Indian Journal of Nephrology最新文献

Background: Kidney transplant recipients (KTRs) are at higher risk for infections, including parvovirus B19 (PVB19). This virus typically presents within the first-year posttransplant, causing anemia and potentially leading to increased morbidity and graft dysfunction.

Materials and methods: Charts of patients undergoing kidney transplantation between May 2013 and March 2022 were reviewed. Twenty-one patients had PVB19. Their clinical presentation, laboratory parameters, and outcomes were studied. The diagnosis of PVB19 was established by PVB19 DNA Polymerase Chain Reaction (PCR) and bone marrow examination (BME).

Results: Prevalence of PVB19 disease was 1.9% (21/1164) with a median onset time of 39 days posttransplantation. The most frequent clinical symptoms were fatigue reported by 76% of patients, followed by fever (47%), dyspnea (23%), and myalgia (33%). All patients (100%) developed anemia, while leukopenia and thrombocytopenia were observed in 14% and 9.5% of patients, respectively. Graft dysfunction was observed in 61.9% (13/21) patients. Diagnosis was confirmed by PCR in 20 out of 21 patients. One patient had a typical viral inclusion on BME. Immunosuppression, especially antiproliferative, was reduced in all patients. Eight patients received intravenous immunoglobulin, eight received packed cell blood transfusion, and seven received erythropoietin therapy. All patients recovered, with a median time of 30 days for hemoglobin levels to normalize. One patient had graft loss secondary to graft rejection.

Conclusion: PVB19, while uncommon, can be a significant cause of refractory anemia, particularly within the first-year posttransplant. Diagnosing PVB19 infection with PCR is crucial, and the primary treatment involves reducing immunosuppressants, especially antiproliferative agents.

Background: Chronic kidney disease poses significant morbidity on patients and subjects them to stressors in financial, occupational, and social aspects, making them vulnerable to mental health problems. We estimated the prevalence of depression in CKD patients undergoing maintenance hemodialysis (MHD) and evaluated the factors affecting it.

Materials and methods: This cross-sectional survey included 282 patients from four Apex Kidney Care centers, Mumbai. Their mental health was assessed using PHQ-9 survey, a validated questionnaire for identifying depression. Categorical variables were compared using the Chi square test and continuous variables with the Mann Whitney U test. Logistic regression was used for multivariate analysis and odds ratios were calculated.

Results: Females constituted 36.52% of the study population. There was an equal distribution of patients from charitable centers (142 patients) and private centers (140 patients). The current analysis focused on those patients (n = 60) with significant depression i.e. a PHQ-9 score of 10 or greater, and these were compared to the rest of patients (n = 222). In logistic regression, female gender (p = 0.002), catheter as access (p = 0.025), stress of food restriction (p < 0.0001) showed statistically significant positive association, whereas being employed (p = 0.022) showed statistically significant negative association with depression. The distribution of patients with significant depression in both public (21.10%) and private (21.40%) centers was equal.

Conclusion: The prevalence of depression in MHD patients is substantial. Employment status, catheter access, and food restrictions are the modifiable factors influencing mental health. A focused approach on maximizing arterio-venous fistula creation, diet counseling, employment friendly shift adjustments, and mental health counseling can help mitigate this challenge.

Sodium-glucose-cotransporter-2 inhibitors (SGLT2i) and statins are increasingly used for reduction of cardiovascular mortality in type 2 diabetics. Few case studies reported an enhanced risk of rhabdomyolysis with this combination. A 57-year-old man with normal renal functions, developed fatigue and oliguria within three days of dapagliflozin addition to his preexistent rosuvastatin therapy. Investigations revealed severe acute kidney injury (AKI) with elevated serum creatine-phosphokinase (CPK) and myoglobinuria. Renal biopsy depicted severe acute tubular necrosis with interstitial nephritis and ropy myoglobin casts, which confirmed the diagnosis of rhabdomyolysis. Rosuvastatin and dapagliflozin were discontinued. Hemodialysis and oral steroids were prescribed. The AKI recovered within few weeks. Rosuvastatin was rechallenged after two months and his renal functions and CPK levels remained normal. This case demonstrates the incidence of severe rhabdomyolysis when an SGLT2i was added to an existing statin, emphasizing the importance of identifying drug-drug interactions and potential for myotoxicity.

Background: Discovering predictors to reduce morbidity and mortality in chronic kidney disease (CKD) is now a critical global priority. Serum phosphate level is considered to be a potential marker for mortality rate in patients with CKD. Previous studies examined the independent pathogenic role of phosphorus in the development of CKD and dialysis patients but have yielded contradictory findings. This study aims at evaluating the relationship between serum phosphate levels and death rates in pre-dialysis CKD and maintenance of dialysis patients.

Materials and methods: PubMed, Scopus, and Web of Science were searched by using MeSH term keywords. The authors did screening, data extraction, and quality assessment in accordance with the inclusion criteria. STATA 14.2 was used for statistical analyses. The analysis was performed using the random- and fixed-effects model when the heterogeneity was >50% and ≤50%, respectively. For evaluating publication bias, Funnel plots and Egger tests were used.

Results: Eleven original studies between 2005 and 2021 met the eligibility criteria. The overall estimate of unadjusted HR of all-cause mortality each 1 mg/dL increase in the serum phosphate concentration using the random-effects model in pre-dialysis CKD and dialysis patients was 1.33 (95% CI: 0.97, 1.82, I² = 99.1%, P = 0.074), and for adjustment, Hazard ratio was 1.27 (95% CI: 1.15, 1.39, I² = 75.4%, P < 0.001).

Conclusion: The findings showed the association between serum phosphate levels and death rates in pre-dialysis individuals with CKD and dialysis patients.