Epidemiology And Risk Factors Of Chronic Kidney Disease In Rural Areas 4 (Badin) Of Sind, Pakistan.

Objective: To evaluate the epidemiology of chronic kidney disease in a rural setting. METHODS: The retrospective study was conducted at Indus Hospital, Badin, Sindh, Pakistan, and comprised data of patients of either gender regardless of age who visited the nephrology clinic between July 2019 and July 2020. Data was retrieved from the institutional health management information system. Data was analysed using SPSS 21. RESULTS: Of the 348 patients, 184(52.9%) were males and 164(47.1%) were females. The overall mean age was 40.4±19 years. Obstructive nephropathy was the most frequent cause of chronic kidney disease 108(31%), followed by chronic kidney disease of unknown aetiology 79(22.7%). The most prevalent comorbid was hypertension in 106(30.5%) patients, while 56(16.1%) were diabetic. The stone disease was found in 90(24.6%) patients. Age was strongly associated with chronic kidney disease (p<0.001). Among those with chronic kidney disease of unknown aetiology, 35(44.3%) patients were aged 31-50 years 35. The expected glomerular filtration rate in such patients was significantly associated with the cause of chronic kidney disease (p<0.001). Conclusion: Unknown aetiology and kidney stones were the leading causes of chronic kidney disease among the rural population studied.

Epidemiology and complications of snakebite in rural area of Badin and Thar Sind, Pakistan.

OBJECTIVE: To identify the population at risk of snakebite, the peak season and the site of bite. METHODS: The retrospective study was conducted at the Indus Hospital, Badin, Pakistan, and comprised data of patients bitten by snake between January 2017 and December 2020 in the rural area of the Sindh province who presented to the emergency room and were treated according to the institutional protocol. Data was collected on a structured proforma. Data was analysed using SPSS 21. RESULTS: Of the 695 patients, 517(74.4%) were males and 178(25.6%) were females. The overall mean age was 29.9±15.7 years. Majority of the patients were farmers 294(42.3%), followed by labourers 195(28.1%). The most common site of snakebite was foot 556(80%). In 476(68.5%) cases, the snake type was not identified. Viper bite was noted in 193(28.2%) cases. Proteinuria, haematuria and renal dysfunction were observed in 302(43.5%), 302(43.5%) and 112(16.1%) patients, while leucocytosis, raised prothrombin time and low platelets were found in 305(43.5%), 268 (38.6%) and 100(14.4%) patients, respectively. Maximum number of cases took place in the peak summer month of July 112(16.1%). There were 8(1.2%) mortalities. CONCLUSIONS: Morbidity and mortality by snakebite was found to be prevalent in the study site, calling for preventing strategies.

Clinical Course and Outcome of ESRD Patients on Maintenance Hemodialysis Infected with COVID-19: A Single-Center Study.

BACKGROUND: In an ESRD subset of patients, COVID-19 infection is associated with increased disease burden and higher mortality rates. METHODS: We conducted a retrospective single-center cohort study in which 43 ESRD patients had a diagnosis of COVID-19. Association of risk factors with mortality was assessed by chi-square test and logistic regression analysis. Data were collected on a structured performa which included variables like age, gender, comorbid conditions, drug history, clinical presentation, hemodynamic status and laboratory parameters. Outcome variables were recovery and death. All patients received standard treatment for COVID-19 according to hospital protocols, along with hemodialysis and continuous renal replacement therapy (CRRT) when needed. RESULTS: Those most affected were found to be male, 25 (58.1%), while the number of females affected was 18 (41.9%). The most frequent comorbid condition was hypertension (HTN), seen in 35 (81.4%) patients; however, thromboembolic complications were very few in these patients. The mortality rate in our study was 25.6%, and the population most susceptible to poor outcomes in the ESRD subgroup was elderly people (45.5%), while younger patients recovered the most from COVID-19 (53.1%). Hypoalbuminemia, leukocytosis, lymphopenia and raised LDH were also found to be associated with death in ESRD patients suffering from COVID-19 (81.8, 72.7, 100 and 100%, respectively). In multivariate logistic regression analysis, we found that the odds ratio of dying from COVID-19 was 19.5 times higher in patients aged >65 years as compared to patients aged 18-50 years (p=0.039). Similarly, patients with a high TLC were 24.1 times more likely to die than patients with a normal TLC (p=0.008). CONCLUSION: In our center, the mortality rate of ESRD patients affected with COVID-19 disease was 25.6%, and older age, leukocytosis, lymphopenia, hypoalbuminemia and high LDH were significantly associated with mortality.

The role of the poultry industry on kidney and genitourinary health in Pakistan.

Pakistan is experiencing a "double burden'' of disease. Under-development is associated with illnesses like infections and nutritional deficiency, and is accompanied with diseases linked with development, such as diabetes, hypertension, cancer and chronic kidney disease. In Pakistan, renal and genitourinary diseases are an important, unaddressed health issues. Chronic kidney disease of unknown etiology (CKDu) is a recognized form of renal failure in Pakistan. A possible cause of CKDu is toxins such as arsenic, cadmium, lead and other heavy metals associated with renal and genitourinary diseases. The poultry industry is an important source of both heavy metal toxins and also mycotoxins spread in the process of farming. Of the numerous mycotoxins, zearalenone and ochratoxin are well-known for their hazardous effects on genitourinary and renal parenchyma respectively. We reviewed the literature using PubMed and Google Scholar databases for levels of these toxins in various constituents of chicken farming like chicken feed, meat, litter and human drinking water contamination in various parts of the country. We found that these toxins are in higher levels than recommended.

A review of the epidemiology of chronic kidney disease in Pakistan: A global and regional perspective.

Both the incidence and prevalence of chronic kidney disease (CKD) are rising with immense pace worldwide. People living in developing countries are speculated to suffer the consequences due to economic deprivation and high cost of treatment. The prevalence of CKD is highly variable in different parts of the world, due to various environmental, ethnic, socioeconomical, and rural-urban differences. It has become very important for the developing countries to understand the true nature of the disease and its prevalence, rather than to hypothesize or make supposition on the bases of Western data. It is imperative to understand the risk factors in our region or country. Few studies have reported that the prevalence of CKD in Pakistan and its risk factors. Through the internet, we searched the terms prevalence of CKD, and included articles that discussed the CKD prevalence in different regions. We reviewed all studies along with the global as well as regional data to have better insight into the problem.

Risk factors of hospitalization among chronic kidney disease patients in tertiary care hospitals - A single-center experience.

Chronic kidney disease (CKD) affects health and life of patients. They confront anemia, hypertension, infections and cardiovascular disease. Due to these health issues, they are at risk of repeated hospitalizations. The risk factors which propel them to hospitalize are important to know, and by controlling these factors, we can impede preventable hospitalization. This case-control study included 1050 adult CKD patients, conducted in two tertiary care hospitals of Karachi. Variables included were age, gender, ethnicity, area of residence, marital status, education smoking status, comorbids, blood pressure, type of angioaccess, hemodialysis (HD) status, stage of CKD, activity level, and laboratory parameters. Two predicted models using multivariable logistic regression analysis were established to evaluate the effect of factors leading toward hospitalization. Patients with ischemic heart disease had 3.56 [95% confidence interval (CI): 2.14-5.9] times higher rate of admission. The nonactive and moderately active patients were admitted 3.8 and 2.26 times more respectively as compared to the active patients (P <0.001). Patients with HD venous catheter were admitted 33.43 (95% CI: 12.45-89.81) times more than patients without any angioaccess. All laboratory parameters had highly significant effect on admission (P <0.001), odds ratio for low albumin, low hemoglobin, and high total leukocyte count were 6.87(95% CI: 4.45-10.6), 4.2 (95% CI: 2.73-6.57) and 7.9 (95% CI: 4.93-12.66) respectively. In conclusion, cardiovascular disease was observed as the most important risk factor of hospitalization for CKD patients. The other plausible risk factors were late referral to nephrologist, low activity level anemia, and hypoalbuminemia.

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.

Clinical variables differentiating diabetic from nondiabetic kidney disease in patients with diabetes: A single-center study.

Patients with diabetes may have kidney diseases other than the diabetic kidney disease. Kidney biopsy is the investigation of choice when this is suspected. This retrospective analysis included all patients known to have diabetes mellitus (DM) and who had a kidney biopsy at our center between 1998 and 2014. The aim of this study was to assess if an association exists between the clinical factors on the presence or absence of diabetic nephropathy (DNP). A total number of 206 patients were included in our study. The association between the diabetic retinopathy (DRP) and DNP was high (P = 0.001). We found that the DRP is highly specific for the presence of DNP [89.7% (78 out of 87)] whereas sensitivity of DRP for DNP was 56.3% (67 out of 119). Among other factors, only duration of DM showed a significant association (P = 0.005) (odds ratio: 1.1085 and confidence interval: 1.025-1.149) with the development of DNP. We conclude that the absence of DRP is strongly associated with the presence of nondiabetic renal disease while the presence of DRP has a low sensitivity for the presence of DNP.

Analysis of renal diseases detected in renal biopsies of adult patients: A single-center experience.

Renal biopsy is crucial while evaluating for the diagnosis of glomerular, vascular, tubulointerstitial, and genetic diseases. It gives vital information which helps in estimating the disease prognosis, progression, and management. This is the retrospective analysis of all adult patients aged above 18 years, who underwent percutaneous renal biopsy at The Kidney Center Post Graduate Training Institute, Karachi, over a duration of 18 years, i.e., January 1, 1996, to December 2013. Renal graft biopsies and those which were inadequate were excluded from analysis. Of the1962 biopsies performed, we included 1521 biopsies in our assessment. The mean age of the population was 38 ± 15.26 years (range 18-88 years). There were 920 (60.5%) males and 601 (39.5%) females. The most common clinical indication of kidney biopsy was nephrotic syndrome, i.e., 741 (45.7%), followed by chronic kidney disease, 253 (16.6%); acute renal failure, 184; (12.1%) and rapidly progressive glomerulonephritis (GN), 124 (8.2%). Primary GN was found in the majority of the patients, 984 (64.7%), followed by secondary GN in 249 (16.4%), tubulointerstitial disease in 224 (14.7%), and vascular disease in 64 (4.2%). In primary GN, focal segmental glomerulosclerosis was the most common histopathological diagnosis in 297 (19.5%) patients, followed by MGN in 224 (14.7%), chronic GN in 98 (6.4%), crescentic GN in 93 (6.1%), minimal change disease in 87 (5.7%), membranoproliferative glomerulonephritis in 58 (3.8%), and postinfection glomerulonephritis in 53 (3.5%) patients. This study shows that focal segmental glomerulosclerosis is the most common lesion in renal biopsy in the young age group followed by membranous nephropathy. Diabetic nephropathy and chronic interstitial nephritis were dominant secondary pathological lesions in older age group, whereas lupus nephritis was the most common secondary disease in young age females.

Clinical and Biochemical Parameters of Hemodialysis Patients Before and During Islamic Month of Ramadan.

INTRODUCTION: Month of Ramadan bring many changes in life style, especially the diet of Muslims all over the world among both fasting and nonfasting individuals. Hemodialysis patients are kept on restricted diet because of fluid and electrolytes imbalance. The aim of this study was to compare changes in the clinical and biochemical parameters in fasting and nonfasting hemodialysis patients during the Ramadan. MATERIALS AND METHODS: In a longitudinal study, we recruited 282 patients who were on maintenance dialysis for more than 3 months. Measurements included body weight, blood pressure, serum potassium, serum albumin, and serum phosphorus at the beginning and during the last week of Ramadan. RESULTS: There were 252 patients who were not fasted while 34 patients were those who fasted during the Ramadan. In the nonfasting hemodialysis patients, serum albumin significantly increased at the end of Ramadan (P < .001), while serum phosphorus levels (P = .004) and diastolic blood pressure (P = .002) showed a decrease as compared with the measurements before Ramadan. In the fasting group, only serum albumin had a significant increase (P < .001) during Ramadan, while other parameters were not significantly different between the two measurements. CONCLUSIONS: Changes in dietary pattern and content during the Ramadan is safe in terms of electrolyte balance and blood pressure changes for patients on hemodialysis. It is also safe for those patients who want to fast during this month.

Type of immune and complement deposits and response of immunosuppressive treatment on Membranoproliferative Glomerulonephritis -- a single centre experience.

OBJECTIVE: To see the response of steroid and cyclophosphamide if membranoproliferative glomerulonephritis is classified by pattern of immune and complement deposits. METHODS: The retrospective study was conducted at The Kidney Centre, Karachi, and comprised patients treated for membranoproliferative glomerulonephritis between 1996 and 2013. Records of patients who were not treated with immunosuppressive medications were excluded. Patients were classified according to the types of immune deposits; one group had patients with only Complement factor 3 deposits, and the other with Complement factor 3 and immunoglobulin deposits. The effect of steroid alone and steroid with cyclophosphamide was observed on two histological patterns, according to the severity of kidney dysfunction and degree of interstitial fibrosis. SPSS 17 was used for statistical analysis. RESULTS: Of the 54 patients, 31(57%) were males and 23(42%) were females, with an overall mean age of 30.26±15.41 years. Group with Complement factor 3deposits had 17(31%) patients, while that with Complement factor 3 and immunoglobulin had 37(68%). Both groups were similar in terms of clinical and laboratory parameters (p>0.05). Both groups showed better response when treated with steroid and cyclophosphamide: 8/9(88.9%) vs. 3/8(37.5%) in Complement factor 3 only; and 10/15(66.7%) vs. 12/22(54.5%) in Complement factor 3 with immunoglobulin. Increasing severity of interstitial fibrosis (p=0.014) and presence of renal dysfunction (p=0.001) hampered the response. After adjusting the confounders, the odds ratio of response was 4.654(95%confidence interval: 0.957-22.63) in patients who received the treatment with steroid and cyclophosphamide compared to steroid alone. CONCLUSIONS: Steroids and cyclophosphamide together have a beneficial role if treatment is initiated early in the course of the disease.