ABSTRACT
Objective: To describe the causes, characteristics and factors associated with ascites in patients on maintenance hemodialysis
Study Design: Observational study
Place and Duration of Study: Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, from November 2007 to November 2014
Methodology: All patients on maintenance hemodialysis and age > 16 years with ascites were included. Frequencies and percentages were computed for different categorical variables. Chi-square or Fischer exact test were used to identify factors associated with ascites like frequency of hemodialysis, serum albumin and cardiac ejection fraction [EF]. Odds ratios were calculated for associated factors
Results: Ninety patients were included in this study; 55.5% were males. Median age was 33 years. Cause of ascites was nephrogenic in 77.8%, cardiac failure in 16.7%, hypothyroidism in 6.67%, liver cirrhosis in 4.4%, abdominal tuberculosis in 2.2%, and peritoneal carcinomatosis in 1.1% patients. The ascites was severe in 53.3% patients and severity was associated with serum albumin < 2.8 gm/dL [p=0.007] and cardiac EF < 40% [p=0.028]. The ascites was low serum ascites albumin gradient [SAAG], high protein type [LSHP] in 60% patients and associated with hemorrhage [p=0.040]. High SAAG, high protein [HSHP] ascites, found in 33.3%, was associated with cardiac EF < 40% [p=0.005] and portal hypertension [p=0.048]. High SAAG, low protein [HSLP] ascites, seen in 6.7%, was associated with portal hypertension [p=0.006]
Conclusion: The commonest cause of ascites in hemodialysis dependent patients is nephrogenic followed by cardiac failure. Low serum albumin and low cardiac EF predispose to severe forms of ascites
ABSTRACT
Hepatitis B [HB], Hepatitis C [HC] and their risk factors are amongst the major health problems in developing countries including Pakistan. This study aimed to screen for HB and HC among people who visited General Practice clinics and also to identify the differences of screening positive cases by age and sex. This was a retrospective study conducted in Tando Muhammad Khan city, one of the rural districts of Sindh. All together we reviewed 5989 laboratory reports of people for hepatitis B and C on consecutive basis from two laboratories. A pre-designed and structured perform was used to collect the required information. Chi-squared test and univariate analysis was calculated to assess the difference in HB and HC proportion by age groups and sex. One-fourth of reports were positive for at least one entity whereas 8% and 17% of reviewed reports of adults [>18 years and above] were screened positive for HB and HC respectively. Positive screened tests were higher among older age group compared to young age group [HB: older age group=56.6% vs. younger age group=43.4%; OR=1.07] and [HC: older age group=58.3% vs. younger age group=41.7%; OR=1.08]. In the same way, positive screened tests were higher among men compared to women [HB: men=67.0% vs. women=33.0%; OR=1.2] and [HC: men=62.0% vs. women=38.0%; OR=1.3]. A large proportion of people were screened positive for HB and HC in this study. Prevention and screening are suggested at larger scale for urgent planning and implementation of intervention strategies in this regard. Further research is also recommended to explore this important health issue at large scale