Correlation of anemia, secondary hyperparathyroidism with left ventricular hypertrophy in Chronic Kidney Disease patients.

AIMS: To demonstrate the correlation of anemia and intact parathormone with left ventricular hypertrophy in a cohort of Chronic Kidney Disease (CKD) patients in a tertiary care centre. METHODS: A cross-sectional study was done over 2 years on 230 renal failure patients (160 males, 70 females), aged 15-75 years, who had elevated serum creatinine and reduced GFR. The patients were assessed based on clinical history and a number of laboratory parameters including serum creatinine, calcium, iPTH level, Hb, Hct, GFR and LVMI. Settings : Patients were seen as inpatients and outpatients in a tertiary care centre. RESULTS : In CKD stages I, II and III, 51% of the patients had anemia Hb<11gm/dl), 16%of the patients had elevated iPTH, 79% of male patients and 71% of female patients had LVH. In Stage IV CKD, 55% of the patients had anemia, 25% of the patients had elevated iPTH, 74% of male patients and 100% of female patients had LVH. In stage V CKD, 76% of the patients had anemia, 31% of the patients had elevated iPTH, 77% of male patients and 96% of female patients had LVH. In all five stages, 78% of male patients and 71% of female patients with elevated iPTH had LVH, 81% of male patients and 90% of female patients with anemia had LVH. Systemic hypertension was present in 69% of the patients. CONCLUSION: Anemia is widely prevalent in our cohort of CKD patients. Severity of anemia is correlated to LVH and secondary hyperparathyroidism in these patients.

Comparison of target concentration intervention strategy with conventional dosing of digoxin.

Digoxin is a widely used drug in patients with congestive heart failure. The present study compared the quality of life of congestive heart failure patients on one year follow-up period with two different dosing of digoxin (5/7 therapy and 7/7 therapy in whom the target serum digoxin concentration is maintained). Quality of life significantly improved in intervention group thus emphasizing the need for continuous dosing of digoxin based on target concentration.

Proximal flow convergence method in the assessment of mitral stenosis.

Mitral valve area (MVA) was calculated using the proximal flow convergence method in 60 patients with severe mitral stenosis. Using the apical 4 chamber view, colour Doppler was used to measure the peak forward flow rate. From this, the mitral valve area was calculated according to the formula: mitral valve area = peak forward flow rate/peak mitral velocity. This method compared well with the established 2D planimetry derived valve area (r = 0.89) and Doppler pressure half time method (r = 0.88). Hence, this can be used as an alternative method to estimate the valve area in patients with mitral stenosis.

Plasma insulin levels in coronary artery disease.

Seventy two consecutive patients without a history of diabetes and normal fasting plasma glucose were included in this study of insulin levels. Standard oral glucose tolerance test with 75 gm glucose and fasting and two hour insulin levels were estimated in all patients. Coronary artery disease (CAD) was confirmed or excluded by selective coronary arteriography. In 20 patients, CAD was diagnosed by electrocardiographic (ECG) and clinical evidence of earlier myocardial infarction. Mean fasting plasma insulin was 31.40 +/- 22.2 IU/dl in the CAD positive and 32.3 +/- 13.6 IU/dl in the CAD negative group. The mean two hour plasma insulin was 274.6 +/- 301.1 IU/dl in the CAD positive and 104.8 +/- 74.9 IU/dl in the CAD negative group (p < 0.04). Two hour plasma insulin levels were significantly higher in patients with atherosclerotic coronary artery disease. It is concluded that the estimation of a two hour plasma insulin level after 75 gm of glucose load, could help differentiate CAD from normals.