Comparison of Outcomes of Different Modalities of Renal Replacement Therapy in Patients of Acute Kidney Injury: A Single Centre Prospective Observational Study.

BACKGROUND: Acute Kidney Injury (AKI) is one of the most important causes of in-hospital mortality. The global burden of AKI continues to rise without a marked reduction in mortality. As such, the use of renal replacement therapy (RRT) forms an integral part of AKI management, especially in critically ill patients. There has been much debate over the preferred modality of RRT between continuous, intermittent and intermediate modes. While there is abundant data from Europe and North America, data from tropical countries especially the Indian subcontinent is sparse. Our study aims to provide an Indian perspective on the dialytic management of tropical AKI in a tertiary care hospital setup. METHODS: 90 patients of AKI, 30 each undergoing Continuous Renal Replacement Therapy (CRRT), Intermittent Hemodialysis (IHD) and SLED (Sustained Low-Efficiency Dialysis) were included in this prospective cohort study. At the end of 28 days of hospital stay, discharge or death, outcome measures were ascertained which included mortality, duration of hospital stay, recovery of renal function and requirement of RRT after discharge. In addition median of the net change of renal parameters was also computed across the three groups. Lastly, Kaplan Meier analysis was performed to assess the probability of survival with the use of each modality of RRT. RESULTS: There was no significant difference in the primary outcome of mortality between the three cohorts (p=0.27). However, CRRT was associated with greater renal recovery (p= 0.015) than IHD or SLED. On the other hand, SLED and IHD were associated with a greater net reduction in blood urea (p=0.004) and serum creatinine (p=0.053). CONCLUSION: CRRT, IHD and SLED are all complementary to each other and are viable options in the treatment of AKI patients.

Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19.

INTRODUCTION: The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities. METHODS: Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting. RESULTS: Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03). CONCLUSION: Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Impact of Structured Training Program about Cadaver Organ Donation and Transplantation on Knowledge and Perception of Nursing Students at Public and Private Nursing Teaching Institute of Northern India - An Interventional Study.

Background: "Donation gap" refers to the shortage of organ donors worldwide. The medical/nursing students and various healthcare workers have poor awareness and attitude toward organ donation. Objective: We conducted this study to assess the current level of knowledge and perception regarding cadaver organ donation and transplantation among nursing students and to evaluate the impact of structured training interventions on their baseline knowledge and perception level. Methods: It was a single-group pre-post interventional study done by nursing students of one government and one private nursing college.A pre-tested questionnaire was used as a study tool. Statistical Analysis: Various statistical tests like one-way repeated measure ANOVA, Mauchly's test of sphericity, and Greenhouse-Geisser correction were used. Pairwise comparisons used Bonferroni corrections. Results: The pre-test group had the lowest mean knowledge (50.2346, SD = 15.35188), and immediately after training group had the highest (57.3900, SD = 14.34626). After one month, knowledge decreased but was still higher than pretraining (mean = 52.3607, SD = 13.28141). Conclusions: The positive attitude of nursing students may augment cadaver organ donation and transplantation in the future. The study has also highlighted the further training needs of the participants.

Renal Outcomes of Pregnancy-Related Acute Kidney Injury: a Single Centre Experience in India.

Objective:This study aimed to investigate the incidence, clinical characteristics, and outcomes of acute kidney injury (AKI) during pregnancy in Indian population. Materials and methods:A prospective observational study was conducted in pregnant patients admitted to Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India. Acute kidney injury was assessed using Risk, Injury, Failure, Loss of function, and End-stage renal disease (RIFLE) criteria. Patients were analyzed on the basis of demographic data, detailed history, clinical examination, and laboratory investigations. The primary outcome was maternal renal outcome, including return to normal renal function and progression to chronic kidney disease (CKD). The secondary outcomes included the mode of delivery, complications of pregnancy, intensive care unit (ICU) admission, and maternal death. Results:A total of 51 patients with an average age of 29.5 years were included in the present study. About 49.9% of subjects had severe anemia and 41.2% were primigravida. The main cause of AKI was pre-eclampsia and postpartum hemorrhage. There was a marked improvement in renal outcome with 33 patients having complete renal recovery and six patients developed CKD was observed during three months follow-up period. The peaked median value of blood urea was 62.0 mg% in patients with normal renal function, 178.5 mg% in those with CKD and 120.0 mg% in expired patients (P=0.001). A statistically significant change in serum potassium (P=0.010) and creatinine levels (P<0.001) was observed during the follow-up period. Liver enzymes, including serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase, were high in all patients at the time of admission, but decreased to normal on follow-up. Conclusion:Our study indicates that pregnancy-related AKI patients present with multiorgan complications and many of them require mechanical ventilation and renal replacement therapy. Most of these patients have poor outcome. Hence, the management of pregnancy-related AKI presents a challenge that requires proper evaluation of causative factors to facilitate appropriate treatment.

Evaluation of Expected Ventilatory Response to Metabolic Acidosis in Severely Ill Patients.

INTRODUCTION: Winters' formula (pCO2 =1.5*HCO3 +8) is used worldwide to predict the ventilatory response to metabolic acidosis, namely to predict the pCO2 value complying with reduction of serum bicarbonate concentration (HCO3 ). This equation was obtained half a century ago in mostly pediatric subjects. Subsequently different and inconsistent rules have been suggested. The study was done to verify the reliability of Winters' formula in severely ill patients with respect of other modern and commonly used formulas. METHODS: We applied Winters' formula and some other formulas to a dataset of arterial gas analysis from 29 severely ill malaria patients (about half of them requiring ICU or hemodialysis). The expected pCO2 value was computed by each formula and the root mean square error (RMSE) was measured. Beyond predicting the expected pCO2 value, expected range of values was also computed (as expected value ± each own error) and agreement with the best fit equation (± its error) was assessed. RESULTS: In this dataset featured by metabolic acidosis of moderate degree (mean pH 7.2, mean HCO3 : 15.3 mmol/l) a strong positive linear relationship between pCO2 and HCO3 was found (R squared =0.97). The best fit linear equation was in form of pCO2 = 1.28*HCO3 +11.55. Winters' formula exhibits the lowest RMSE (1 mmHg) and shows the better agreement (Cohen's kappa=0.7) with the best fit equation Conclusions: Winters' formula can still profitably used to compute the expected pCO2 value and in turn to infer mixed (metabolic plus respiratory) acid-base disorders in severely ill patients.

Cognitive Dysfunction in Patients with Chronic Kidney Disease.

Cognitive impairment is a common entity in patients with chronic kidney disease (CKD), which plays an important role in increasing the morbidity in these patients. This study was performed to evaluate cognitive dysfunction and its severity in different stages of CKD and identify the correlation with factors affecting this dysfunction. A cross-sectional design study was conducted on 100 patients with CKD Stage III to V-D fulfilling the eligibility criteria. Cognitive status was assessed using the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) tests. The patients were divided into four groups according to their estimated glomerular filtration rate (eGFR); Group A with eGFR ranging between 30 and 59 mL/min/1.73 m2, Group B with eGFR between 15 and 29 mL/min/1.73 m2, Group C with eGFR <15 mL/min/1.73 m2 not on hemodialysis (HD), and Group D with eGFR <15 mL/min/1.73 m2 and on HD for the past six months. Factors affecting MMSE and MoCA scores were assessed using univariate and multivariate linear regression analysis. Mean MMSE score was 28.72 ± 1.37 in Group A, 26.00 ± 3.67 in Group B, 20.76 ± 4.84 in Group C, and 17.28 ± 3.32 in Group D, which showed a statistically significant difference. The mean MoCA score also showed a statistically significant decline from Group A to Group D with values being 26.36 ± 1.91, 24.56 ± 1.94, 22.08 ± 2.12 and 20.12 ± 1.81, respectively (P < 0.05). The MMSE and MoCA scores were found to have a statistically significant positive correlation with hemoglobin; serum corrected calcium and eGFR (P < 0.01) and statistically significant negative correlation with blood urea, serum creatinine, serum uric acid, serum phosphate, serum potassium and stage of CKD (P < 0.01). By raising the clinician's awareness about cognitive dysfunction in CKD patients and its potential effects on medication, fluid and, dietary compliance improved quality of care is expected. Early intervention will improve the patient's quality of life.

Evaluation of visual evoked potentials and brain-stem auditory evoked response in patients of chronic kidney disease.

Chronic kidney disease (CKD) is associated with functional changes in the central nervous system (CNS) which, in the initial stages do not manifest clinically. Early involvement of the CNS can be identified by the assessment of the electrocortical activity. Visual evoked potential (VEP) and brain-stem auditory evoked response (BAER) are useful tests for the early diagnosis of CNS involvement in CKD and are more sensitive compared to electroencephalography. One hundred adult CKD patients (stage 3-5 and 5D) and 50 controls were included in the study. Clinical and biochemical parameters were assessed and all the patients and controls underwent VEP and BAER evaluation. Evaluation of the VEP showed prolonged latencies of all the three peaks (N75, P100, and N145) compared to controls. Furthermore, all the absolute and interpeak BAER latencies for the CKD patients were similarly prolonged compared to controls. CNS dysfunction is common in CKD patients. The electrophysiological tests of VEP and BAER can be used for the early diagnosis of these disorders, even in the sub-clinical stages, thus allowing for their better management.

Prevalence and Clinical Correlates of Microalbuminuria in Patients with Essential Hypertension - A Tertiary Care Center Cross Sectional Study.

Introduction: Albuminuria is predictor of target organ damage and worse cardiovascular outcomes. Microalbuminuria has been found in a large number of patients with essential hypertension. Aim of our study was to evaluate the frequency of microalbuminuria in essential hypertension and to study its correlation with severity of hypertension and target organ damage. Materials and Methods: This cross-sectional study was conducted at the outpatient clinic of General Medicine department of Pt. B D Sharma PGIMS, Rohtak. Hundred patients of essential hypertension (group A) in the age group of 18-65 years were included in the study. A control group (group B) consisting of hundred healthy normotensive, age and sex matched volunteers were also entered into the study. Arterial blood pressure was measured by digital sphygmomanometer after five minutes of rest; the values reported represented the average of three consecutive measurements taken over a 15-minute period. Urine albumin excretion (UAE) was estimated by an immunoturbidometry method. Microalbuminuria was defined as UAE between 30 and 300 mg/24 hours. Statistical analysis was performed by standard methods to measure rates and proportions; chi square test was used for analyzing the associations between the variables. Results: In this study it was observed that prevalence of microalbuminuria in essential hypertension was 47%. Risk factors for microalbuminuria included higher age, SBP and MAP. Microalbuminuria was associated with dyslipidemia, deranged renal parameters and end organ damage in form of LVH, ischemic changes, hypertensive retinopathy and renal dysfunction. In conclusion, this study confirmed that increased urinary albumin excretion is associated with a worse pattern of cardiovascular risk factors and is a marker of concomitant cardiovascular damage in essential hypertension. Conclusion: Microalbuminuria can therefore be regarded as a useful, relatively inexpensive, integrated marker to help identify patients at higher cardiovascular risk for whom more aggressive preventive strategies and additional treatment measures may be advisable.

Assessment of Malnutrition Inflammation Score in Different Stages of Chronic Kidney Disease.

BACKGROUND: Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and is associated with high morbidity and mortality. Malnutrition-Inflammation Score (MIS) has significant correlations with prospective hospitalization and mortality, as well as measures of anemia, inflammation, and nutrition in dialysis patients. MATERIAL AND METHODS: The study was conducted on 100 adult patients of CKD selected from K&D clinic PGIMS, Rohtak. All the patients went under detailed socioeconomic, clinical, biochemical and radiological examination. The average of three measurements of body weight, height, triceps skin fold thickness (TST), and mid-arm muscle circumference (MAMC) were measured in all patients. MIS was calculated for all the patients. RESULTS: Out of total 100 patients, 64 were male and 36 were female. Overall, the prevalence of malnutrition was 60%. A total of 42%, 16% and 2% patients had mild, moderate and severe malnutrition respectively. Our study also shows significant association between staging of CKD (3 to 5-D) and MIS. A significant negative correlation was found between MIS and factors such as BMI, eGFR, serum calcium and hemoglobin levels. A significant positive correlation of this score was found with blood urea serum creatinine, serum uric acid, serum potassium and serum phosphate. Multivariate analysis showed significant association between MIS and serum albumin, TIBC, BMI, family income and hs-CRP. CONCLUSION: Assessment of key components of malnutrition and inflammation early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life for CKD patients.

Prevalence of Depression, Anxiety and Insomnia in Chronic Kidney Disease Patients and their Co-Relation with the Demographic Variables.

BACKGROUND: Chronic kidney disease (CKD) is an emerging health problem in both developed and developing countries. Depression, anxiety and sleep disturbances are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patients' health. Assessment of key components of mental health early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life in CKD patients. METHODS: We did a cross sectional study in 200 patients of CKD stage III to V-D fulfilling the eligibility criteria who were on follow up in a single tertiary care center in the state of Haryana, India. We assessed the prevalence of anxiety, depression and insomnia and their correlation with demographic variables in these patients. The structured questionnaire used in this study gathered information on respondent demographic and disease characteristics, and information obtained from the HADS and PSQI questionnaire. Factors associated with anxiety, depression and insomnia were examined by a multiple logistic regression analysis. RESULTS: The prevalence of anxiety, depression and insomnia were found to be 71%, 69% and 86.5% respectively. As the CKD stage advanced, the prevalence as well as severity of these parameters increased. Anxiety, depression and sleep quality were found to be significantly correlated to unemployment, low income, low education, urban residence and presence of co-morbidities. The anxiety, depression and insomnia scores were found to have a strong negative correlation with eGFR, hemoglobin, serum calcium (p <0.01) and a positive correlation with TLC, blood urea, serum creatinine and serum phosphate (p <0.05). CONCLUSION: We observed a high prevalence of anxiety, depression and insomnia in CKD patients. There is a need to develop strategies to accurately identify "high risk" subjects who may benefit from preventive measures before complications occur. By identifying CKD patients with high risk of developing these mental health related issues, healthcare provider may be better able to ensure the provision of appropriate rehabilitation to this population.

An enigmatic trio of Klinefelter's syndrome, autoimmune hypothyroidism and nephrotic syndrome.

Klinefelter's syndrome is the most common chromosomal disorder associated with testicular dysfunction and male infertility. Those affected by Klinefelter's syndrome are at increased risk of systemic lupus erythematosus, breast cancer, non-Hodgkin's lymphoma, and lung cancer. Nephrotic syndrome in association with Klinefelter's syndrome has never been reported in the literature.

Isolated oculocutaneous sarcoidosis in a teenage male: a rare case report.

Sarcoidosis is an inflammatory disease with multisystem involvement characterized by the presence of noncaseating granulomas. It can affect virtually every organ of the body, with lung involvement being most common occurring in >90% of patients. Other organs affected are skin, eye and liver. Skin involvement is common, affecting 25-35%. Here we present a rare case of a 15 year-old male with isolated oculocutaneous sarcoidosis without systemic involvement.

Systemic lupus erythematosus presenting as fulminant lupus pneumonitis: a rare case report.

We report a case of 19 year-old female patient diagnosed as systemic lupus erythematosus (SLE) presented with fever and diffuse cutaneous lesions. During the hospital stay she had acute pneumonia, pleural effusion and respiratory failure, which required intensive care unit (ICU) care and mechanical ventilator support. A fulminant course of the disease, decreased values of complement levels and positive antinuclear antibodies (ANA) in pleural fluid and repeated negative sputum for acid-fast bacillus, blood cultures enabled diagnosis of fulminant lupus pneumonitis. Fulminant lupus pneumonitis is a rare but potentially life threatening complication of SLE. Management requires involvement of multiple specialties and rigorous efforts in reviving the patient.

Health-related quality of life in different stages of chronic kidney disease.

INTRODUCTION: Improved survival of chronic kidney disease (CKD) patients has led to an increased focus on health-related quality of life (HRQoL) for evaluating treatment effectiveness and assessing health outcomes of these patients. OBJECTIVE: To evaluate HRQoL in patients in different stages of CKD and to explore possible correlating and influencing factors. METHODS: Cross-sectional design with 200 patients from India in CKD stages 1-5 assessed for HRQoL through 36-item short-form together with biomarkers. Patients were divided into four groups according to their estimated Glomerular Filtration Rate (eGFR); group A with GFR range > 90 ml/min/1.73 m2, group B with GFR range 30-59 ml/min/1.73 m2, group C with GFR range 15-29 ml/min/1.73 m2 and group D with GFR < 15 ml/min/1.73 m2 RESULTS: HRQoL scores in all dimensions impaired progressively and significantly across renal function levels and CKD stages. A statistically significant decreasing trend in physical composite summary and mental composite summary scores was found in patients from group A to D (P< 0.001). Patients with eGFR < 30 ml/min/1.73 m2, Diabetes Mellitus, Cardio vascular disease (CVD), C-reactive protein (CRP) ≥ 5 mg/l, Hemoglobin ≤ 90 g/l, erythrocyte sedimentation rate ≥ 20 and mean arterial pressure ≥ 100 mm hg had significantly lower scores on all HRQoL dimensions. Among these CRP, reduced GFR and CVD were the most important predictors of impaired HRQoL. CONCLUSION: Considering the worldwide growing prevalence of CKD and increasing importance of HRQoL in chronic diseases, improving our knowledge about HRQoL and its predictors in CKD patients is important. Assessment of HRQoL early in disease course will help to identify high risk patients in whom modifying these factors may help them lead an active and healthy life.

Assessment of renal functions in patients of chronic liver disease.

AIMS AND OBJECTIVES: Renal involvement in patients of chronic liver disease (CLD) is one of the dreaded complications associated with a steep rise in mortality and morbidity. Derangements in various homeostatic mechanisms in CLD leading to direct renal injury or circulatory compromise have been associated with renal impairment. METHOD: Consecutive cirrhotic patients (n = 100) were included in the study. Structural and functional renal failure was identified and patients were classified into various renal syndromes pre renal, intra-renal and hepatorenal syndrome (HRS). RESULTS: At the time of presentation, 37 patients had renal dysfunction. Thirty patients had pre-renal type of renal failure, six patients had intrinsic renal disease and one patient had structural renal disease. Patients with pre-renal type were further classified into volume responsive pre-renal failure and volume non responsive HRS. Five patients had features suggestive of HRS. Patients with decompensation such as portal hypertension (PHTN), jaundice, upper gastro-intestinal bleed and hepatic encephalopathy had significantly higher incidence of renal derangements as compared to their counterparts. Infection in the form of SBP and/or sepsis predisposed patients to develop renal dysfunction. CONCLUSION: Renal impairment in patients with advanced liver disease is not an uncommon phenomenon and is more commonly associated with a more advanced disease. Presence of PHTN and various signs of decompensation increase the chances of renal derangements in these patients. In view of rising incidence of CLD and higher survival (due to better treatment options available), one should be vigilant for the renal derangements in these patients.

Anti-dsDNA negative and anti-Ro positive lupus nephritis: a report of a rare case.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, characterized by an autoantibody response to various nuclear and cytoplasmic antigens. Renal disease in SLE occurs in 40-75% of patients, most often within five years of onset of disease, and is one of the strongest predictors of a poor outcome. A hallmark of glomerular involvement in lupus nephritis is the presence of autoantibodies against double-stranded DNA (dsDNA). Its level usually correlates with disease activity. Our patient presented with a rash resembling malar rash and features of nephrotic syndrome. On investigating, patient was found to have pancytopenia, raised erythrocyte sedimentation rate and depressed serum C3 levels with positivity of antinuclear antibodies and anti- Ro antibodies. However, most of the markers of lupus nephritis including anti dsDNA antibody were negative. Renal biopsy showed features of lupus nephritis (class-IV). Differential item functioning studies showed a full house immunoflourescence staining pattern characteristic of lupus nephritis. Association of Anti-Ro antibody alone with lupus nephritis is less known in literature. Negativity of anti-dsDNA antibody, which is usually considered to be diagnostic of lupus nephritis, poses a diagnostic dilemma short of renal biopsy. Till date only very few cases of non-drug induced lupus nephritis with negative dsDNA antibodies have been reported. In this report we wish to highlight a case of lupus nephritis which was negative for its specific anti dsDNA antibodies and with possible role of anti-Ro antibodies in the pathogenesis of lupus nephritis although the underlying mechanism is incompletely understood.

Primary hepatic tuberculosis presenting as acute liver failure.

Abdominal tuberculosis is a common clinical entity in Indian subcontinent; however, hepatic tuberculosis in the absence of miliary abdominal tuberculosis is restricted to the case reports and small case series in English literature. It mimics common liver diseases like liver abscess and tumors. We report a case of 25-year-old immunocompetent female who presented with features of acute liver failure. Ultrasonography (USG) abdomen revealed multiple hypoechoic lesions. However, patient expired within 48 h of presentation but her liver autopsy revealed multiple epithelioid cell caseating granulomas with positive staining for acid fast bacilli (AFB). Polymerase chain reaction (PCR) was also positive for Mycobacterium tuberculosis.

Bone mineral density in patients with predialysis chronic kidney disease.

BACKGROUND: There is limited data available especially in Indian Population about prevalence of reduced bone mineral density (BMD) and various factors associated with it in CKD patients not on dialysis. MATERIAL: This study included 75 adult patients. Patients were divided into three groups depending upon GFR. Serum creatinine, albumin, calcium, phosphate (PO4), alkaline phosphatase, iPTH and Vitamin D were measured at baseline. BMD was measured by dual energy X-ray absorptiometry. RESULTS: There were 51 male and 24 female patients. The mean serum phosphate, alkaline phosphatase and iPTH levels increased steadily as CKD progressed. On the other hand, mean corrected serum calcium and Vitamin D levels decreased progressively in group A, B and C. The mean serum PTH values in group A, B and C were 137.16 ± 109.85, 265.02 ± 132.03 and 328.14 ± 119.23 pg/mL, respectively and there was significant increase in mean PTH level from group A to group C (p < 0.05). The mean level of vitamin D showed a trend of declination from group A to C (p < 0.05). Z-score for group A, group B and group C was 1.11 ± 2.39, 0.87 ± 2.66 and -0.92 ± 1.59, respectively. Similarly, T score for the three groups were 0.47 ± 2.34, -0.4 ± 2.00 and -1.524 ± 1.42. Both T-score and Z-score positively correlated with GFR. There was negative correlation between Z-score and iPTH, and positive correlation with Vitamin D. CONCLUSION: Reduced bone density was seen early in the course of CKD as estimated from reduced BMD levels, increased prevalence of osteoporosis and increased fracture risk and it worsened with the progression of CKD.

Anxiety, locus of control, and coping strategies among end-stage renal disease patients undergoing maintenance hemodialysis.

End-stage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) have a lot of anxiety. Anxiety and coping are associated with the locus of control; the present investigation aimed to study the state and trait anxiety, locus of control, and active and passive coping among patients on MHD. Thirty MHD patients and 30 controls were administered State-Trait Anxiety Inventory, Rotter's Locus of Control Scale, and Coping Responses Inventory. There were significantly higher scores on state and trait anxiety, respectively (67.53 ± 10.89 vs. 59.40 ± 6.97, P < 0.01, and 62.97 ± 8.45 vs. 58.07 ± 7.06, P < 0.05), and locus of control (11.27 ± 3.55 vs. 9.04 ± 1.86, P < 0.01) in patients as compared to controls. On coping responses, patients and controls differed on positive reappraisal (54.33 ± 4.67 vs. 51.17 ± 3.12, P < 0.01), seeking guidance and support (58.07 ± 5.51 vs. 53.27 ± 4.22, P < 0.01), problem solving (51.03 ± 4.70 vs. 47.57 ± 4.73, P < 0.01), cognitive avoidance (60.27 ± 6.76 vs. 56.80 ± 4.08, P < 0.05), acceptance or resignation (61.67 ± 6.30 vs. 58.83 ± 4.23, P < 0.01), emotional discharge (68.07 ± 6.78 vs. 64.30 ± 4.50, P < 0.05), approach coping (205.57 ± 10.55 vs. 189.70 ± 11.37, P < 0.01), and avoidance coping (255.30 ± 16.45 vs. 241.10 ± 10.50, P < 0.01). A higher prevalence of anxiety trait could be the cause of anxiety in MHD patients besides the medical problems. The locus of control among patients though a mixed one was significantly more toward externalism. Thus, there is a need to identify this group well in advance and prepared not only medically but also psychologically for MHD.