Aluminium exposure in haemodialysis and peritoneal dialysis patients: Experience of a single centre

Introduction: Aluminium exposure and toxicity are uncommon in humans. However it may occur in patients on long term haemodialysis (HD) due to water exposure during treatment. We retrospectively assessed the extent of aluminium exposure in our HD and peritoneal dialysis (PD) patients from 2002 to 2008. Materials and Methods: The study population included 43 HD patients and 77 PD patients whose blood samples were collected at four monthly intervals. In addition, HD patients were also interviewed on lifestyle factors (aluminium cookware, diet, aluminium-containing medications and tap water consumption) that may impact on serum aluminium levels. Reverse osmosis (RO) water aluminium levels were also collected during this timeframe. Results: More patients on HD had readings above the accepted range (>0.01mg/L) than peritoneal dialysis (36.9% vs. 23.8%). The mean aluminium values for HD and PD patients were 63.35 ± 34.69μg/L and 38.34 ± 17.02μg/L respectively (p<0.05). Use of aluminium cookware was identified as a risk factor for high aluminium readings in HD patients. The trend of serum aluminium correlated with that of RO water aluminium during the studied period. There was no evidence of clinical toxicity in our patients during follow up. Conclusion: The study showed that HD patients are at a higher risk of aluminium toxicity compared to PD patients. Treated RO water aluminium should be analysed on a regular basis to prevent aluminium toxicity in HD patients. Lifestyle factors may have an impact on aluminium levels in patients with renal disease.

Aetiology, maternal and foetal outcome in 60 cases of obstetrical acute renal failure

Acute renal failure is a serious complication in pregnancy. Not only does it result in significant maternal morbidity and mortality but also results in significant number of foetal loss. Although incidence of obstetrical acute renal failure has decreased in developed countries but still it is one of the major health problem of developing nations. The objective of this study was to study aetiology, maternal and foetal outcome in obstetrical acute renal failure. This study was conducted at Department of Nephrology, Khyber Teaching Hospital, Peshawar from August 2006 to December 2007. It was a descriptive, case series study. Female patients with pregnancy and acute renal failure, irrespective of age, were included in the study. Patients were thoroughly examined and baseline urea, creatinine, serum electrolytes, peripheral smear, prothrombin time, partial thromboplastin time, fibrinogen degradation products, renal and obstetrical ultrasound were performed on each patient and 24-hr urinary protein and bacterial culture sensitivity on blood, urine or vaginal swabs were done in selected patients. Foetal and maternal outcome were recorded. Data were analysed using SPSS. A total of 60 patients were included in the study. Mean age of the patients was 29 +/- 5.4 years and duration of gestation was 33 +/- 4.9 weeks. Mean gravidity was 4 +/- 2.2. Sixteen patients [26.66%] were treated conservatively while 44 [73.33%] required dialysis. Postpartum haemorrhage was present in 14 [23.33%], postpartum haemorrhage and disseminated intravascular coagulation [DIC] in 11 [18.33%], eclampsia-preeclampsia in 8 [13.33%], antepartum haemorrhage in 8 [13.33%], antepartum haemorrhage with DIC in 6 [10%], DIC alone in 4 [6.66%], obstructed labour in 3 [5%], septic abortion in 3 [3.33%], HELLP [haemolysis elevated liver enzyme and low platelet] in 2 [3.33%], urinary tract infection with sepsis in 1 [1.66%] and puerperal sepsis in 1 [1.66%]. Foetal loss was 40 [66.66%]. Maternal mortality was 9 [15%] while 28 [46.66%] fully recovered. Among the rest 6 [30%] had partial recovery and 5 [8.33%] had dialysis dependent chronic kidney disease. Obstetrical acute renal failure not only results in foetal loss but also causes significant maternal morbidity and mortality

Glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 patients of type 2 diabetes mellitus

To assess the glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 type 2 diabetes mellitus patients. Material and This descriptive observational study was carried out at Medical A Unit, Khyber Teaching Hospital Peshawar. A total of 100 type 2 diabetic patients were included through non-probability sampling. Glycosylated hemoglobin of each patient was determined and questions were asked about income, self-monitoring of glycemic status, education and compliance of the patients. Majority of the patients [78%] had poorly controlled diabetic mellitus. Most of the patients [42%] were poor and their monthly income was less than 5000 rupees. Only 57% of the patients monitored their blood sugar once a month. No patient was using glycosylated hemoglobin for assessment of his or her glycemic status. Majority of the patients [82%] were illiterate. Oral hypoglycemic agents were used by 81% of the patients. Most of the patients had poorly controlled diabetes mellitus. Majority of the patients were poor and illiterate and there was poor self-monitoring. Most of the patients were using oral hypoglycemic drugs