CKD or group two. The spilt night study revealed an 88% incidence of OSA of varying severity. A sub group analysis was done to assess the severity of OSA. A statistical significance (p < 0.05) between early and late CKD group was observed with respect to AHI and ODI. An improvement in the late CKD is observed and the Z values for AHI and ODI are 4.273 and 2.307, respectively. The prevalence and incidence of OSA was found to be 28% and 88% in non-dialysis CKD patients, respectively and the risk and severity of OSA increased with the progression of CKD stages and thus necessitating the need for screening the non-dialysis CKD population.
    Renal Failure 11/2014; · 0.94 Impact Factor
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    ABSTRACT: Abstract Hydration and nutritional status of end stage renal disease (ESRD) patients are linked to increased morbidity and mortality. Body composition monitoring (BCM) by multi-frequency bioimpedance spectroscopy (MFBS) is considered to be a superior modality of fluid assessment in chronic kidney disease (CKD) dialysis. We did a longitudinal prospective study in South India on maintenance hemodialysis (MHD) and continuous ambulatory peritoneal dialysis (CAPD) patients over 24 months and looked at impact of baseline nutritional parameters and body composition parameters on 24-month mortality. Ninety-nine patients stable on dialysis for at least 3 months were recruited (MHD 85, CAPD 14) at baseline and at 24 months, 41 were alive and 33 had expired, 12 had undergone renal transplant and 13 were lost to follow-up. BCM and nutritional assessment were done at baseline and at follow-up. Baseline overhydration (OH) differed significantly between surviving and dead patients (p < 0.05). Receiver operating characteristic (ROC) curve between OH and mortality showed that the best cut-off point to differentiate between survived and expired patients was 3.15 L. ROC curve for BMI showed lower than cut-off of 22.65 kg/m(2) to predict mortality with sensitivity 41.30% and specificity 81.81%. At follow-up, triceps skin fold thickness (TSF), biceps skin fold thickness (BSF) and mid arm circumference (MAC) increased significantly from baseline (p < 0.001, p = 0.001 and p < 0.001, respectively). Overhydration and BMI are important predictors of mortality in dialysis patients. Improvement in anthropometric markers TSF, BSF and MAC in MHD patients was associated with survival.
    Renal Failure 09/2014; · 0.94 Impact Factor
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    ABSTRACT: There is a paucity of data on mineral bone disease in maintenance hemodialysis (MHD) patients from India. This retrospective analysis was undertaken on 858 (males: 599; females: 259) patients from two medical centers on MHD from 1998 to 2010. Age, gender, months on dialysis, hours per session of dialysis, hemoglobin, serum calcium, inorganic phosphorus, intact parathyroid hormone (iPTH), urine output, erythropoietin dosage per week, blood sugar, blood pressure, urea reduction rate, gain in fluid and fluid removed per session, serum albumin, alkaline phosphatase, vitamin D level, supplemental vitamin D and use of phosphate binder for therapy were documented. Overall, 191 patients died (22%) during the observation period. There was an 86% patient survival rate at 1 year on dialysis and an overall predicted 3-year survival rate of 78%. A relatively higher iPTH (P = 0.012), a need for vitamin D supplementation (P = 0.003), less hours on dialysis per session (P = 0.046) and a non-vegetarian diet (P = 0.022) were significantly associated with mortality.
    Indian Journal of Nephrology 09/2014; 24(5):302-7.
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    ABSTRACT: Abstract A 68-year-old diabetic chronic kidney disease patient on continuous ambulatory peritoneal dialysis for two years developed Candida haemulonii peritonitis without any predisposing factors. There is no effective treatment for this fungus. A peritoneal biopsy showed morphological changes of acute inflammation and chronicity.
    Renal Failure 07/2014; · 0.94 Impact Factor
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    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. Methods 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. Results 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). Conclusion 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.
    Indian heart journal 06/2014;
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    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.
    Renal Failure 01/2014; · 0.94 Impact Factor
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    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.
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    ABSTRACT: There has been an exponential increase in the incidence of diabetes and hypertension in India in the last few decades, with a proportional increase in chronic kidney disease (CKD). Preventive health care and maintenance of asymptomatic chronic disease such as CKD are often neglected by patients until they become symptomatic with fluid retention and uremia. Management of hyperphosphatemia in CKD remains one of the challenges of nephrology in India for this reason, as it is almost completely asymptomatic but contributes to renal osteodystrophy, metastatic vascular calcification, and acceleration of cardiovascular disease. Lack of understanding of the dangers of asymptomatic hyperphosphatemia, the huge pill burden of phosphate binders, difficulty with dietary and dialysis compliance, and most importantly, the added expense of the drugs places additional road blocks in the treatment of hyperphosphatemia at a population level in developing countries like India. In this review we seek to address the contribution of hyperphosphatemia to adverse outcomes and discuss economic, cultural, and societal factors unique to the management of phosphate levels in Indian patients with advanced CKD.
    International Journal of Nephrology and Renovascular Disease 01/2014; 7:391-9.
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    Kidney International 11/2013; 84(5):1055. · 8.52 Impact Factor
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    Journal of the Indian Medical Association 08/2013; 111(8):518-20, 522-3.
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    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.
  • Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 07/2013; 33(4):464-465.
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    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
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    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
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    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
    Kidney international. Supplement 05/2013;
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    Indian Journal of peritoneal dialysis. 05/2013;
  • Transplantation 01/2013; 95(2):e10-2. · 3.78 Impact Factor
  • Ashish Verma, Milly Mathew, Georgi Abraham
    Journal of Association Physician India- Tamil Nadu Chapter. 01/2013; 5(1).

Publication Stats

352 Citations
173.57 Total Impact Points


  • 2009–2014
    • Pondicherry Institute of Medical Sciences
      • Department of Nephrology
      Pondichéry, Pondicherry, India
    • Madras Medical Mission
      Chennai, Tamil Nādu, India
  • 1998–2012
    • Sri Ramachandra University
      • • Department of General Medicine
      • • Department of Nephrology
      Porur, Tamil Nādu, India
  • 2005
    • Vijaya Insitute Of Medical Sciences
      Pollāchi, Tamil Nādu, India