Renal Resistive Index: Revisited.

Introduction Chronic kidney disease (CKD) is universally considered a public health burden and the majority of cases are found to be diabetic at the time of diagnosis. Renal biopsy is the prime modality for the complete evaluation of renal injuries but is invasive. Duplex Doppler sonography can help to determine renal resistive index (RRI), which is an excellent marker for demonstrating dynamic or structural changes of intrarenal vessels. In this study, we evaluated the intrarenal hemodynamic abnormalities with RRI in diabetic and non-diabetic kidney disease patients. Also, RRI was correlated with the established parameters of renal dysfunction, i.e., estimated glomerular filtration rate (eGFR) and other biochemical parameters. Results There was a significant correlation of RRI with eGFR and serum creatinine indicating its role as a Doppler parameter, which can be used as complementary to biochemical parameters. A remarkable difference was noted in the RRI values between diabetic and non-diabetic groups in the early stages of CKD, revealing its ability to arrive at etiopathogenesis in the early stages. The renal resistive index increases in a sequential pattern and is an indicator of declining renal function. Conclusions The addition of sonographic parameters like renal resistive index could help in the complete evaluation of chronic kidney disease in diabetic and non-diabetic groups. A sequential increase in renal resistive index is a better indicator of the progressive worsening of renal function as opposed to an absolute cut-off value.

Impact of Exercise on Fatigue in Patients Undergoing Dialysis in a Tertiary Care Hospital.

Background Chronic kidney disease (CKD) is a current public health problem associated with progression to end-stage renal disease (ESRD), cardiovascular disease, and increased mortality rates. The disease is progressive. It is estimated that there are about 20-25 patients with milder kidney damage for every patient on renal replacement therapy. Physical activity is one of the critical elements for the prevention of chronic diseases and exercises in CKD help to improve muscular strength, cardiorespiratory endurance, overall function, and quality of life. Fatigue can cause an inability to perform exercises and can affect physiological and psychological function. There is a need to analyze the effects of exercises on fatigue in outpatients undergoing dialysis in the Indian rural population. Methods This study was a randomized, controlled, interventional, single-center trial. The participants diagnosed with ESRD and who were on hemodialysis were randomly assigned to group A, the exercise group (EG), which had exercise training during dialysis, and group B, the control group (CG), which had no added exercises during dialysis or at home and followed a standard routine method. The outcome measure of fatigue was evaluated through the total Fatigue Assessment Scale (FAS) score at 0, 12, 24, and 36 weeks. The exercise was pilot tested and planned based on the guidelines and carried out during hemodialysis two days a week. It was followed up with a five-day home exercise program when the patients did not undergo dialysis. Results A total of 48 participants were chosen for the study, of which 30 participants completed 36 weeks of training, with exercise adherence of more than 60%. There was a statistically significant difference in FAS between the two groups (F (3, 84) = 10.513, P < 0.001) at a 95% confidence interval (P < 0.05). Post hoc comparisons between groups at baseline and at 12 weeks indicated that there was no significant difference in FAS (P = 0.271 and P = 0.08), but recorded a significant difference (P = 0.001) at 24 and 36 weeks, respectively, between the EG and CG. Conclusions The results indicate that the intradialytic exercise intervention was effective in reducing the level of fatigue in outpatients undergoing dialysis on a long-term exercise program.

Intensive monitoring of adverse drug reactions in nephrology unit of tertiary care teaching hospital.

Adverse drug reactions (ADRs) are one of the common causes of morbidity and mortality. Renal insufficiency is considered as one of the risk factors for the development of ADR. The study determined the occurrence of ADRs in patients with renal failure and their incidence of hospital admission. The study also evaluated the nature and severity of ADRs. This was a prospective study conducted in the nephrology unit at a tertiary care teaching hospital for a period of nine months. Patients receiving regular hemodialysis and those either referred or admitted to the nephrology ward were included. ADRs were intensively monitored throughout the study. The causality of suspected ADRs was assessed with the WHO probability scale, Naranjo algorithm, and Karch and Lasagna's scale. The predictability and preventability of ADRs were also determined. A total of 45 ADRs were identified in 369 patients; incidence was 12.19%. Nine ADRs (20%) needed hospitalization. A total of 27 (60%) and 17 (37.8%) ADRs were found to be probable and possible, respectively when assessed by the WHO probability scale. On the contrary, 33 (73.3%) and 26 (57.8%) ADRs were possible in causality when assessed by Karch and Lasagna's scale and Naranjo scale, respectively. Most of the ADRs [26 (57.8%)] were predictable in nature. A wide range of ADRs was noticed in patients with renal impairment, and our study has systematically assessed the nature and severity of ADRs.

Correlation of carotid intimal-medial thickness with estimated glomerular filtration rate and cardiovascular risk factors in chronic kidney disease.

Carotid intimal-medial thickness (CIMT) predicts future vascular events in the general population. However, the correlation of traditional cardiovascular risk factors and stages of chronic kidney disease (CKD) with CIMT is not studied extensively. To determine the correlation of CIMT with traditional cardiovascular risk factors like age, body mass index (BMI), dyslipidemia and various stages of CKD patients, CIMT was measured by means of high-resolution B-mode ultrasonography in 70 CKD patients and compared with the 30 healthy controls. The mean CIMT in patients was 0.86 ± 0.21 mm vs 0.63 ± 0.17 mm in healthy age- and sex-matched controls (P <0.001). There was a significant univariate positive correlation between CIMT and age (r = 0.605, P <0.001), BMI (r = 0.377, P = 0.001), total cholesterol (r = 0.236, P ≤0.018) and serum triglyceride (r = 0.387, P ≤0.001). No statistically significant correlation was found between mean CIMT and estimated glomerular filtration rate (eGFR) (r = -0.02, P = 0.30), very low-density lipoprotein and high-density lipoprotein-cholesterol. Atherosclerotic changes very well correlate with the traditional cardiovascular risk factors like age, BMI, serum total cholesterol and serum triglyceride level in CKD patients. Even though CIMT was marginally more in the late stages of CKD patients, no statistically significant correlation was found with CIMT and eGFR.

Effect of nutritional intervention on malnutrition indicators in patients on haemodialysis.

OBJECTIVE: To formulate a nutrient supplement using low cost, commonly available food ingredients and test its efficacy on various nutritional parameters in haemodialysis (HD) subjects. DESIGN: Prospective intervention study. SUBJECTS: 15 subjects who did not have diabetes were recruited for the study. The subjects served as self controls. APPROACH: The subjects received a multi-nutrient formulation for a period of 3 months. Somatic status [weight, mid upper arm circumference (MUAC), mid upper arm muscle circumference (MUAMC), waist and hip measurements], biochemical parameters [blood urea nitrogen (BUN), total iron binding capacity (TIBC),serum levels of creatinine, albumin, triglycerides, sodium, potassium, calcium, phosphorus and high sensitive C-reactive protein(HsCRP)], dietary intake and malnutrition inflammation score (MIS) were assessed. RESULTS: Significant increments (P ≤ 0.01) in anthropometric measurements. Significant increases (P ≤ 0.01) in Hb, BUN, serum creatinine, albumin and total protein and a significant decrease (P ≤ 0.01) in HsCRP and MIS were observed at the end of the study. An increase in baseline food/nutrient intake was also observed. CONCLUSION: Nutritional supplementation designed for haemodialysis, improved their nutritional status in the short term study.