Comparison Of Vascular Calcification And Mineral Bone Disease In Non-Dialysis (CKD4/5ND) Vs Dialysis Dependent (CKD5D) Patients.

BACKGROUND: Chronic kidney disease (CKD) has been a highly prevalent medical condition in all parts of the world affecting the haemostasis of the body in number of ways. Epidemiological data suggest that no region of the world has been spared from this condition and both developing and developed countries equally share the burden of this disease. Objective was to compare the vascular calcification and mineral bone disease in non-dialysis vs dialysis patients suffering from chronic kidney disease at a tertiary care hospital of Pakistan. It is a Comparative study, conducted at the Department of nephrology Pak Emirates Military Hospital Rawalpindi. Four months from November 2020 to February 2021. METHODS: A total of 310 cases were included in the study, which were diagnosed as chronic kidney disease in nephrology department by a consultant nephrologist on basis of National Kidney Foundation/Kidney Disease Outcome Quality Initiative (NKF/KDOQI) 2002. They were divided into two equal groups by block randomization. Group I had the patients who were not dependent on dialysis (CKD4/5ND) while group II had dialysis dependent patients. Abdominal aorta, mitral and tricuspid valves were assessed to look for vascular calcification. Calcium, phosphate and parathyroid hormone levels were done to assess the mineral bone profile. RESULTS: Out of 310 patients, 192 (61.9%) patients were males and 118 (38.1%) were females. Ninty-eight (31.6%) had evidence of vascular calcification while 212 (68.4%) did not have vascular calcification. 147 (47.4%) had hypocalcaemia, 167 (53.8%) had hyperphosphatemia while 98 (31.6%) patients had raised Parathyroid hormone levels. Regression analysis revealed that vascular calcification and abnormal mineral bone profile was significantly present more among patients who were dependent on dialysis (p-value<0.05). CONCLUSIONS: Bone mineral disease and vascular calcification were consistent findings among patients suffering from chronic kidney disease. Patients who were dependent on dialysis were more prone to develop these complications as compared to those who were not dependent on dialysis.

The Comparison Of Efficacy Between Losartan And Diltiazem As Antiproteinuric Agent In Non-Diabetic Renal Diseases.

BACKGROUND: Multiple options have been tried to counter the proteinuria secondary to renal diseases. Clinicians and researchers are trying to find the best option for this purpose. OBJECTIVE: To compare efficacy of Losartan and Diltiazem in management of proteinuria in nondiabetic renal diseases at a tertiary care hospital of Pakistan. It was a Quasi-experimental study, conducted at the Department of nephrology Pak Emirates Military Hospital Rawalpindi. Five months, November 2020 to March 2021. METHODS: A total of 122 patients of non-diabetic renal diseases with significant proteinuria were included in the study. They were randomly divided into two groups via lottery method. Group I received losartan while group II received Diltiazem in standard dose for three months. After three months they underwent 24 hours' urinary protein levels and divided into complete, partial and non-responders to treatment. Age, gender, duration of illness and type of antiproteinuric treatment was correlated with response to treatment among the study population. RESULTS: Out of 122 patients, 80 (65.6%) were males while 42 (34.4%) were females. Membranous nephropathy 20 (16.4%) was the commonest non-diabetic renal disease seen in our study participants. Thirty (24.5%) had complete remission after three months of treatment, 60 (49.2%) had partial response while 32 (26.3%) had no response to treatment. Chisquare test revealed that use of losartan had statistically significant relationship (p-value<0.001) with good response among the study participants. CONCLUSIONS: Membranous nephropathy leading to proteinuria was the commonest non-diabetic renal disease encountered in our setup. Around 2/3rd of our patients showed either complete or partial response to treatment and Losartan was superior to Diltiazem in achieving response in our study participants.

Ultrasound Guided Tunnelled Cuffed Catheter Placement Without Fluoroscopic Guidance By Anatomical Landmarks; Accuracy And Safety.

BACKGROUND: Chronic kidney disease is a growing disease with high morbidity and mortality. Haemodialysis remains the most common option available for all those not planning for renal transplantation. Vascular access is the most important aspect of haemodialysis. Though not recommended but central venous catheters remain the most common vascular access in starters on haemodialysis. There is a growing trend towards placement of tunnelled cuffed catheters (TCC). Tunnelled cuffed catheters placement requires fluoroscopic guidance which is not available in all centres. The rationale of this study was to describe safety and accuracy of a catheter placement technique not dependent on fluoroscopic guidance for resource limited settings. METHODS: Dialysis dependent patients of a single hospital without long term vascular access were selected over a period of 15 months after getting informed written consent. A new technique was described in which depth of catheter was estimated by superficial anatomical and ultrasound guided measurements for TCC placement which were checked by conventional chest radiography post procedure. RESULTS: A total of 209 catheters were placed over a period of 15 months, 189 males and 30 females. Various sites were used predominantly right Internal jugular vein (IJV) (85.6%). Overall success rate was 97.1% (98.3% males, 90% females, p=0.08). Right IJV was successful 98.9%, left IJV 87.5% (p<0.001). Multiple thrombosed/stenosed veins were associated with higher failure rate (p<0.001). CONCLUSIONS: Tunnelled cuffed catheters can be placed successfully and safely in right IJV under ultrasound guidance using anatomical landmark measurement technique without fluoroscopic guidance.