[Show abstract][Hide abstract] ABSTRACT: In many developing countries in the South Asian region, screening for chronic diseases in the community has shown a widely
varying prevalence. However, certain geographical regions have shown a high prevalence of chronic kidney disease (CKD) of
unknown etiology. This predominantly affects the young and middle-aged population with a lower socioeconomic status. Here,
we describe the hotspots of CKD of undiagnosed etiology in South Asian countries including the North, Central and Eastern
provinces of Sri Lanka and the coastal region of the state of Andhra Pradesh in India. Screening of these populations has
revealed cases of CKD in various stages. Race has also been shown to be a factor, with a much lower prevalence of CKD in whites
compared to Asians, which could be related to the known influence of ethnicity on CKD development as well as environmental
factors. The difference between developed and developing nations is most stark in the realm of healthcare, which translates
into CKD hotspots in many regions of South Asian countries. Additionally, the burden of CKD stage G5 remains unknown due to
the lack of registry reports, poor access to healthcare and lack of an organized chronic disease management program. The population
receiving various forms of renal replacement therapy has dramatically increased in the last decade due to better access to
point of care, despite the disproportionate increase in nephrology manpower. In this article we will discuss the nephrology
care provided in various countries in South Asia, including India, Bangladesh, Pakistan, Nepal, Bhutan, Sri Lanka and Afghanistan.
[Show abstract][Hide abstract] ABSTRACT: Various modalities of renal replacement therapy (RRT) are available for the management of acute kidney injury (AKI) and end-stage
renal disease (ESRD). While developed countries mainly use hemodialysis as a form of RRT, peritoneal dialysis (PD) has been
increasingly utilized in developing countries. Chronic PD offers various benefits including lower cost, home-based therapy,
single access, less requirement of highly trained personnel and major infrastructure, higher number of patients under a single
nephrologist with probably improved quality of life and freedom of activities. PD has been found to be lifesaving in the management
of AKI in patients in developing countries where facilities for other forms of RRT are not readily available. The International
Society of Peritoneal Dialysis has published guidelines regarding the use of PD in AKI, which has helped in ensuring uniformity.
PD has also been successfully used in certain special situations of AKI due to snake bite, malaria, febrile illness, following
cardiac surgery and in poisoning. Hemodialysis is the most common form of RRT used in ESRD worldwide, but some countries have
begun to adopt a ‘PD first’ policy to reduce healthcare costs of RRT and ensure that it reaches the underserved population.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew
Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the importance of positive cultures in the choice of the appropriate therapy in an extremely rare case of an immunocompetent patient with osteomyelitis of the clavicle.
[Show abstract][Hide abstract] 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.
Full-text · Article · Oct 2014 · International Journal of Nephrology and Renovascular Disease
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
No preview · Article · Sep 2014 · Indian Journal of Nephrology
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: Non-communicable diseases are on the rise in India, of which chronic kidney disease (CKD) forms a considerable part. Little is known about CKD in India. The CKD registry of India submitted its first report in 2012 attempting to decipher the load of CKD. Only the tip of the iceberg has been explored, because this registry is the data collection from 200 odd nephrologists to whom these patients were referred, which is hospital based. The burden of CKD is felt to be immense and presumed to catapult in the forthcoming years. The available facilities for renal replacement therapy are sparse, confined to urban areas and certain regions of the country. There is an imminent need for focusing on preventive aspect including screening practices and educational measures to alleviate the burden of CKD. Screening of high risk groups with urine dipstick test and serum creatinine estimation and estimated glomerular filtration rate (eGFR) based on this, is currently recommended by international experts, although debate exists as to whether to screen the entire population or only susceptible and older individuals. Educational interventions aimed at creating awareness are warranted owing to the current circumstances. The Government has to put in place decisive measures to control and monitor the disease. Public private partnerships could play a major role in the future. For the control of CKD as a whole in India, participation from professionals industry, philanthropic necessary.
Full-text · Article · Jul 2014 · The Open Urology & Nephrology Journal
[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.
Full-text · Article · Jun 2014 · Indian Heart Journal