DIALYSIS PRACTICE PATTERN IN PATIENTS UNDERGOING HEMODIALYSIS IN A TERTIARY AND A PRIVATE HOSPITAL

Objective: To evaluate the dialysis practice pattern in chronic kidney disease patients undergoing hemodialysis in a tertiary and a private hospital Methods: A prospective observational study of six months duration was carried out in 158 CKD patients on hemodialysis for a minimum period of one month. Data such as socio-demographic, clinical characteristics and dialysis practice details were captured from the patient’s medical records into the pre-designed Patient Proforma. The collected data were analysed. Results: Majority of respondents were male (67.09%), more than 60 y of age (32.28 %), married (89.24%). Hypertension (26.51%, 17.33%) was found to be the leading cause of CKD in a tertiary and private hospital. In the tertiary hospital, 78.31% of patients were undergoing twice-weekly hemodialysis, whereas in the private hospital thrice weekly (50.67%) hemodialysis was common. About 51.81% of patients in the tertiary and 58.67% in the private hospital was undergoing hemodialysis for 1-5 y with Arterio-Venous Fistula (59.04%, 94.67%) as the permanent vascular access (P<0.001). Conclusion: This study shows that hypertension was the leading cause of CKD in both hospitals. In the tertiary hospital twice weekly hemodialysis with arteriovenous fistula (AVF) and Permanent Catheter (IJV), were both preferred as the permanent vascular access. Whereas in the private hospital majority were undergoing thrice weekly hemodialysis and AVF was highly preferred

Clinical course and outcomes of COVID-19 in kidney transplant recipients

Introduction: Kidney transplant recipients (KTR) are at increased risk of morbidity and mortality due to coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics and outcomes of COVID-19 in KTR. Methods: We reviewed the clinical profile, outcomes, and immunological responses of recipients admitted with COVID-19. We determined the risk factors for mortality and severe COVID-19. Results: Out of 452 recipients on follow-up, 60 were admitted with COVID-19. Prevalent comorbidities were hypertension (71%), diabetes (40%), lung disease (17%). About 27% had tuberculosis. The median Sequential Organ Failure Assessment score at presentation was 3 (interquartile range [IQR] 1–5). There was a high incidence of diarrhea (52%) and anemia (82%). Treatment strategies included antimetabolite withdrawal (85%), calcineurin inhibitor decrease or withdrawal (64%), increased steroids (53%), hydroxychloroquine (21%), remdesivir (28.3%), and tocilizumab (3.3%). Severe COVID-19 occurred in 34 (56.4%) patients. During a median follow-up of 42.5 days (IQR 21–81 days), 83% developed acute kidney injury (AKI) and eight (13%) died. Mortality was associated with the baseline graft dysfunction, hypoxia at admission, lower hemoglobin and platelets, higher transaminases, higher C reactive protein, diffuse radiological lung involvement, hypotension requiring inotropes, and Kidney Diseases Improving Global Outcomes (KDIGO) stage 3 AKI (univariate analysis). Around 57% of patients remained RT-PCR positive at the time of discharge. By the last follow-up, 66.6% of patients developed IgM (immunoglobulin M) antibodies and 82.3% of patients developed IgG antibodies. Conclusion: COVID-19 in kidney transplant recipients is associated with a high risk of AKI and significant mortality