An analytical observational study on chronic kidney disease of unknown etiology at a rural tertiary care hospital in West Bengal.

Background: Chronic kidney disease of unknown etiology (CKDu) has been a growing concern in the Indian population causing significant morbidity and mortality in these recent years. Thus, it is vital to understand the probable risk factors associated with its manifestation. This study aims to assess the distribution of various etiologies among CKD patients, investigate all the probable risk factors associated with CKDu, and estimate the health-related quality of life (QoL) among all CKDu patients in the study area. Materials and Methods: It was an analytical, observational, cross-sectional study where one objective had a case-control study design. It was conducted at Bankura Sammilani Medical College in Bankura district, West Bengal, during July 2022-August 2022. A total of 198 patients have been studied through detailed interviews using a predesigned, pretested, semi-structured schedule. Potential risk factors and their strength of association were analyzed with the help of multivariate logistic regression. Results: It was found that the prevalence of CKDu was almost 71% in the study population, mostly affecting agricultural workers (67.17%), daily laborers (46.46%), and construction workers. Perceived heat stress, excessive daily dietary intake of salt, and drinking contaminated water are the factors that had shown the strongest association with the occurrence of CKDu in this population. The deterioration in QoL in CKDu pretty much mirrors that of CKD. Conclusion: CKDu is definitely an occupational disease, mostly affecting the wage workers and farmers spending long hours in unhealthy work environments. Environmental exposure to heavy metals must be checked and dietary modification must be done through counseling to regulate salt intake. CKDu, as a rising public health concern certainly needs special attention and immediate planning as it has a different etiopathology than CKD and the affected population, disease progression, and risk factors are markedly distinctive as well.

Effect of Chronotherapy of Antihypertensives in Chronic Kidney Disease: A Randomized Control Trial.

INTRODUCTION: There is a higher prevalence of non-dipping pattern in hypertensive chronic kidney disease (CKD) patients. Nocturnal hypertension has been shown to predict cardiovascular mortality and morbidity and is often superior to daytime blood pressure. We studied the effect of shifting or adding antihypertensive to night time on blood pressure profile of CKD III-IV patients. METHODS: In this single-center, prospective, randomized controlled trial, eligible participants were adults from eastern India aged 18-65 years with CKD stages 3 and 4, with a non-dipping pattern on ambulatory blood pressure monitor (ABPM). The intervention group received all the antihypertensives in the night time whereas the standard care group continued to take the medication in the morning. Both groups were followed up for 1 year. The primary outcome was the number of patients changed from non-dippers to dippers in the standard care group and intervention group. Secondary outcomes included a change in estimated glomerular filtration rate (eGFR) and change in the cardiac structure. RESULTS: 39 patients in the intervention group and 36 patients in the standard care group were analyzed. 10 patients (26%) reverted to dipping pattern in the intervention group as compared to none in the standard care group. Mean changes in eGFR were -2.55 and -0.18 mL/min/1.73 m2 in the standard care and intervention group at the end of the study, respectively. Between-group difference in eGFR was significant at 1 year (5.22 [95% CI, 4.3-6.1] ml/min/1.73 m2); (P = 0.03). The cardiac structure showed no significant changes in either group. CONCLUSIONS: Bedtime administration of antihypertensives reverted non-dippers to dippers and slowed the decline in eGFR in CKD stages 3 and 4 compared to morning administration of antihypertensives.