scholarly journals Prevalence, clinical presentation and outcome of tuberculosis in patients with chronic kidney disease at a tertiary care hospital in Nepal

2019 ◽  
Author(s):  
Ravi Ranjan Pradhan ◽  
Mahesh Raj Sigdel
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Tertiary Care ◽  
University Teaching ◽  
Sputum Smear ◽  
Renal Transplant Recipients ◽  
Care Hospital ◽  
Institute Of Medicine ◽  
Clinical Presentations ◽  
Ckd Stage

Abstract Background: Tuberculosis (TB) is a serious public health threat in low- and middle-income countries like Nepal. Chronic kidney disease (CKD) patients are at higher risk of developing new infection as well as reactivation of TB. We aimed to determine the prevalence, clinical presentations, and outcome of TB in patients with CKD in Nepal. Methods: A hospital-based cross-sectional study was performed at Tribhuvan University Teaching Hospital (TUTH), a tertiary level referral centre in Kathmandu, Nepal. We included patients older than 16 years with the diagnosis of CKD stage 3, 4, 5, and 5D (CKD 5 on maintenance dialysis); renal transplant recipients and patients living with HIV/AIDS were excluded. Tuberculosis was diagnosed based on clinical, radiological and laboratory findings. Prior written informed consent was obtained. Approval was obtained from Institutional review Board of Institute of Medicine. Data entry and statistical analysis were performed using SPSS v21. Results: A total of 401 patients with CKD were included in the study (mean age, 50.92 ±17.98 years; 64.8% male). The prevalence of TB in CKD patients was found to be 13.7% (55), out of which 49 were newly diagnosed cases. Most common clinical presentations of TB in CKD were anorexia (85.7%), fever (83.7%), weight loss (51%), and cough (49%). Thirty eight patients (69.1 %) had extrapulmonary TB (EPTB), 12 (21.8%) had pulmonary TB, 3 (5.5%) had disseminated TB and 2 (3.6%) had miliary TB. Only 4.1% cases were sputum smear positive. Pleural effusion (34.2%) was the most common EPTB. At 2 months of starting anti-tubercular therapy, 29 patients out of the 49 newly cases of TB (59.2%) had responded to therapy. Mortality at 2 months was 28.6% (14 died amongst 49 patients). Four out of 49 patients (8.2%) didn’t improve, and 2 (4%) patients were lost to follow up. Conclusion: Prevalence and mortality of TB was higher in cohort of CKD. Special attention must be given to these people for timely diagnosis and treatment as the presentation is different and diagnosis can be missed.

scholarly journals Prevalence, Clinical Presentation, and Outcome of Tuberculosis in Patients with Chronic Kidney Disease at a Tertiary Care Hospital in Nepal

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Ravi R. Pradhan ◽  
Mahesh Raj Sigdel
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Tertiary Care ◽  
University Teaching ◽  
Sputum Smear ◽  
Renal Transplant Recipients ◽  
Care Hospital ◽  
Newly Diagnosed ◽  
Clinical Presentations ◽  
Ckd Stage

Background. Tuberculosis (TB) is a serious public health threat in low- and middle-income countries like Nepal. Chronic kidney disease (CKD) patients are at higher risk of developing new infection as well as reactivation of TB. We aimed to determine the prevalence, clinical presentations, and outcome of TB in patients with CKD in Nepal. Methods. A hospital-based cross-sectional study was performed at Tribhuvan University Teaching Hospital (TUTH), a tertiary level referral centre in Kathmandu, Nepal. We included patients older than 16 years with the diagnosis of CKD stage 3, 4, 5, and 5D (CKD 5 on maintenance dialysis); renal transplant recipients and patients living with HIV/AIDS were excluded. Tuberculosis was diagnosed based on clinical, radiological, and laboratory findings. Prior written informed consent was obtained. Approval was obtained from the Institutional Review Board of the Institute of Medicine. Data entry and statistical analysis were performed using SPSS v21. Results. A total of 401 patients with CKD were included in the study (mean age, 50.92 ± 17.98 years; 64.8% male). The prevalence of TB in CKD patients was found to be 13.7% (55), out of which 49 were newly diagnosed cases. The most common clinical presentations of TB in CKD were anorexia (85.7%), fever (83.7%), weight loss (51%), and cough (49%). Thirty-eight patients (69.1%) had extrapulmonary TB (EPTB), 12 (21.8%) had pulmonary TB, 3 (5.5%) had disseminated TB, and 2 (3.6%) had miliary TB. Only 4.1% of cases were sputum smear positive. Pleural effusion (34.2%) was the most common EPTB. At 2 months of starting antitubercular therapy, 29 patients out of the 49 newly diagnosed cases of TB (59.2%) had responded to therapy. Mortality at 2 months was 28.6% (14 died amongst 49 patients). Four out of 49 patients (8.2%) did not improve, and 2 (4%) patients were lost to follow-up. Conclusion. Prevalence and mortality of TB were higher in patients with CKD. Special attention must be given to these people for timely diagnosis and treatment as the presentation is different and diagnosis can be missed.

scholarly journals Evaluation of role of heart rate variability with holter monitoring in chronic kidney disease

2020 ◽  
Vol 8 (6) ◽  
pp. 2188
Author(s):  
Naveen Reddy Avula ◽  
Tusahr Dighe ◽  
Atul Sajgure ◽  
Charan Bale ◽  
Pavan Wakhare
Keyword(s):  
Chronic Kidney Disease ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Kidney Disease ◽  
Kidney Diseases ◽  
Tertiary Care ◽  
Holter Monitoring ◽  
Stage Iii ◽  
Care Hospital ◽  
Ckd Stage

Background: Chronic kidney disease is prevalent disease even in absence of diabetes and hypertension in 12% adults over 65 yrs of age. Autonomic imbalance is not studied in detail which could be a risk factor for chronic kidney disease.Methods: This Study was observational study in a tertiary care Hospital in pune, india and was conducted for a period of 1 year with sample size of 52. All subjects were known cases of chronic kidney disease from stage III to VD. All individuals of age >18yrs and eGFR ≤60ml/min/1.73m2 according to CKD- EPI equation were included in the study and who were not giving consent were excluded. 24 hrs Holter monitoring was done in stages from ckd stages III to V, for ckd stage VD on both Hemodialysis day and Non hemodialysis. Analysis was done using SPSS version 20 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software program. The paired t test, analysis of variance (ANOVA) and Chi-square test were used. Level of significance was set at p≤0.05.Results: In this study when Heart rate variability (HRV) parameters were compared in different stages of ckd from stage III to VD (on Hemodialysis day) SDNN, SDNN Index were found to be statistically significant and on non Hemodialysis day SDNN Index was found to be statistically significant. In each subgroup of ckd stage V when diabetic subjects were compared with non-diabetic subjects, HRV parameters like ratio of P/S which was found to be low and significant in ckd stage V diabetic subjects.Conclusions: Chronic kidney disease itself can affect the HRV parameters. Causal relationship between HRV and chronic kidney diseases can be vice versa and further needs larger and prospective studies.

scholarly journals Hyponatremia in hospitalized patients with chronic kidney disease; aetiology, treatment, and outcome, in a tertiary care hospital, Dubai, UAE

2021 ◽  
Vol 9 (4) ◽  
pp. 943
Author(s):  
Fakhriya Alalawi ◽  
Ayman Aly Seddik ◽  
Hussain Yousif ◽  
Mohammad Railey ◽  
Amna Alhadari
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Sodium ◽  
Sodium Level ◽  
Demographic Data ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Ckd Stage

Background: Hyponatremia is common among hospitalized patients. Unfortunately, articles describing the management of profound hyponatremia (serum sodium <125 mEq/l) in the background of kidney disease are scarce. This review focuses on the incidence, prevalence, patient characteristics, and clinical features among hospitalized chronic kidney disease (CKD) patients with particular attention to CKD stage 3 to 5.Methods: 71 adult patients with CKD stage 3 to 5 and had presented with profound hyponatremia (serum sodium <125 mEq/l) were included. Patient demographic data, laboratory parameters and treatment received were recorded. The primary endpoint was the development of central nervous syste (CNS) manifestations, while the secondary outcomes included early mortality (death within 30 days).Results: 97 episodes of hyponatremia were recorded in 71 patients. 35 patients (49%) were UAE national and 53.5% patients were females. 52% were in CKD stage-5 refusing dialysis. Diabetic nephropathy was the underlying cause in 66%. The initial Sodium level upon admission ranged from 107-125 mEq/l, with a mean±standard deviation (SD) value of 117.7±4.54 mEq/l. The correction of hyponatremia had ranged between 24 hours in 60% of the patients to 96 hours. Diuretics were used in conjunction with the saline in 85%. Hospital stay ranged between 2-58 days (average 11.7 days). No CNS symptoms were recorded in any of the treated patients. Three patients had died (within 30 days) of sepsis of different sources.Conclusions: Management of hyponatremia in CKD patients remains challenging and should be directed to the underlying cause. Yet, complex patients with advanced CKD particularly in concurrence with heart failure might represent a medical dilemma. Administering hypertonic saline in different mixed concentrations depending on the volume status of the patients appear to be safe, efficient, and suitable for high-risk CKD patients while monitoring Sodium level carefully.

scholarly journals Attributable causes of chronic kidney disease in adults: a five-year retrospective study in a tertiary-care hospital in the northeast of the Malaysian Peninsula

2015 ◽  
Vol 133 (6) ◽  
pp. 502-509 ◽  
Author(s):  
Muhammad Salman ◽  
Amer Hayat Khan ◽  
Azreen Syazril Adnan ◽  
Syed Azhar Syed Sulaiman ◽  
Khalid Hussain ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Retrospective Study ◽  
Kidney Disease ◽  
Hospital Admissions ◽  
Tertiary Care Hospital ◽  
Obstructive Uropathy ◽  
Adult Population ◽  
Tertiary Care ◽  
Care Hospital ◽  
Ckd Stage

ABSTRACT CONTEXT AND OBJECTIVE: Chronic kidney disease (CKD) is an escalating medical and socioeconomic problem worldwide. Information concerning the causes of CKD, which is a prerequisite for reducing the disease burden, is sparse in Malaysia. Therefore, this study aimed to evaluate the attributable causes of CKD in an adult population at a tertiary referral hospital. DESIGN AND SETTING: Retrospective study at Hospital Universiti Sains Malaysia (HUSM). METHODS: This was an analysis based on medical records of adult patients at HUSM. Data regarding demographics, laboratory investigations, attributable causes and CKD stage were gathered. RESULTS: A total of 851 eligible cases were included. The patients' mean age was 61.18 ± 13.37 years. CKD stage V was found in 333 cases (39.1%) whereas stages IV, IIIb, IIIa, and II were seen in 240 (28.2%), 186 (21.9%), 74 (8.7%) and 18 (2.1%), respectively. The percentage of CKD stage V patients receiving renal replacement therapy was 15.6%. The foremost attributable causes of CKD were diabetic nephropathy (DN) (44.9%), hypertension (HPT) (24.2%) and obstructive uropathy (9.2%). The difference in the prevalence of CKD due to DN, HPT and glomerulonephritis between patients ≤ 50 and > 50 years old was statistically significant. CONCLUSION: Our results suggest that DN and HPT are the major attributable causes of CKD among patients at a Malaysian tertiary-care hospital. Furthermore, the results draw attention to the possibility that greater emphasis on primary prevention of diabetes and hypertension will have a great impact on reduction of hospital admissions due to CKD in Malaysia.

scholarly journals Evaluation of carotid intima media thickness and associated risk factors in patients with chronic kidney disease: a cross sectional study

2019 ◽  
Vol 6 (2) ◽  
pp. 526
Author(s):  
Mote Srikanth ◽  
Jeyapalan Kuppusamy ◽  
Hemachandar Radhakrishnan ◽  
Arun Prasath Palamalai
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
P Value ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ckd Stage

Background: Chronic kidney disease is distinguished by progressive loss of kidney function over a period of years in the end leading to irreversible kidney failure. CKD is a significant prognosticator of cardiovascular disease. Atherosclerosis is common in patients with risk factors associated with chronic kidney disease.Methods: It was a cross sectional study on CKD patients in a tertiary care hospital. About 90 CKD stage 3-5 patients aged above 18 years were enrolled in the study. Serum lipid profile, RFT, serum calcium, phosphorous, and BP were estimated among all the patient. Patient risk factors were noted and CIMT levels were compared accordingly.Results: Out of 90 patients, males were predominant. There was a significant positive correlation between stage 5 and CIMT (P value <0.001). Mean CIMT was higher in patients with type 2 Diabetes. Patients with higher phosphorous the mean CIMT was significantly higher.Conclusions: The CIMT is early marker for atherosclerosis. Author observed it was significantly higher in patients with stage 3 and 5 CKD. CIMT is a non- invasive marker which should be done in all patients with CKD which is cost effective.

MO229PROFILE OF TUBERCULOSIS AND ITS MANAGEMENT IN CHRONIC KIDNEY DISEASE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Divya Datta ◽  
Ravindra Attur Prabhu ◽  
Indu Ramachandra Rao ◽  
Srinivas Vinayak Shenoy ◽  
Shankar Prasad Nagaraju ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Adverse Drug Reactions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Drug Reactions ◽  
Case Record ◽  
Incidence And Mortality ◽  
Ckd Stage

Abstract Background and Aims Estimates of Tuberculosis(TB) burden indicate an estimated incidence and mortality of 199 and 32 respectively per 100000 in our country. Risk factors for acquiring TB disease include HIV infection, Diabetes Mellitus, Tobacco consumption and undernutrition. We retrospectively studied profile of TB in Chronic Kidney disease(CKD) in our population. Method Retrospective case record based study of consecutive TB patients visiting a Tertiary care hospital attached to a Medical College diagnosed by standard methods to demonstrate TB bacilli in sputum or affected tissue. CKD was diagnosed based on estimated Glomerular filtration rate less than 60 ml/min/m2 for at least three months. Pattern of TB and adverse drug effects were studied. Statistical analysis was done on SPSS version 20 Results Over ten months, of 746 TB patients seen, 41(5.4%) had CKD, Stage 3b,4 and 5 in 7/41(17.1%), 11(26.8%), 23(56.1%) respectively. Among CKD 24(58.5%) had Diabetes Mellitus, 1(2.4%) HIV and 37(90.2%) hypertension. Pattern of TB is shown in table 1. Adverse drug reactions were significantly higher in CKD 24/41(54.5% vs 17% in non CKD, P &lt; 0.05). Mortality in CKD was 3/41(7.3%) and not significantly higher on multivariable analysis than in those without CKD. Conclusion In this retrospective survey of TB patients CKD constituted 5.4%, was associated with more adverse drug reactions but did not impact on mortality. Pulmonary TB was the common pattern in CKD.

MO515CONSTIPATION IN CHRONIC KIDNEY DISEASE: PREVALENCE AND RISK FACTORS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sourabh Sharma ◽  
Neha Sharma ◽  
Kailash Sharma
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Tertiary Care ◽  
Functional Constipation ◽  
Common Symptom ◽  
Psychological Burden ◽  
Ckd Stage ◽  
Stool Form ◽  
Rome Iv

Abstract Background and Aims Among various gastrointestinal disorders, constipation is one of the most common symptom in chronic kidney disease (CKD). However it is often neglected by nephrologists as self-limiting condition. Constipation impacts quality of life in multiple ways and increases socio-psychological burden. Constipation and associated risk factors have been poorly studied and most studies are retrospective. Method We enrolled CKD stage 3 to 5 patients on regular follow-up with nephrologist from June 2018 to June 2020, at a tertiary care centre in North India. Constipation was defined using Rome IV criteria (Functional constipation) which is composed of six constipation related symptoms, and diagnosis of constipation is established by presence of two or more symptoms for at least 3 months. Patients were also asked to maintain a 7 day prospective stool diary. It consisted of seven day written prospective chart of stool form and frequency. Patients were instructed to record when each bowel movement happened and to mark stool form type for each movement as described in words and pictures on Bristol Stool Form Scale (BSFS). Opioid induced constipation was defined as per Rome IV criteria. The diagnostic criteria is similar to functional constipation, but with requisite that new or worsening symptoms occurred when initiating, changing or increasing opioid therapy. Results Two hundred twenty five patients were studied out of which 59 (26.2%) patients were in CKD stage3, eighty one (36%) patients were in CKD stage4 and 85 (37.8%) patients were in stage5. Out of 85 CKD stage5 patients, 23 (27%) were on dialysis. Mean age of patients was 49.1 years. Out of 225 patients, 135 (60%) were male. Constipation symptoms and diagnosis reported in each stage has been depicted in Table 1. Clinical correlates of constipation has been depicted in Table 2. Conclusion Constipation measured using Rome IV criteria affects around two-third of CKD stage 3-5 patients. Diabetes, hypertension and opioid use has been found to be significantly associated with constipation.

Correlation of Iron Profile with Different Stages of Chronic Kidney Disease in Children Presenting at a Tertiary Care Hospital

2021 ◽  
Vol 15 (8) ◽  
pp. 2013-2016
Author(s):  
Shahid Ishaq ◽  
Muhammad Imran ◽  
Hashim Raza ◽  
Khuram Rashid ◽  
Muhammad Imran Ashraf ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iron Overload ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Tertiary Care ◽  
Transferrin Saturation ◽  
Maintenance Hemodialysis ◽  
Care Hospital ◽  
Iron Profile

Aim: To determine correlation of iron profile in children with different stages of chronic kidney disease (CKD) presenting to tertiary care hospital. Methodology: A total of 81 children with chronic kidney disease stage having glomerular filtration rate (GFR) less than 90 (ml/min/m2) aged 1 – 14 years of either sex were included. Three ml serum sample was taken in vial by hospital duty doctor for serum ferritin level, serum iron, transferrin saturation and total iron binding capacity. The sample was sent to hospital laboratory for reporting. Iron profiling was done evaluating hemoglobin (g/dl), serum iron (ug/dl), serum ferritin (ng/ml), transferrin saturation (%) and total iron binding capacity (ug/dl) while iron load was defined as serum ferritin levels above 300 ng/ml. Correlation of iron profile with different stages of CKD was determined applying one-way analysis of variance (ANOVA). Results: In a total 81 children, 46 (56.8%) were boys while overall mean age was 7.79±2.30 years. Mean duration on hemodialysis was 11.52 ± 9.97 months. Iron overload was observed in 26 (32.1%) children. Significant association of age above 7 years (p=0.031) and residential status as rural (p=0.017) was noted with iron overload whereas iron overload was increasing with increase in stages of CKD (p=0.002). Hemoglobin levels decreased significantly with increase in stages of CKD (p<0.001). Serum iron levels increased significantly with increase in the CKD stages (p=0.039). Serum ferritin levels were increasing significantly with the increase in CKD stages (p=0.031). Transferrin saturation also increased significant with increase in CKD stages (p=0.027). Conclusion: High frequency of iron overload was noted in children with CKD on maintenance hemodialysis and there was linear relationship with stages of CKD and iron overload. Significant correlation of hemoglobin, serum iron, serum ferritin and transferrin saturation was observed with different stages of CKD. Keywords: Iron overload, maintenance hemodialysis, ferritin level.

scholarly journals A study of secondary hyperparathyroidism in patients with chronic kidney disease in a tertiary care hospital

2019 ◽  
Vol 6 (2) ◽  
pp. 271
Author(s):  
Vishnu Shankar H. ◽  
Mahendra Kumar K. ◽  
Jagadeesan M. ◽  
Kannan R. ◽  
Chitrambalam P. ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Study Population ◽  
Chronic Morbidity ◽  
Spss Software

Background: Secondary hyperparathyroidism (SHPT) is one of the less recognized complications in patients with chronic kidney disease (CKD). The prevalence of SHPT in various stages of CKD was evaluated by measuring the levels of intact parathyroid hormone (iPTH).Methods: This cross-sectional study was carried out in 100 CKD patients. Serum creatinine, calcium, phosphorous and iPTH levels were measured and statistical analysis was carried out using the SPSS software (IBM, NY, USA).Results: Among the 100 participants, the mean age (SD) was 59.3 (7.8) years. In our study population, 52% were men and the rest were females. Hypertension (75%) was the most common chronic morbidity. Prevalence of hyperparathyroidism among chronic kidney disease patients was 22% (95% CI: 14.7-30.9%). The prevalence of secondary hyperparathyroidism among dialysis and non-dialysis patients were 30% and 14% respectively which was statistically significant.Conclusions: SHPT is an important complication which is often underdiagnosed. Secondary hyperparathyroidism starts to develop when eGFR falls below 60ml/min. PTH levels starts to rise as the disease progress. Hence it is important for the treating physicians to monitor the PTH levels early in the course of CKD to prevent and treat bone mineral disease.

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