Difference in Antihypertensive Medication Pattern in the First Year Compared to More than a Year of Maintenance Hemodialysis: A Northern India Tertiary Care Experience

Introduction?There is a high prevalence of hypertension in maintenance hemodialysis patients. Information regarding prevalent pattern of antihypertensive medications will help modify it to prevent future cardiovascular morbidity and mortality. Materials and Methods?In this cross-sectional study, patients on maintenance hemodialysis, aged ?18 years visiting Nephrology outpatient department (OPD) from April 2019 to May 2020 were included. The patients were divided into two groups based on their dialysis vintage, ?12 months and >12 months. Their antihypertensive medication patterns and two-dimensional (2D) echocardiography (ECHO) findings were compared. Independent t-test was used to compare continuous variables. One-way analysis of variance was used to study the antihypertensive drug-dosing pattern in both the groups. Results?Out of 250 patients, 131 had a dialysis vintage of ?12 months, whereas 119 had a vintage of >12 months. There was no significant difference in the number of antihypertensive agents used in either of the vintage groups. Calcium channel blockers (87.02 and 89.07%, respectively, in ?12 and >12 months' vintage groups) and ? blockers (64.12 and 65.54%, respectively, in ?12 and >12 months' vintage groups) were the commonly used antihypertensive agents. Metoprolol use was higher in ?12 months' group, whereas carvedilol usage was higher in >12 months' group (p?=?0.028). Mean pill burden was more than five in both the groups. Concentric left ventricular hypertrophy was significantly more common in >12 months' group. Renin–angiotensin system (RAS) blocking agent use was limited to 3% of patients. Conclusion?This study shows a high antihypertensive pill burden in dialysis patients likely due to underlying chronic volume overload in addition to the perceived efficacy of certain class of drug in a frequent dosing pattern. Low use of RAS blocking agent was also underlined. This study highlights the need to bring about changes in the antihypertensive prescription pattern in line with the existing evidence

Selection of appropriate statistical methods for data analysis

In biostatistics, for each of the specific situation, statistical methods are available for analysis and interpretation of the data. To select the appropriate statistical method, one need to know the assumption and conditions of the statistical methods, so that proper statistical method can be selected for data analysis. Two main statistical methods are used in data analysis: descriptive statistics, which summarizes data using indexes such as mean and median and another is inferential statistics, which draw conclusions from data using statistical tests such as student's t-test. Selection of appropriate statistical method depends on the following three things: Aim and objective of the study, Type and distribution of the data used, and Nature of the observations (paired/unpaired). All type of statistical methods that are used to compare the means are called parametric while statistical methods used to compare other than means (ex-median/mean ranks/proportions) are called nonparametric methods. In the present article, we have discussed the parametric and non-parametric methods, their assumptions, and how to select appropriate statistical methods for analysis and interpretation of the biomedical data.

Descriptive statistics and normality tests for statistical data

Descriptive statistics are an important part of biomedical research which is used to describe the basic features of the data in the study. They provide simple summaries about the sample and the measures. Measures of the central tendency and dispersion are used to describe the quantitative data. For the continuous data, test of the normality is an important step for deciding the measures of central tendency and statistical methods for data analysis. When our data follow normal distribution, parametric tests otherwise nonparametric methods are used to compare the groups. There are different methods used to test the normality of data, including numerical and visual methods, and each method has its own advantages and disadvantages. In the present study, we have discussed the summary measures and methods used to test the normality of the data.

Ureteral Obstruction By An Aberrant Renal Artery: A Case Report

The ureter is a muscular tubular structure that carries urine from the kidney to the urinary bladder. It is usually about 20–25 cm in length and 3–5 mm diameter. The upper half lies in the belly and the lower half in the pelvic area. A ureteral obstruction is a blockage of either unilateral or bilateral ureters that carry urine from the kidneys to the urinary bladder. Ureteral obstruction can be curable. However, if it is not treated, symptoms can quickly move from mild pain, fever, and infection to severe including loss of kidney function, sepsis, and death. Here, we report the case of an upper ureteral obstruction by an aberrant artery. The artery was originating from the right renal artery, supplying the right psoas muscle, and causing gross proximal hydroureteronephrosis in a 24-year-old male patient. The patient was diagnosed using contrast-enhanced computed tomography through the abdomen examination.

Scales of measurement and presentation of statistical data

Measurement scale is an important part of data collection, analysis, and presentation. In the data collection and data analysis, statistical tools differ from one data type to another. There are four types of variables, namely nominal, ordinal, discrete, and continuous, and their nature and application are different. Graphs are a common method to visually present and illustrate relationships in the data. There are several statistical diagrams available to present data sets. However, their use depends on our objectives and data types. We should use the appropriate diagram for the data set, which is very useful for easily and quickly communicating summaries and findings to the audience. In the present study, statistical data type and its presentation, which are used in the field of biomedical research, have been discussed.