Systemic fungal infections in renal diseases.

Invasive fungal infections are a major challenge in the management of immunocompromised patients and those with renal dysfunction. These challenges are due to the immense morbidity and mortality in such situations. Also the management strategies for invasive mycosis in patients with renal dysfunction have narrow safety profile and involve high-cost. In this review we will discuss the issues involved in the management of invasive mycosis in the patients with renal dysfunction in the form of acute renal failure, chronic kidney disease, dialysis dependency of renal transplant recipients. We also emphasize that the use of Intravenous Liposomal Amphoterecin appears to be an effective alternative to the conventional Amphoterecin B for the treatment of invasive fungal infections in patients with renal dysfunction due to its greatly improved tolerability profile. Commercially two true liposomal preparations (Fungisome and Ambisome) are available. Judgement about the preferred formulation should be made on the basis of disease morbidity, severity of renal dysfunction and the cost involved.

Protein intake in Indian haemodialysis patients.

OBJECTIVES: Aim of our study was to find out the amount of protein consumed by Indian haemodialysis patients. METHODS: Twenty patients with endstage renal disease on regular haemodialysis at a major urban dialysis centre in India had their Kt/V and nPCR measured monthly for 4 months utilising urea kinetic methods. RESULTS: Despite an adequate amount of dialysis per session being delivered to almost all of these patients (19 out of 20 had a Kt/V greater than 1.2) none of our patients had an nPCR greater than 1 gm/kg/day and only 4 patients i.e. 20% had a protein intake greater than 0.8 gm/kg/day which is a cut off point below which mortality has been shown to increase dramatically. Most of the patients had a protein intake between 0.7-0.8 gm/kg/day which is alarmingly low. Patients who consumed non vegetarian food at least thrice a week did appear to have a significantly higher protein intake compared to the rest of the patients. CONCLUSION: We believe that these results are likely to be representative of other dialysis centers in India and that an intensive effort at dietary education aimed at increasing the protein intake in our haemodialysis patients is urgently required. The morbidity and mortality of dialysis patients is high and perhaps appropriate dietary intervention can help to reduce this.