The 25-hydroxyvitamin D level in Kidney Transplant Recipients and Its Association With Renal Function and Other Cardio-Metabolic Risk Markers.

BACKGROUND: Vitamin D is the main hormone that plays a critical role in controlling mineral homeostasis. Transplant recipients frequently have altered levels of 25-hydroxyvitamin D (25[OH] D) and 1, 25-hydroxyvitamin (1, 25[OH] D). OBJECTIVES: To explore the status of vitamin D level in renal allograft recipients and its association with renal function and cardio-metabolic risk markers. METHODS: One hundred two adult kidney transplant recipients (KTRs) were included. Clinical history and information about transplantation and immunosuppression were recorded. Blood and urine samples were collected for relevant laboratory tests, including chronic kidney disease (CKD)-mineral and bone disorder markers (Ca, PO4, and 25[OH] D). RESULTS: The mean age was 35 ± 8 years, with a male/female ratio of 89/11%. The transplant duration was 34 ± 26 (4.5-112) months. All donors involved were living-related: fathers comprised 44%, wives 16%, sisters 13%, mothers 11%, and the others 16% (ie, brothers, sons, daughters, uncles, aunts). The immunosuppression regimen included prednisolone and tacrolimus in all, with mycophenolate mofetil in 96%. The estimated glomerular filtration rate showed CKD distribution from stage 1 to 5 in 6%, 29%, 44%, 15%, and 6%, respectively. Vitamin D level was lower in 22% (<20 ng/mL), insufficient (20-30 ng/mL) in 48%, and adequate (>30 ng/mL) in 30%. We compared different clinical and laboratory variables in 3 different vitamin D groups but found no difference in cardio-renal risk factors (P = Not Significant). Similarly, no correlation was seen between vitamin D levels and other clinical and metabolic factors. CONCLUSION: According to conventional cutoffs, the vitamin D (25[OH] D) level is inadequate in 70% of renal allograft recipients. The hormone level has no apparent association with renal function and major cardio-metabolic risk factors.

Quality of Life Is Improved in Renal Transplant Recipients Versus That Shown in Patients With Chronic Kidney Disease With or Without Dialysis.

OBJECTIVES: Health-related quality of life is increasingly used as an important measurement of treatment outcome. Here, quality of life parameters in renal transplant recipients were evaluated and compared with patients with chronic kidney disease on maintenance hemodialysis and with those who were not on dialysis. MATERIALS AND METHODS: This cross-sectional study included patients seen at a number of tertiary renal care hospitals (there were 15 renal transplant recipients, 20 patients on maintenance hemodialysis, and 28 patients with chronic kidney disease not on dialysis). Forty healthy individual were also included as the control group. Different biochemical parameters were analyzed. Quality of life was assessed with the KDQOL-SF-36 (version 1.3) questionnaire. RESULTS: Mean age was 39 ± 11 for transplant patients, 43 ± 11 years for patients on hemodialysis, 49 ± 12 years for patients with chronic kidney disease not on dialysis, and 34 ± 11 years for the healthy control group. Distribution of sex was similar. Transplant recipients had higher quality of life scores, with some scores similar to healthy controls patients, like physical function (P = .85) and social function (P = .25). Scores were 100 ± 12, 69 ± 27, 37 ± 28, and 91 ± 10 (P < .001) for physical function; 94 ± 12, 44 ± 17, 30 ± 14, and 69 ± 29 (P < .001) for pain; 99 ± 11, 61 ± 46, 24 ± 15, and 70 ± 28 (P < .001) for social function; and 91 ± 11, 51 ± 13, 40 ± 7, and 66 ± 11 (P < .001) for energy/fatigue in healthy control, chronic kidney disease patients not on dialysis, hemodialysis patients, and transplant recipients, respectively. CONCLUSIONS: Quality of life is poor in patients with chronic kidney disease. However, renal transplant can improve quality of life. Transplant patients showed many quality of life scores similar to healthy individuals.

Experience Managing Adult Patients on Continuous Ambulatory Peritoneal Dialysis in Bangladesh.

Continuous ambulatory peritoneal dialysis (CAPD) is becoming increasingly known to the patients of Bangladesh, and patient numbers are increasing. Here, we report our experience and clinical outcomes in this field.Our analysis included all CAPD patients managed in a tertiary care hospital in Bangladesh between 2003 and 2015. All patients received a Tenckhoff double-cuff catheter by mini-laparotomy, and twin bags were used in most patients. In acute cases, regular exchanges were started manually with small-volume dwells the same or the next day.During the study period, 500 patients (mean age: 62 ± 18 years; 62% men; 86% percent with diabetes) were managed. Selection of CAPD was made by choice (47%) or for hemodynamic instability (32%), remote residence (17%), or poor vascular access (4%). Total duration of follow-up was 9364 patient-months (range: 1 - 78 months). The peritonitis rate was 1 episode in 30 patient-months. Fewer than 5% of patients required catheter removal. Similarly, the percentages of catheter tip migration and fluid leak were at the lower end. Patient survival was 68%, 48%, 38%, 22%, and 8% at 1, 2, 3, 5, and 7 years. Deaths were mostly attributable to vascular events.In a population with predominantly diabetic patients, CAPD was shown to be a viable mode of renal replacement therapy. The rates of peritonitis and catheter-related complications were low. Survival in the initial years can be considered acceptable.

Spectrum of organisms causing peritonitis in peritoneal dialysis patients--experience from Bangladesh.

In the present study, organisms responsible for peritonitis and their sensitivity to antibiotics were evaluated in peritoneal dialysis (PD) patients in Bangladesh. We collected PD effluent from 100 peritonitis cases and sent samples to the laboratory for Gram stain and cytology. Cultures used direct inoculation of PD fluid in plate media and broth media simultaneously. Organisms were isolated by Gram stain in 60% of cases. Cell counts showed a mean of 700 (range: 90-7000) white blood cells per milliliter Plate media yielded 33% growth, and broth media, 67% growth. In continuous ambulatory PD, 77% samples were culture-positive; the organisms isolated were gram-positive bacteria in 41% of cases, gram-negative bacteria in 52%, and fungus in 7%. In intermittent PD, only 43% samples were culture-positive; the isolated organisms were gram-positive bacteria in 18% cases and gram negative bacteria in 82%. Gram-positive organisms (Staphylococcus and Streptococcus species) were sensitive to vancomycin and rifampicin; moderately sensitive to ciprofloxacin, ceftriaxone, and ceftazidime; and resistant to ampicillin, cloxacillin, and cephalexin. Gram-negative organisms (Escherichia coli, Klebsiella species) were sensitive to imipenem and aztreonam, and moderately sensitive to ciprofloxacin, ceftriaxone, ceftazidime, and gentamicin. Pseudomonas species were sensitive to aztreonam and ceftazidime, and moderately sensitive to ciprofloxacin, ceftriaxone, and gentamicin. Gram-negative organisms were predominantly responsible for peritonitis in PD patients, and before culture results are received, combined empiric therapy with vancomycin and imipenem or aztreonam may be started.

Outcome of peritoneal dialysis and hemodialysis in elderly patients with diabetes: early experience from Bangladesh.

In the present study, we analyzed the short-term outcome of continuous ambulatory peritoneal dialysis (PD) and hemodialysis (HD) in a group of elderly Bangladeshi patients with diabetes. Over a period of 2 years, we tracked various parameters in 60 patients on maintenance dialysis (25 on PD, 35 on HD). Mean age of the patients was 62 +/- 12 years (PD) and 57 +/- 8 years (HD), p < 0.03. Pre-dialysis systolic blood pressures (SBP) were 156 +/- 12 mmHg and 160 +/- 15 mmHg, and diastolic blood pressures (DBP) were 86 +/- 7 mmHg and 84 +/- 6 mmHg, both p = nonsignificant (NS). Pre-dialysis serum creatinine (SCr) levels were 1036 +/- 139 micromol/L and 1028 +/- 408 micromol/L, and daily urine volumes (UV) were 1.1 -/+ 0.4 L and 1 +/- 0.1 L, both also p=NS. At the end of the 2 years, durations of dialysis were 14 +/- 8 months (PD) and 13 +/- 12 months (HD), p=NS; SBPs were 142 +/- 15 mmHg and 155 +/- 18 mmHg, p < 0.004; DBPs were 81 +/- 6 mmHg and 80 +/- 7 mmHg, p=NS; and SCr levels were 538 +/- 154 micromol/L and 578 +/- 195 micormol/L, p=NS. The daily UVs had declined to 0.7 +/- 0.3 L and 0.3 +/- 0.3 L (p < 0.001) after periods of 12 +/- 7 months and 7 +/- 5 months (p < 0.001) respectively. During the study period, mortality in the PD group was 60% and in the HD group was 43% (p=NS). We conclude that elderly diabetic patients on PD have better control of blood pressure and maintain residual renal function longer than do similar patients on HD; at the same time, mortality in the two groups is comparable.

Outcome of continuous ambulatory peritoneal dialysis in a group of elderly patients from Bangladesh.

In the present study, we evaluated the clinical course and outcome of chronic peritoneal dialysis (PD) in a group of elderly patients. We enrolled 60 elderly patients (37 men, 23 women) starting PD over a 4-year study period and assessed outcomes. The mean age of our patients was 61 +/- 7 years; mean PD duration was 16 months (range: 3 - 40 months). Primary diseases were mainly diabetic nephropathy (54%) and glomerulonephritis (20%). In most patients, the PD modality was chosen because of cardiac instability. Complications during PD included peritonitis (1 episode per 9 patient-months) and exit-site infection (1 episode per 26 patient-months). Technique survival was 89% at 1 year. Patient survival was 83% and 32% at 1 and 4 years respectively. The most frequent causes of death were cerebrovascular accident, cardiac complications, and sepsis. We also compared predialysis parameters to final parameters for 20 deceased patients. Mean age in this group was 62 +/- 8 years, and mean PD duration was 13 +/- 8 months. Body mass index (BMI) was 23 +/- 3 kg/m2 predialysis versus 22 +/- 3 kg/m2 at the end of dialysis (p < 0.01); residual renal creatinine clearance was 4.4 +/- 2 mL/min versus 2.3 +/- 2 mL/min (p < 0.003), and weekly total Kt/V was 2.1 +/- 0.3 versus 1.8 +/- 0.3 (p < 0.002). Albumin showed positive correlations with BMI (r = 0.40, p < 0.02) and with creatinine (r = 0.40, p < 0.01). We conclude that survival of elderly patients on continuous ambulatory peritoneal dialysis is reasonable in the first year, and that further improvement may be achieved by initiating dialysis early, by increasing the dialysis dose, and by improving the patients' nutrition status.