A multicenter study of malnutrition status in chronic kidney disease stages I-V-D from different socioeconomic groups.

There is a paucity of data on malnutrition in different socioeconomic status in chronic kidney disease (CKD) patients. Hence, this cross-sectional study was undertaken in CKD-ND and CKD-D. The aim of the study was to assess the prevalence of malnutrition in the various stages of CKD among the various socioeconomic groups, namely the low-income groups and the upper-middle-income groups. This is a cross-sectional study conducted among 394 patients. The patient data were obtained from three institutions: Institution 1, Institution 2, and Institution 3. Patients were predominantly from the South Indian population and were between the age groups of 18 and 80 years. Measurements: malnutrition was assessed using anthropometry, body composition monitor, biochemical parameters, and dietary recall. Subjective Global Assessment Scale for nondialyzed patients and Malnutrition-Inflammation Score for dialyzed patients were also collected . As per the CKD stages, we found the percentage of malnutrition to be 7% in Stage III, 14% in Stage IV, 18% in Stage V, and 68% in Stage V-D in the upper-middle-income group, whereas it was 10% in Stage III, 26% in Stage IV, 40% in Stage V, and 93% in Stage V-D in the low-income group. The severity of malnutrition was stratified according to the stages of CKD, and it was found to be higher in progressive stages of CKD among the low-income groups as compared to the high-income groups.

Epidemiology and risk factors of chronic kidney disease in India - results from the SEEK (Screening and Early Evaluation of Kidney Disease) study.

BACKGROUND: There is a rising incidence of chronic kidney disease that is likely to pose major problems for both healthcare and the economy in future years. In India, it has been recently estimated that the age-adjusted incidence rate of ESRD to be 229 per million population (pmp), and >100,000 new patients enter renal replacement programs annually. METHODS: We cross-sectionally screened 6120 Indian subjects from 13 academic and private medical centers all over India. We obtained personal and medical history data through a specifically designed questionnaire. Blood and urine samples were collected. RESULTS: The total cohort included in this analysis is 5588 subjects. The mean ± SD age of all participants was 45.22 ± 15.2 years (range 18-98 years) and 55.1% of them were males and 44.9% were females. The overall prevalence of CKD in the SEEK-India cohort was 17.2% with a mean eGFR of 84.27 ± 76.46 versus 116.94 ± 44.65 mL/min/1.73 m2 in non-CKD group while 79.5% in the CKD group had proteinuria. Prevalence of CKD stages 1, 2, 3, 4 and 5 was 7%, 4.3%, 4.3%, 0.8% and 0.8%, respectively. CONCLUSION: The prevalence of CKD was observed to be 17.2% with ~6% have CKD stage 3 or worse. CKD risk factors were similar to those reported in earlier studies.It should be stressed to all primary care physicians taking care of hypertensive and diabetic patients to screen for early kidney damage. Early intervention may retard the progression of kidney disease. Planning for the preventive health policies and allocation of more resources for the treatment of CKD/ESRD patients are imperative in India.

Screening for latent tuberculosis in refugees with renal failure.

Refugee camps are prone for easy spread of infections of various kinds and tuberculosis (TB) is no exception. Refugees with renal failure are often a vulnerable group because they are immunocompromised due to reasons such as poor nutrition, overcrowding and immune suppression due to renal failure. Latent pulmonary TB is a particular problem in this patient population as it is not easily diagnosed and has immense potential for spread. Tuberculin Skin Test (TST), although easy to perform and is cost-effective, suffers from the limitations of giving false positive results due to cross-reaction with the vaccination. Chest radiography though cheap, has not yet been validated in refugee populations for this purpose. Sputum analysis shows promise due to ease of performing but again has not been validated in refugees. Newer assays such as IF-γ show great promise but needs large scale studies for validation and cheaper assays need to be developed for use in resource poor refugee setting. In short, an ideal tool for effective screening of latent TB in refugees with renal failure is lacking. Future studies are required to identify this ideal tool.

Prevalence of Subclinical Hypothyroidism in Patients with End-Stage Renal Disease and the Role of Serum Albumin: A Cross-Sectional Study from South India.

BACKGROUND/AIM: Subclinical hypothyroidism (SCH) and end-stage renal disease (ESRD) are independent risk factors for cardiovascular mortality. We aimed to study the prevalence of SCH in ESRD patients and assessed its associated risk factors. METHODS: This cross-sectional study was conducted at 2 tertiary-care centers in Chennai, India, over a 3-year period. The study group comprised 137 patients with ESRD on thrice weekly regular maintenance hemodialysis. Free thyroxine (FT(4)) and thyroid-stimulating hormone (TSH) were measured using an electrochemiluminescence immunoassay. SCH was defined as TSH ranging between 4.5 and 10 mIU/l with normal FT(4) (0.93-1.7 ng/dl). Patients with overt hypothyroidism, SCH and overt hyperthyroidism, those on medications affecting thyroid function and pregnant women were excluded from the study. RESULTS: Of 137 ESRD patients (mean age: 43 ± 13.38 years), 107 were males (78.1%), 45 diabetics (32.8%), 127 hypertensives (92.7%), and 38 smokers (27.7%). Prevalence of SCH was 24.8%. In unadjusted (OR: 3.37, 95% CI: 1.91-5.21) and adjusted (for age, gender, HbA(1C), and albumin/creatinine ratio; OR: 3.11, 95% CI: 2.15-4.98) logistic regression analysis, serum albumin was significantly associated with SCH. Further, multiple linear regression identified that for every 1 g/dl drop in serum albumin TSH increased by 4.61 mIU/l (95% CI: 2.75-5.92). CONCLUSION: We observed a high prevalence of SCH in our ESRD patients. Also, serum albumin was significantly associated with SCH in our study.

Association between primary hypothyroidism and metabolic syndrome and the role of C reactive protein: a cross-sectional study from South India.

BACKGROUND: Hypothyroidism (sub-clinical and overt) and metabolic syndrome are recognized risk factors for atherosclerotic cardiovascular disease. This study is an effort to identify the proposed association between these two disease entities and the risk factors involved in this association. METHODS: A cross - sectional study from a tertiary care teaching hospital in Chennai city, South India. 420 patients with metabolic syndrome (NCEP - ATP III criteria) were included in the study group. 406 appropriately age and sex matched controls having no features of metabolic syndrome (0 out of the 5 criteria) were compared with the study group. The study extended over a 5 year period. TSH, FT4 were measured for both the groups using electrochemiluminescence immuno assay. HsCRP was measured for all the patients in the study group. The baseline characteristics between the groups were compared with Student's't' test. Chi-square test was used to analyze the association between metabolic syndrome and hypothyroidism (overt and sub-clinical). Logistic regression analysis was applied to identify the association between hypothyroidism and the patient characteristics in the study group. RESULTS: Of the 420 patients in the study group, 240 were females (57.1%), 180 were males (42.9%) with mean age 51 +/- 9.4 years. Of the 406 patients in the control group, 216 were females (53.2%), 190 males (46.8%) with mean age 49 +/- 11.2 years. In the study group, 92 had sub-clinical hypothyroidism (SCH) (21.9%), 31 were overtly hypothyroid (7.4%) and 297 were euthyroid (70.7%). In the control group 27 patients had sub-clinical hypothyroidism (6.6%), 9 patients had overt hypothyroidism (2.2%) and 370 patients were euthyroid (91.2%). On comparison SCH (P < 0.001) and overt hypothyroidism (P < 0.001) were significantly associated with the study group as compared to the control group. Logistic regression analysis recognized the association between female gender (P = 0.021) and HsCRP (P = 0.014) with sub-clinical hypothyroidism and female gender (P = 0.01) with overt hypothyroidism in the study group. CONCLUSION: Hypothyroidism is associated with metabolic syndrome and females are more at risk. Metabolic syndrome patients with a raised HsCRP are at significant risk of having sub-clinical hypothyroidism.