Osmolar gap in hyponatraemia: An exploratory study.

Hyponatraemia has indeed been extensively studied from multiple angles, including volume status, tonicity, and aetiology; however, the specific consideration of the osmolar gap (OG) within the context of hyponatraemia and its potential impact on their overall outcomes received limited attention in research. The current study represents an effort to address this gap in our understanding. This prospective exploratory study was conducted on adults aged 14 years and older at the Indus Hospital, Karachi, from 2017 to 2020. The study involved categorising severity of hyponatraemia and volume status. The osmolar gap (OG) was calculated and categorised as either increased (OG>10) or normal (OG<10). Among the 262 patients included in the study, there were 139 females and 123 males. Elevated OG was observed in 141(53.8%) patients. There were 28 (10.7%) recorded fatalities and majority of these individuals had an elevated OG. These findings underscore the importance for clinicians to consider the osmolar gap when managing patients with hyponatraemia.

Nutritional vitamin D is efficacious for reducing intact parathyroid hormone in chronic kidney disease, a prospective interventional study.

OBJECTIVE: To see the efficacy of oral cholecalciferol administered to chronic kidney disease patients with vitamin D deficiency. Methods: The prospective interventional study was conducted at the Indus Hospital, Karachi, from January 11, 2017, to January 10, 2018, and comprised diagnosed pre-dialysis chronic kidney disease patients of either gender aged >14 years having vitamin D deficiency. Oral vitamin D 50,000IU was given weekly to those who had severe deficiency <10ng/ml, and every other week to those with less severe 10-25ng/ml deficiency for 3 months. Improvement in vitamin D level was checked along with other chronic kidney disease markers every month over the 3-month period. Data was analysed using SPSS 24. RESULTS: Of the 186 patients enrolled, 129(%) completed the study; 76(58.5%) males and 53(40.8%) females. Overall, 105(81.4%) patients achieved normal vitamin D levels after 3 months of treatment. Significant negative but weak correlation of phosphate, creatinine and intact parathyroid hormone levels was found with vitamin D (p<0.05). Significant positive but weak correlation was found between albumin and vitamin D levels (p<0.05). Conclusion: Significant efficacy of oral vitamin D in chronic kidney disease patients was seen.

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 frequency of vitamin D deficiency in chronic kidney disease and its relation with baseline mineral bone markers.

OBJECTIVE: To assess the frequency of Vitamin D deficiency in chronic kidney disease and its association with baseline mineral bone markers in patients visiting nephrology clinics. METHODS: The observational study was conducted at the Indus Hospital, Karachi, from January 2017 to January 2018, and comprised patients of either gender aged >16 years diagnosed with chronic kidney disease stage I-V. The patients were divided into two groups on the basis of severity of vitamin D deficiency. Severe vitamin D deficiency was defined as <10ng/ml, and moderate deficiency ad 10- 25ng/ml. Data was analysed using SPSS 21. RESULTS: Of the 267 patients, 146(54.7%) were males and 189(70.8%) had vitamin D deficiency. Vitamin D-deficient patients were younger than those with normal levels (p=0.044). Serum creatinine was raised in the deficient patients compared to those with normal vitamin D level (p=0.042). Females and currently employed patients were at a higher risk of having vitamin D deficiency (p=0.048, 0.009). There was no si gn ific ant as s ociation between disease stage a nd vitamin D defic ienc y ( p= 0.311). CONCLUSIONS: Vitamin D deficiency was found in a significant proportion of chronic kidney disease patients irrespective of the disease stage. Females, currently employed and young patients were more prone to having vitamin D deficiency.