Practice pattern of hemodialysis among end-stage renal disease patients in Rural South India: A single-center experience.

Hemodialysis (HD) is the most common mode of renal replacement therapy for end-stage renal disease (ESRD) patients in India. However, the practice and pattern of dialysis in a hospital serving rural population is largely unknown. A prospective study of 127 ESRD patients initiated on HD between January 2013 and December 2014 was done. The study included 101 males and 26 females, with a mean age of 50.05 ± 13.80 years. Native kidney disease was unknown in 45.67% of patients as they presented very late in their disease course. Nearly 87.4% of patients had emergency dialysis. Only 6.30% of patients had started dialysis with an arteriovenous fistula while 93.70% with a temporary catheter. The mean creatinine and hemoglobin at the initiation of dialysis were 11.18 mg/dL and 6.8 g/dL, respectively. All patients underwent twice weekly HD of 4 h duration with achieved average single-pool Kt/V of 1.52. The hospitalization rate was 3.25 per patient-year. The outcomes in our cohort were as follows: 3.94% transferred to other centers, 16.54% died, 0.79% underwent transplantation, 33.07% continued on HD, and majority 45.67% stopped dialysis. The most common cause of death was sepsis. The Kaplan-Meier analysis showed median survival time on dialysis to be 64 days. Patients initiated on HD in rural area often present late with poor predialysis care leading to high morbidity. Prognosis is generally poor with majority of the patients stopping dialysis within few weeks.

Brachiocephalic Arteriovenous Fistula for Hemodialysis through the Median Antecubital Vein.

In patients unsuitable for radiocephalic fistula creation, the next option is brachiocephalic fistula. In such patients, we exploited the venous interconnections in the cubital fossa for median cubital vein-Brachiocephalic arteriovenous fistula (AVF) creation. In this article, we describe our experience in the creation of such technical variant of the brachiocephalic fistula AVF, its success and associated complications. A retrospective review of such AVF created between September 2014 and August 2015 was done. The data collected included demographics, co-morbidities, basic disease, operative details, patency, complications, and mortality. A total of 68 vascular access surgeries were done which included 26 (38.2%) brachiocephalic AVF using the median antecubital vein. The mean cephalic vein diameter and mean flow rate were 7.18 mm and 1415 ml/min, respectively 2 months after fistula creation. The primary and secondary failure rates were 3.87% and 7.69% respectively. Complications included aneurysm (7.69%), edema (19.23%), hematoma (11.53%), and wound infection (3.8%). Using reverse flow in the median antecubital vein is a safe and simple way to perform brachiocephalic AVF before brachiobasilic AVF and grafts.

Analysis of Vascular Access in Haemodialysis Patients - Single Center Experience.

BACKGROUND: Vascular access is the key in successful management of chronic haemodialysis (HD) patients. Though native arteriovenous fistula (AVF) is considered the access of choice, many patients in our country initiate haemodialysis through central venous catheter (CVC). There is paucity of data on vascular access in haemodialysis patients from southern India. AIM: Aim of the present study was to review our experience of vascular access in Haemodialysis patients (both central venous catheters and arteriovenous fistula) and to assess its success rate and common complications. MATERIALS AND METHODS: This prospective study was conducted between January 2014 and December 2014 in our institute. A total of 50 patients with Chronic Kidney Disease (CKD) underwent vascular access intervention during the above period. RESULTS: A temporary venous catheter (96%) in the right internal jugular vein was the most common mode of initiation of haemodialysis with 34.48% incidence of catheter related sepsis. Fifty percent of catheters were removed electively with mean duration of catheter survival of 77.23 ± 14.8 days. Wrist AVF (60%) was the most common site of AVF creation followed by arm (30%), mid-forearm (7.5%) and leg (2.5%). Complications include distal oedema (17.5%) and venous hypertension (2.5%). Primary failure occurred in 25% of patients and was more common in diabetic, elderly (>60 years) and in distal fistulas. Elderly patients (>60 years) starting dialysis with a CVC were more likely to be CVC dependent at 90 days. CONCLUSION: Late presentation and delayed diagnosis of chronic kidney disease (CKD) necessitates dialysis initiation through temporary catheter. Dialysis catheter with its attendant complications further adds to the morbidity, mortality, health care burden and costs. Early nephrology referral and permanent access creation in the pre dialysis stage could avert the unnecessary complications and costs of catheter.

Bardet-Biedl syndrome: A rare cause of end stage renal disease.

Bardet-Biedl syndrome is a rare autosomal recessive disorder, recently categorized as ciliopathy characterized by dysfunction of primary cilia which results in myriad manifestations in various organ systems. Though renal abnormalities can occur in this syndrome, renal failure is a rare presentation. The author reports a case of 18-year-old female who presented with polydactyly, obesity, retinitis pigmentosa, learning disability and renal failure.

Hyper Vitaminosis D: Are we Overprescribing Vitamin D?

Vitamin D, the sunshine vitamin is now considered to be a hormone due to its important role in many physiological functions. Vitamin D deficiency has been associated with many disorders ranging from bone diseases, cardiovascular diseases to cancer. Hence, there is a recent surge in the empirical prescription of vitamin D for various disorders without documentation of vitamin D deficiency and monitoring the treatment. We report a case of iatrogenic hypercalcemia and acute kidney injury due to vitamin D toxicity after empirical and overzealous use of vitamin D and calcium supplements. We present this case to remind clinicians the importance of monitoring the patients treated with mega doses of vitamin D.