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.

Reusing dialyzer in low income countries: A good cost saving tactic with complex ethics.

Despite almost universal practice of dialyzer reuse from the earliest days of haemodialysis, reusing dialyzer always remains a controversial issue and several ethical concerns have been raised. Some of the important are safety of reuse over single use, informed consent of the patient, conflict of interest on the part of physician or manufacturer, fiscal responsibility and environmental stewardship. Indeed, at the beginning of this century, there was a drastic shift of practice in favour of single use in developed countries due to availability of biocompatible haemodialyzers, at favourable price. Despite this mega shift, dialyzer reuse is still widely practised in low-income countries. Considering cost inflation and limited medical resources in such countries, dialyzer reuse may be justified as a cost-saving strategy for this part of world. However, it poses the same ethical questions to us which were a matter of debate for the western world in the 1980s and 1990s. This review of literature was planned to revisit and highlight these concerns.

More hostile dyslipidaemia in chronic kidney disease patients on maintenance haemodialysis than on conservative management.

OBJECTIVE: To study the pattern of dyslipidaemia in patients with stage-V chronic kidney disease on conservative management and those on maintenance haemodialysis. METHODS: This comparative observational study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from February to July, 2008, and comprised stage-V chronic kidney disease patients. The patients were divided in two groups. Those who were on conservative management were placed in Group A, and those who were on maintenance haemodialysis were in Group B. Serum total lipid, cholesterol, triglycerides and high-density lipoprotein for both groups were assayed on chemical analyser and low-density lipoprotein was calculated by Friedwald equation. SPSS 17 was used for data analysis. RESULTS: Of the 120 patients, there were 60(50%) in each group. The mean age of patients in Group A was 46.33±14.56 years and in Group B was 43.4±14.1years. Of all, 64(53.3%) were men and 56(46.7%) were women. Mean systolic and diastolic blood pressure was 134±19.58mmHg and 83.6±14.14mmHg in Group A and 129±19.7mmHg and 79.7±12.1mmHg in Group B. Mean serum total lipid was significantly higher (p<0.01) whereas mean serum cholesterol was significantly lower (p<0.01) in Group B. Comparison of mean serum triglycerides between the groups was also statistically significant (p<0.01) and was high in Group B. Mean serum high-density lipoprotein was lower in Group B (p<0.01). The difference between serum low-density lipoprotein levels was statistically insignificant between the groups (p=0.11). CONCLUSIONS: Pattern of dyslipidaemia in patients on maintenance haemodialysis was more hostile than those on conservative management, and posed increased risk of coronary heart disease.

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.