Clinical Profiles and Outcomes of Cytomegalovirus Positive Renal Transplant Patients in Early Post-Transplant Period.

Cytomegalovirus infection can cause increased mortality and morbidity in renal transplant recipient. The purpose of the present study was to observe the clinical profiles and outcomes of Cytomegalovirus positive renal transplant patients in early post-transplant period. This prospective cohort study was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2016 to August 2017. Adult patients who had undergone renal transplantation were selected as study population. CMV serology (CMV IgM and CMV IgG) of both donor and recipient were detected before renal transplantation. Cytomegalovirus viral DNA was extracted from both serum by using a commercially available DNA extraction kit and PCR was done by the StepOne™ PCR machine using real time PCR kit in all patient during the early post-transplant period. During this period, sign symptoms of patients with cytomegalovirus infection as well as clinical outcomes were also noted. Total number of 32 patients was included in this study with the mean age of 31.15±11.56 years. Cytomegalovirus was found positive in 11(34.4%) patients and negative in 21(65.6%) patients. Anorexia was the most common presentation which was found in 81.8% cases followed by renal impairment, fever, diarrhea, cough and weight loss which were present in 6(54.5%), 3(27.3%), 2(18.2%), 2(18.2%) and 2(18.2%) cases respectively. The outcomes of cytomegalovirus positive patients in first 6 months after renal transplantation revealed 25.0% patients had cytomegalovirus infection; 6.2% patients had cytomegalovirus disease and 6.2% patients were died. However, 9.4% patients had co-infection in the form of UTI and 6.2% patients had re activation of hepatitis C infection associated with cytomegalovirus infection. Cytomegalovirus was found positive in approximately one third of renal transplant recipients in early post-transplant period. Careful clinical evaluation and appropriate laboratory parameters should be looked over for timely diagnosis and management of these cases.

Plastic waste recycling: existing Indian scenario and future opportunities.

This review article aims to suggest recycling technological options in India and illustrates plastic recycling clusters and reprocessing infrastructure for plastic waste (PW) recycling in India. The study shows that a majority of states in India are engaged in recycling, road construction, and co-processing in cement kilns while reprocessing capabilities among the reprocessors are highest for polypropylene (PP) and polyethylene (PE) polymer materials. This review suggests that there are key opportunities for mechanical recycling, chemical recycling, waste-to-energy approaches, and bio-based polymers as an alternative to deliver impact to India's PW problem. On the other hand, overall, polyurethane, nylon, and polyethylene terephthalate appear most competitive for chemical recycling. Compared to conventional fossil fuel energy sources, polyethylene (PE), polypropylene (PP), and polystyrene are the three main polymers with higher calorific values suitable for energy production. Also, multi-sensor-based artificial intelligence and blockchain technology and digitization for PW recycling can prove to be the future for India in the waste flow chain and its management. Overall, for a circular plastic economy in India, there is a necessity for a technology-enabled accountable quality-assured collaborative supply chain of virgin and recycled material. Supplementary Information: The online version contains supplementary material available at 10.1007/s13762-022-04079-x.

A Middle-Aged Woman Presented with Catastrophic Anti-phospholipid Syndrome in Nephrology Department of BSMMU.

A life threatening rare condition called catastrophic antiphospholipid syndrome leading to multiple organ failure is characterized by vascular thrombosis in the presence of anti-phospholipid antibody which often appear as a medical emergency. Antiphospholipid antibody syndrome whether primary or secondary cause thromboembolic manifestation resulting recurrent fetal loss, but catastrophic antiphospholipid antibody syndrome may not present in such a way, rather multi-system involvement occurs within a short period of time. We would like to present a case of 50 years old female who is hypertensive, non-diabetic, a known case of hypothyroidism for two years, who was admitted to our hospital after developing fever for 7 days and black discoloration of lateral three fingers of left hand for short period of time. The patient had no medical problems and had been in her usual state of health until 7 days before admission. Patient is anaemic and found to have severe renal failure. She was found high titer antiphospholipid antibody both IgM and IgG positive and anti-cardiolipin antibody positive. Her routine investigations revealed very high neutrophilic leukocytosis, high acute phase reactant, urinary findings revealed no active sediment; we thought that our patient might have sepsis that may trigger catastrophic antiphospholipid syndrome. Multi-disciplinary consultation gave us valuable opinion. Considering her septicemia, she was given broad spectrum antibiotic. Anticoagulation was given with unfractionated heparin followed by warfarin and as an immunosuppressive protocol methylprednisolone followed by prednisolone along with pulse cyclophosphamide was given. Treatment option with plasma pheresis and monoclonal antibody was not attempted, but she was given several session of hemodialysis, within a few days her biochemical parameters improved. Severe renal failure in this patient may be explained by septicemia or thrombotic micro-angiopathy that was reversed with anti-coagulation or proper antibiotic. Amputation of three digit of left hand was done by orthopedic surgeon but unfortunately two weeks after admission the patient expired due to sudden stroke.

Renal Involvement as a Presenting Feature of Multiple Myeloma.

Renal involvement may be the presenting feature in a vast majority of patients with multiple myeloma and is one of the key for clinical manifestations of symptomatic multiple myeloma. The purpose of the study was to find out the pattern of renal involvement at the time of presentation of multiple myeloma and to explore its association with clinical, laboratory and pathologic features of these cases. This cross sectional study was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from February 2016 to September 2017. Forty seven (47) patients of newly diagnosed multiple myeloma having renal involvement were included in the study. Multiple myeloma was diagnosed as per criteria proposed by the International Myeloma Working Group, 2003. Renal involvement was considered to be present when any one of proteinuria, microscopic haematuria, renal impairment or urinary tract infection (UTI) was found in the patient. Renal biopsy was done in suitable patients under ultrasound guidance after taking informed written consent. The pattern of renal involvement was detected and status of renal function was assessed and its clinical, laboratory and pathologic associations were analyzed. Data were managed by using computer based software, the Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp.). Median age at presentation was 59 years with the range of 37-76 years. Female (53.2%) was slightly predominant than male (46.8%) and male to female ratio was 1:1.14. Renal impairment, microscopic haematuria, proteinuria, nephrotic range proteinuria, urinary Bence Jones protein and UTI were found in 70%, 19%, 79%, 25%, 19% and 17% of patients respectively. Median serum creatinine and proteinuria were 256µmol/l and 1.24gm/day. Hypercalcaemia and Bence Jones proteinuria were detected in 36% and 27% of patients respectively with renal impairment which were statistically significant. The precipitating factors for renal impairment were NSAIDs use (67%), hyperuricaemia (49%), hypercalcaemia (36%), dehydration (27%), UTI (18%) and no identifiable factor (3%). Dialysis was required in 15% new myeloma patient. Renal biopsy and histopathological examination revealed myeloma cast nephropathy (30%), amyloidosis (30%), glomerulosclerosis (chronic kidney disease) (20%), monoclonal immunoglobulin deposition disease (MIDD) (10%) and interstitial nephritis with fibrosis (10%). Renal involvement was a common and severe complication of multiple myeloma. Renal impairment was strongly associated with hypercalcaemia, NSAIDs use, hyperuricaemia, Bence Jones proteinuria etc.

Pattern of Anaemia in Chronic Kidney Disease.

The prevalence of chronic kidney disease (CKD) in Bangladesh is increasing. Chronic kidney disease refers to an irreversible deterioration in renal function which classically develops over a period of years. Initially, it manifest's only as a biochemical abnormality. Eventually loss of excretory, metabolic and endocrine functions of the kidneys leads to clinical symptoms and signs of renal failure, which are referred to as uraemia. In our country the number of CKD patient is increasing day by day, probably due to having uncontrolled DM, GN(Glumerulonephritis), uncontrolled hypertension, interstitial nephritis in addition to indiscriminate drugs & using of chemicals in fruits and foods. Objective of the study was to find out the morphological pattern of anaemia in patient with chronic kidney disease. This was a cross sectional observational study. This study was carried out at the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2011 to June 2011. Patients admitted in medicine ward male or female who satisfied the inclusion and exclusion criteria of the study were taken as study subjects. The socio demographic characteristics, presenting symptoms, risk factors, investigations and findings of diagnostic modalities and outcome were recorded. Mean age was 55.8 years of the patients who were included in this study, youngest patient is of 19 years old & older one is of 85 years. In this study 33 patients were male & 17 patients were female. Thirty three (33) patients were suffering from normocytic normochromic anaemia, 11 were suffering from microcytic hypochromic anaemia & rest 6 were suffering from combined deficiency. Female patient were suffering mainly from microcytic hypochromic anaemia (58.8%) & male patient suffered from normocytic normochromic anaemia (69.7%). CKD patients also suffered from microcytic hypochromic anaemia & also from combined deficiency.

Knowledge, Attitude, and Perception About Renal Transplantation of CKD Patients, Caregivers, and General Population.

INTRODUCTION: In this study knowledge about kidney disease and the option of transplantation was assessed in chronic kidney disease (CKD) patients and their care givers. PATIENTS AND METHODS: A knowledge, attitude, and perception (KAP) questionnaire comprising 33 items was developed. It had 4 classes: knowledge of kidney disease (9 items), transplantation (10 items), attitude (6 items), and perception (8 items). There were 3 possible answering options (yes/no/don't know) indicating "agree/disagree/no idea" or "optimal understanding/some understanding/no idea," allocating a score of 4/2/0, respectively. A higher score indicated good KAP. CKD patients, accompanying caregivers, and healthy controls from the general population were included. RESULTS: In 218 subjects, 108 were CKD patients (78 pre-end-stage renal disease and 30 maintenance hemodialysis), 40 were caregivers, and 70 were controls. The majority had a primary level of education (52%) and earned low to middle income (67%). Only 34% claimed to have adequate knowledge; information sources were doctors (61%) and relatives (21%); 63% agreed to involve in transplant program; 58% had no knowledge about types of kidney donors; and 71% believed in no religious restrictions to transplantation. The average KAP score for all in total 25 scoring items (59 ± 23) and separately in knowledge of kidney disease (75 ± 34), transplantation (48 ± 28), attitude (64 ± 28), and perception (51 ± 28) showed a generally low score especially in the field of transplantation. Education level (school vs. higher: 50 ± 23 vs. 70 ± 19, P < .001), income (low-middle vs. higher: 52 ± 23 vs. 72 ± 17, P < .001) and location (rural vs. urban: 53 ± 19 vs.74 ± 19, P < .001) conferred higher KAP scores. CONCLUSION: Knowledge, attitude, and perception towards renal transplantation is positively influenced by a person's educational level and economic status.

Acute Oxalate Nephropathy due to "Averrhoa Bilimbi": A Case Report.

Averrhoa bilimbi found in bilimbi tree is a well known fruits of warm climates, found throughout Bangladesh, India, Myanmar and South East Asian countries. This fruit contents high level of oxalate. Acute renal failure due to tubular necrosis caused by oxalate crystal has been reported. We present a patient who developed acute kidney injury following ingestion of bilimbi fruit juice and had complete recovery with conservative management and concluded that star fruit and bilimbi fruit juice should be avoided in CKD and on dialysis patients.

Etiology of Early Renal Allograft Dysfunction and Comparison between Dysfunction and Function Group: A Single Center Study.

Over a period of two years thirty five renal allograft recipients & donors were evaluated to find out the aetiology of early renal allograft dysfunction, in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2010 to February 2012. A comparison was made between dysfunction & functioning graft group. Mean age of recipients were (36.4±9.4) years, mean age of donors were (41.7±8.3) years, with a male and female ratio of 3:1. Fifty percent recipients showed one heliotype match, ninety percent recipients were anti CMV antibody IgG positive, few were anti CMV antibody IgM positive. All kidney transplant recipients received same immunosuppressive drugs. Primary disease of the renal allograft recipients demonstrates that majority 88.58% had glomerulonephritis, 5.72% had polycystic kidney disease, 2.85% had chronic pyelonephritis and another 2.85% had diabetic nephropathy. Among 35 renal allograft recipients 23(66%) showed early graft dysfunction, 12(34%) showed normal graft function. The etiology of early graft dysfunction showed, 50% developed acute rejection, 17% acute cyclosporine toxicity, 17% acute tubular necrosis, 8% had graft thrombosis and 8% developed recurrent glomerulonephritis. Sub-clinical rejection was detected in 20% cases. Comparison of donor characteristics between dysfunctioning and functioning graft groups revealed that age and sex were identically distributed between the groups (p=0.183 and p=0.087 respectively). The mean serum creatinine of donor was significantly higher in the graft dysfunction group than that in the functioning graft group (113.5±12.6 vs. 99.6±17.3; p=0.025), as well as the mean creatinine clearance rate was significantly less in the former group than that in the later group (82.1±13.5 vs. 93.9±18.6, p=0.040). The mean cyclosporine (C2) level on 7th POD were 1593.2±320.4ng/ml in graft dysfunction group and 1439.1±199.5ng/ml in the functioning graft group which decreased to 1364.8±263.7ng/ml and 1114.2±145.1ng/ml after three months in the dysfunction and the functioning graft groups respectively. There was no significant difference in the cyclosporine level between groups on 7th POD and 14th POD, 1st and 2nd month. However, at 3rd month the level of cyclosporine was higher in the dysfunction group than that in the function group. Proteinuria on 14th POD was almost similar between dysfunction and function graft groups (p=0.704). However, higher incidence of proteinuria was observed in subsequent months in the graft dysfunction group compared to the function graft group. All the postoperative variables like systolic blood pressure, diastolic blood pressure, fever and tremor were higher in dysfunction group in comparison to functioning graft group. Per operative biopsy of donor kidney, some showed increased number of sclerotic glomeruli which is more common in dysfunction group. Among 35 recipients 2(16.7%) died due to infection in dysfunction group compared to 1(4.3%) in functioning graft group.

Stability of retained austenite in high carbon steel under compressive stress: an investigation from macro to nano scale.

Although high carbon martensitic steels are well known for their industrial utility in high abrasion and extreme operating environments, due to their hardness and strength, the compressive stability of their retained austenite, and the implications for the steels' performance and potential uses, is not well understood. This article describes the first investigation at both the macro and nano scale of the compressive stability of retained austenite in high carbon martensitic steel. Using a combination of standard compression testing, X-ray diffraction, optical microstructure, electron backscattering diffraction imaging, electron probe micro-analysis, nano-indentation and micro-indentation measurements, we determined the mechanical stability of retained austenite and martensite in high carbon steel under compressive stress and identified the phase transformation mechanism, from the macro to the nano level. We found at the early stage of plastic deformation hexagonal close-packed (HCP) martensite formation dominates, while higher compression loads trigger body-centred tetragonal (BCT) martensite formation. The combination of this phase transformation and strain hardening led to an increase in the hardness of high carbon steel of around 30%. This comprehensive characterisation of stress induced phase transformation could enable the precise control of the microstructures of high carbon martensitic steels, and hence their properties.

Presentation and Treatment Outcomes of 100 Lupus Nephritis Patients: Single Center Study.

Over a period of 3 years (January 2011 to December 2013) 100 cases of Lupus nephritis patients admitted in nephrology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) were evaluated. Their clinical characteristics, biochemical parameters, renal histology according to WHO classification were categorized and their treatment modalities and outcome was observed. Among 100 patients, 84 were female and 16 were male, with F:M ratio 5:1. Mean age of female were 23±4 years and male were 29±4 years, mean BP in male was systolic 135±8 mmHg, diastolic 80±9mmHg and in female systolic was 130±7mmHg, diastolic 75±6 mmHg, mean Serum Creatinine for male was 180±12µmol/L and mean serum creatinine in female was 170±20µmol/L. Sixty five percent (65%) patient showed extra renal manifestation. All patients presented with proteinuria, among them 45% were nephrotic presentation, 25% patients presented with acute nephritic illness, 15% were nephritic nephrotic, 10% patients had rapidly progressing glomerulonephritis (RPGN), and 5% were with asymptomatic proteinuria. Renal biopsy of 100 patient according to WHO classification showed class I - 5%, class II - 20%, class III - 26%, class IV - 35%, class V - 8%, class VI - 6%. Immunosuppressive protocol used was prednisolone and cyclophorphamide in the majority of patients in class III to class VI LN patients. Few patients received prednisolone and mycophenolate mofetil. Twenty four percent (24%) patients were in complete remission during this study period and 12% developed end stage renal disease (ESRD). Seventy six percent (76%) patients passed through various stages of CKD, majority of them were in CKD stage IV and stage III, and few were in CKD stage I and stage II. About 70% of the participants had suffered from one or more complications, where majority were infections. Infections and renal failure were the leading cause of death in our study.

Quality of life in renal transplant recipient and donor.

OBJECTIVES: Quality of life (QoL) assessment in renal transplant patients has become an important tool in evaluating outcomes. In this work the QoL of the renal transplant donor and recipient are compared to healthy, age- and BMI-matched individuals. MATERIALS AND METHODS: The donors were all living related. The immunosuppression protocol was prednisolone, cyclosporine/tacrolimus, and mycophenolate mofetil/azathioprine. Renal function was stable. Quality of life was assessed by KDQOL-SF-36. It includes 36 items divided into 8 scales. RESULTS: Comparison among healthy subjects (n = 20), kidney donor (n = 20), vs recipients (n = 40) for age was 35 ± 8, 40 ± 11, vs 37 ± 10 years (P = NS), and BMI was 23 ± 5, 21 ± 4, vs 21 ± 4 kg/m(2) (P = NS). The mean duration of transplantation of donor and recipients was 22 ± 11 vs 28 ± 25 months (P = NS). Items in SF-36 among 3 groups, respectively, showed general health scores of 48 ± 23, 60 ± 20, vs 59 ± 20; physical functioning 61 ± 28, 84 ± 23, vs 76 ± 265; role physical 31 ± 38, 70 ± 44, vs 636 ± 53; pain 79 ± 36, 73 ± 23, vs 69 ± 25; emotional well-being 63 ± 17, 74 ± 14, vs 73 ± 34; social function 83 ± 20, 95 ± 8, vs 91 ± 15, and energy/fatigue 57 ± 17, 62 ± 16, vs 58 ± 15; (P = NS) was similar in all groups. Correlation studies showed strong positive association of all the items with each other. CONCLUSIONS: This study finding is in accordance with the expected outcome that QoL improves significantly to near normal in renal transplant recipients. At the same time donors' QoL also is not compromised. Both donor and recipient have similar high quality scores to those of a healthy person.

Platelet function testing and prediction of procedural bleeding risk.

The essential role of platelets in haemostasis underlies the relationship between platelet function and spontaneous or procedure-related bleeding, which has important prognostic implications. Although not routinely undertaken, platelet function testing offers the potential to tailor antiplatelet therapy for individual patients. However, uncertainties remain about how well platelet function testing may predict haemostasis and guide management of bleeding risk. Studies of aspirin, P2Y12 inhibitors and other antiplatelet drugs clearly demonstrate how inhibition of platelet function increases bleeding risk. More potent antiplatelet drugs are associated with higher bleeding rates, consistent with the levels of platelet inhibition achieved by these drugs. Studies of patients treated with clopidogrel, which is associated with wide inter-individual variation in antiplatelet effect, suggest that platelet function testing may predict bleeding risk related to coronary artery bypass grafting (CABG) surgery and potentially guide the timing of surgery following discontinuation of clopidogrel. Similarly, some studies have demonstrated a relationship between clopidogrel response and bleeding in patients undergoing percutaneous coronary intervention (PCI), although other studies have not supported this. Carriage of the *17 allele of cytochrome P450 2C19, which is associated with gain of function and enhanced response to clopidogrel, seems to be associated with increased bleeding risk, although studies showing lack of apparent effect of loss-of-function alleles provide contradictory evidence. Further large studies are needed to guide best practice in the application of platelet function testing in the clinical management of patients treated with antiplatelet drugs in order to optimise individual care.

Vitamin B6 deficiency augments endogenous oxalogenesis after intravenous L-hydroxyproline loading in rats.

The effects of an intravenous hydroxyproline load on endogenous oxalogenesis were compared in rats fed a standard diet or a vitamin B6-deficient diet. Twelve male Wistar rats were randomized to two groups and were fed either a standard diet (control group) or a vitamin B6-deficient diet for 3 weeks. Then the animals were intravenously administered 100 mg (762.6 micromol)/ml hydroxyproline. In the control group, infusion of hydroxyproline increased the 5-h urinary oxalate and glycolate excretion above baseline to 0.27% (2.02 +/- 1.11 micromol) and 0.32% (2.43 +/- 1.60 micromol) of the administered dose (mol/mol), while it was respectively 2.01% (15.24 +/- 2.13 micromol) and 0.00% (-0.02 +/- 0.19 micromol) of the dose in the vitamin B6-deficient group. Therefore, vitamin B6 deficiency augmented endogenous synthesis of oxalate from hydroxyproline by 7.56-fold (15.24/2.02) compared with that in the control group. Urinary citrate excretion was significantly lower at baseline and all other times in the vitamin B6-deficient group compared with the control group. In conclusions, L-hydroxyproline loading augmented endogenous oxalogenesis in the vitamin B6-deficient group without causing hyperglycolic aciduria, and also led to significant hypocitraturia. These findings suggest that hydroxyproline is not metabolized to oxalate via glycolate, but rather via the 4-hydroxyglutamate to glyoxylate pathway (usually requiring vitamin B6-dependent enzymes) even in the presence of vitamin B6 deficiency.

Association of HLA class I antigen matching and early graft outcome in living donor kidney transplantation.

INTRODUCTION: HLA antigen matching often plays an important role in organ transplantation. As for HLA class I antigen matching, there are differences of opinion regarding its influence on the outcome of renal transplantations. The aim of this study was to evaluate the association of HLA class I antigen matching with early graft outcomes in living donor kidney transplantation. PATIENTS AND METHODS: We evaluated graft outcomes in the first month of transplantation. Major events were slow graft function (serum creatinine > 250 micromol/L at the end of first week), delayed graft function (patients requiring dialysis in first week), and acute rejection episode. Graft outcomes were compared for normal renal function (NRF, serum creatinine < or = 175 micromol/L) impaired renal function (IRF, serum creatinine > 175 micromol/L) or impaired graft function due to an acute rejection episode (IGF). RESULTS: The 115 subjects had a mean age of 29 +/- 8 years and their donors 38 +/- 11 years (P < .01). Immunosuppression included prednisolone, azathioprine, and cyclosporine. Parents, siblings, and others were kidney donors in 46%, 33%, and 21%, respectively. Comparisons between NRF/IRF (serum creatinine 133 +/- 24 vs 201 +/- 36 micromol/L, P < .01) and NGF/IGF (serum creatinine 146 +/- 44 vs 161 +/- 39 micromol/L, P < .05) showed no difference in number or pattern of HLA matching. CONCLUSION: HLA class I antigen matching may not produce an added influence on early graft outcome among living donor kidney transplantations.

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.

Outcome of acute renal failure in adults in a teaching hospital in Bangladesh.

One hundred and twenty patients with a mean age of 38 years (range 12-85 years; M 91, F 37) were studied over a period of 5 years in a teaching hospital in Dhaka. Sixty-two patients presented with probable anuria with 1-4 days' duration, 63 patients presented with oliguria, and 3 were nonoliguric. The causes of acute renal failure were medical (94), surgical (22), obstetrical (13). Of the medical cases, the causes were gastroenteritis in 42 cases, gastroenteritis with CNS involvement in 11 cases, rapidly progressive glomerulonephritis in 10 cases, acute viral hepatitis in 8 cases, and septicemia in 8 cases. Of 22 surgical cases, postoperative acute renal failure was the cause in 9, road traffic accident in 6, and renal calculus disease in 7. There were 13 cases in the obstetrics group, of whom 9 were due to abortion, 2 were due to preeclampsia, and the other 2 were postoperative. The mean blood urea of all cases was 35 mmol/L and serum creatinine was 988 mumol/L. Dialysis was required in 105 cases; of these, 72 were medical cases, 21 were surgical cases, and 12 were obstetric cases. The overall survival rate was 75%. The improved survival is probably due to timely referral and prompt medical management.