Reasons for removal of non-tunneled double lumen catheters in incident dialysis patients

Objective: To evaluate the reasons of removal of non-tunneled double lumen catheters [NTDLC] in incident hemodialysis [HD] patients in a tertiary renal care hospital. Study Design: Observational retrospective study. Place and Duration of Study: Department of Nephrology, The Kidney Centre Postgraduate Training Institute [TKC PGTI], Karachi, from June 2015 to May 2016

Methodology: All patients were selected who had naive NTDLC placement at TKC PGTI either in Emergency Room [ER] or Intensive Care Unit [ICU] during the study period. The reason for removal were observed. Data was analysed by SPSS 21 and mean, percentages and frequencies were calculated. Cross tabulation between variables was done to find significance

Results: A total of 429 NTDLCs were inserted in the study period, out of which 296 catheters were inserted for incident HD. One hundred and twenty-seven [42.9%] catheters were removed prematurely due to malfunction, and 50 [17%] due to catheter-related blood stream infection [CRBSI]. Methicillin resistant Staphylococcus aureus was the commonest organism responsible for CRBSI. One hundred and five [35.47%] catheters were removed because the permanent vascular access [PVA] became usable

Conclusion: Catheter malfunctions and infections frequently occurred in NTDLC used for HD, which culminated early removal of catheter. Early creation of PVA should be encouraged to reduce the complications in already immunocompromised patients

Acute kidney injury secondary to rhabdomyolysis: a rare presentation of chikungunya fever

Chikungunya fever is an arthropod-borne viral illness characterised by high grade fever and incapacitating arthralgias. It is considered benign; however, in the recent outbreaks, several complications have been reported worldwide. We report a case of male patient with Chikungunya fever, possibly contracted from infected mosquitoes endemic in Karachi, Pakistan. The clinical presentation included fever, myalgias and anuria. Investigations revealed renal failure and significantly raised creatinine phosphokinase [CPK], suggesting rhabdomyolysis to be the cause of acute kidney injury [AKI]. Rhabdomyolysis is likely occurred due to virus-induced myositis; a rare presentation of Chikungunya fever. The patient gradually recovered from renal failure following supportive care and renal replacement therapy

Mortality trend among hemodialysis patients during the islamic month of ramadan: a 24 years retrospective study

The effect of month of Ramadan on the mortality in hemodialysis patients, and to compare it with that in all other Islamic months. A descriptive study. Hemodialysis Unit, The Kidney Center, Karachi, from January 1989 to December 2012. All those patients who were diagnosed to have end stage kidney disease and on maintenance hemodialysis for more than 3 months, regardless of underlying cause of kidney failure were included. Patients with acute kidney injury were excluded. Status of the patients was recorded at the end of the study period. The fasting status of the patients was not mentioned. The deaths of the patients were further evaluated and frequencies of death in all twelve Islamic months were calculated. A total of 1,841 patients were registered, out of whom 897 [48.7%] died, and 269 [14.6%] survived till the end of the study. One thousand and fifty six [57.3%] were males, 651 [35.4%] were diabetic. Total number of 143 [7.76%] events occurred in Ramadan, out of which 94 patients died which make nearly 11% of the total deaths distributed in 12 Islamic months. Frequency of death was higher in Ramadan when compared with other months. Ramadan reflected a higher frequency of death. Therefore, there is a need to evaluate the risk factors in a prospective study so that the dialysis patients can be better managed during this period

Dialyzer reuse: justified cost saving for south Asian region

In spite of controversies, dialyzer reuse has remained an integral part of hemodialysis because of lower cost, good overall safety record, and improved membrane biocompatibility. Reuse declined in developed countries from the beginning of this century because of mass production of hemodialyzers at favourable price with better biocompatible membrane. Abandoning dialyzer reuse became challenging in South Asian region, where more than 40% of the population live below the International Poverty Line of [dollar sign]1.25 per day, less than 10% of end stage renal disease patients receive renal replacement therapy, and upto 70% of those starting dialysis stop treatment due to cost within the first 3 months. Dialyzer reuse is an efficient cost-saving method that allows the use of more efficient and expensive biocompatible synthetic membranes, thereby providing high-quality dialysis to individuals living in countries with limited medical resources without compromising the safety or effectiveness of the treatment

clinical manifestations of systemic lupus erythematosus in Pakistan correlate with rest of Asia?

Systemic Lupus Erythematosus [SLE] is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly, Orientals in the East and Southeast Asia, Indians in South Asia and Arabs in the Middle East. These regions differ significantly from the Caucasians with reference to SLE. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and compare it with Asian data. Patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted at the Aga Khan University Hospital between 1986 and 2001 were studied by means of a retrospective review of their records. The results were compared with various studies in different regions of Asia. Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is generally consistent with Asian data. There was less cutaneous manifestations, arthritis, serositis, haematological and renal involvement compared to various regions in Asia. The neurological manifestations of SLE, however, place Pakistani patients in the middle of a spectrum between South Asians and other Asian races. This study has shown that the clinical characteristics of SLE patients in our country may be different to those of other Asian races. Although our population is similar to South Asians, but clinical manifestations of our SLE patients are considerably different, suggesting some unknown etiology. Further studies are required to confirm the above results and to find statistically sounder associations

Ischemic monomelic neuropathy: a complication of vascular access procedure

Ischemic monomelic neuropathy [IMN] is an infrequently recognized type of ischemic neuropathy produced by shunting of blood or due to acute noncompressive occlusion of the major proximal limb artery. Most reports about this complication appear in the neurology literature. IMN predominantly occurs in diabetic patients with evidence of peripheral neuropathy and atherosclerotic peripheral vascular disease. We report a case of ischemic monomelic neuropathy occurring in a patient with end stage diabetic nephropathy following PTFE [polytetrafluoroethylene] graft placement in proximal upper limb for chronic maintenance hemodialysis

Renal cortical necrosis: a case series of nine patientns and review of literature

The purpose of this study is to review cases of renal cortical necrosis [RCN] which we came across during a period of five years, confirmed on needle biopsy specimens, with literature available so far. All renal biopsy records between January 1996 to December 2001 at the Aga Khan University Hospital, Karachi, Pakistan were reviewed to identify patients with histologically proven renal cortical necrosis. Seven patients were also referred by the department of Nephrology, Lady Reading Hospital, Peshawar, Pakistan. Patients' medical records were reviewed for demographic, clinical, and follow up data. There were total of nine patients identified with renal cortical necrosis. The mean age was 26.21 +/- 13.01 year. Five cases [55.5%] were caused by obstetric complications. The most common histology type of RCN was patchy cortical necrosis in seven patients [77.8%]. Three patients were alive at last follow up; remaining patients were lost to follow up. Obstetric complications remain the leading cause of renal cortical necrosis in our setting. The recognition of this entity and value of renal biopsy in cases of acute renal failure needs to be emphasized as this helps in establishing diagnosis, to assess prognosis and to aid in selection of a rational approach to therapy