Prevalence and distribution of cardiovascular risk factors in an urban industrial population in south India: a cross-sectional study.

BACKGROUND: Cardiovascular diseases (CVD) are leading cause of death in developing countries including India. The huge burden of CVD in Indian subcontinent is the consequence of the large population and high prevalence of cardiovascular risk factors. This study was done to determine the prevalence of cardiovascular risk factors in two industrial units in Chennai, India. METHODS: Survey of behavioural risk factors using structured questionnaires and anthropometric measurements were done for the study population. Blood samples were collected for the fasting plasma glucose and serum cholesterol. Trend chi-square was employed to test the linear trend. RESULTS: The total study population included 2262 male subjects. Blood samples were collected for 2148 (95.0%) subjects. Age range was 18-69 years. Prevalence of major cardiovascular risk factors was: current smokers 462 (20.2%), body mass index > or = 23 kg/m2 1510 (66.8%), central obesity 1589 (70.2%), hypertension 615 (27.2%), diabetes mellitus 350(16.3%) and total cholesterol > or = 200mg/dl in 650(30.3%). CONCLUSIONS: The study results indicated high prevalence of behavioural risk factors, central obesity, hypertension and diabetes in a select group of middle and high-income young urban males. The long-term follow-up in such settings will provide an opportunity to understand the influence of risk factors on cardiovascular disease outcomes.

A Comparison of Practice Pattern and Outcome of Twice-weekly and Thrice-weekly Hemodialysis Patients.

Renal replacement therapy (RRT) options and practice varies in countries worldwide and is influenced by patients' choice, nephrologists' practice patterns, health system, payer practice, public policy, and socioeconomic factors. In India, hemodialysis (HD) remains the dominant RRT modality, and the practice is largely influenced by socioeconomics of the region of practice since third party payer is limited. Resource stretch to maximize outcome benefit is essential and HD session twice weekly is an improvized and cost-effective clinical practice. However, within the country, the patient characteristics, practice patterns, and outcomes of twice-weekly HD compared against patients dialyzed thrice weekly remain unclear. We did a retrospective analysis of patients who underwent twice- and thrice-weekly HD in a single center under similar settings. The patients on thrice a week dialysis were older and with a higher proportion of diabetics and were insured by private payers. Weight gain, ultrafiltration rates, blood pressures, and hemoglobin remained more favorable in the thrice-weekly patients. There was no significant difference in the hospitalization rates or mortality rates in the two groups. Patients who undergo twice-weekly HD have poorer intermediate measures of the outcome; although, morbidity and survival were not different in a small study population with short follow-up. The small sample size and the short duration of follow-up may limit the scope of findings of our study.

Tacrolimus-associated hypomagnesemia in renal transplant recipients.

BACKGROUND: Since hypomagnesemia occurs frequently in tacrolimus treated patients, we studied the correlation between renal magnesium wasting and tacrolimus blood levels in renal transplant patients. METHODS: Serum magnesium, fractional excretion of magnesium (FEMg), and 24-hour urinary excretion of magnesium were measured in 41 transplant patients and 10 healthy volunteers for correlation with tacrolimus level. RESULTS: Of tacrolimus-treated patients, 43% displayed hypomagnesemia. FEMg (7.42+/-3.59% versus 1.88+/-0.43%) and 24-hour urinary excretion (112.36+/-51.43 mg/dL versus 6.7+/-2.79 mg/dL) were significantly higher among tacrolimus-treated patients than controls. Magnesium replacement did not influence FEMg or 24-hour urinary magnesium excretion. Tacrolimus level was the best predictor of 24-hour urinary magnesium excretion and FEMg. Serum magnesium levels correlated inversely with tacrolimus concentrations and creatinine clearance. CONCLUSION: Hypomagnesemia in renal transplant recipients results from renal magnesium wasting. Tacrolimus levels and renal function impact on the excess renal magnesium excretion. Studies of longer duration are warranted to assess the long-term effects of this early posttransplant hypomagnesemia.

An analysis of the increased demands placed on dialysis health care team members by functionally dependent hemodialysis patients.

A team of health care providers is integral to the care of chronic hemodialysis patients and includes nephrologists, social workers, dietitians, and nurses. Increasingly, the chronic hemodialysis population is composed of older patients with multiple comorbid conditions and reduced functional independence. The demands placed on social workers, nurses, and dietitians caring for the increasingly fragile chronic hemodialysis population have not been examined. We compared the interventions required by social workers, dietitians, and nurses caring for two demographically matched chronic hemodialysis patient groups undergoing dialysis in two outpatient units over a 6-month period to examine the demands imposed by these functionally dependent patients. Patients underwent dialysis in either a step-down unit or an ambulatory unit. Patients undergoing dialysis in the step-down unit had more coronary artery disease (6 of 12 patients [50%] versus 1 of 12 patients; P < 0.025) and peripheral vascular disease (6 of 12 versus 0 patients; P < 0. 004). Mean urea reduction ratio, hematocrit, and serum albumin values, as well as number of hospitalizations and mean days hospitalized for the 6-month study period, were not different between the groups. Patients undergoing dialysis in the step-down unit were more likely to have lower scores on activities of daily living (11 +/- 5 versus 15 +/- 3; P < 0.02), live in a nursing home (58% versus 8%; P < 0.01), be nonambulatory (66% versus 0%; P < 0. 01), and have a catheter as permanent dialysis access (66% versus 9%; P < 0.004). Significantly more social worker and dietitian time in hours per week were provided to the patients in the step-down unit (social workers, 259 versus 201 h/wk; P < 0.001; dietitians, 115 versus 96 h/wk; P < 0.001). Similarly, dialysis treatments requiring nursing interventions (treatments with hypotension, 36% versus 13%; obtaining blood cultures, 7% versus 2%; administering intravenous medications, 9% versus 2%; communicating with other health care providers, 3% versus 0.1%; and non-dialysis-related interventions, 5% versus 0.5%; all P < 0.005) were more common in the patients in the step-down unit. We conclude that increased dialysis provider care is required by patients who are functionally dependent and have increased comorbid conditions. The increased demands this fragile patient population places on dialysis providers must be recognized, examined more closely, and reimbursed appropriately.

Cryofibrinogenemia: an addition to the differential diagnosis of calciphylaxis in end-stage renal disease.

Cryofibrinogenemia is a disorder characterized by cryoprecipitation with variable clinical presentation that was first described by Korst and Kratochvil in 1955. Cryofibrinogen is a cold insoluble complex of fibrin, fibrinogen, and fibrin split products with albumin, cold insoluble globulin, factor VIII, and plasma proteins. Cryofibrinogenemia is associated with metastatic malignancies, collagen vascular diseases, and thromboembolic disorders and may be clinically asymptomatic or present with thromboembolic phenomena of skin and viscera. The pathogenesis of cryofibrinogenemia is unknown. It may be caused by the inhibition of fibrinolysis, leading to an accumulation of cryofibrinogen. Treatment of cryofibrinogenemia may include Stanozolol, plasmapheresis, and fibrinolytics. Cryofibrinogenemia simulates calciphylaxis clinicopathologically, because both may present with skin necrosis. Calciphylaxis has been reported in end-stage renal disease, but we report the first case of cryofibrinogen in a chronic dialysis patient. We suggest that in the appropriate clinical setting, cryofibrinogenemia should be considered in the differential diagnosis of calciphylaxis, and serum cryofibrinogen levels should be measured in end-stage renal disease patients presenting with skin necrosis.

Identification of a novel form of renal glucosuria with overexcretion of arginine, carnosine, and taurine.

Glucosuria occurs in diabetes mellitus, generalized proximal tubular dysfunction of Fanconi's syndrome, glucose-galactose malabsorption syndrome, and primary renal glucosuria. Patients with primary renal glucosuria have normal blood glucose levels, normal oral glucose tolerance test results, and persistent glucosuria that may approach the filtered load of glucose in the most severe cases. The primary defect is proposed to be in the sodium-glucose cotransporter type-2 (SGLT2) located in the apical membrane of S1 segment proximal renal tubule cells. Primary renal glucosuria is classified as types A, B, or O based on the characteristics of the transport defect. The magnitude of glucosuria has varied from 20 to 150 g of glucose excreted in 24 hours. Described inheritance patterns have included both autosomal dominant and autosomal recessive mechanisms. Some cases have been associated with selective aminoaciduria, distinctly unlike the generalized aminoaciduria seen in Fanconi's syndrome. We report the first case of primary renal glucosuria with selective overexcretion of arginine, carnosine, and taurine. This case may represent a genetic defect unique from the abnormalities in previously described cases of primary renal glucosuria with different amino acid excretion patterns. Future investigations could determine whether the syndrome involves a defect in the SGLT2 gene.

Outcomes and characteristics of intermittent hemodialysis for acute kidney injury in an intensive care unit.

Renal replacement therapy in intensive care units (ICUs) varies globally and is dependent on medical and non-medical factors. We performed a retrospective analysis of patients initiated on dialysis in an ICU. Patient and clinical characteristics, cause of kidney injury, laboratory parameters, hemodialysis characteristics, and survival were reviewed. Acute physiological and chronic health (APACHE II) score was use to study the sickness profile. A total of 92 patients underwent 525 hemodialysis sessions. There were 60 male and 32 female patients. The mean age of the patients was 56.5 ± 16 years. The cause of acute kidney injury included sepsis 64, cardiac 7, malaria 7, postoperative 4, trauma 3, poisoning 2, and others 4. Vasopressors were used in 75% and mechanical ventilation was used in 74 (82%) of the cases. APACHE II score was 22.3 + 7.4. The mean creatinine level was 3.6 + 3.7 mg/dl. The duration of dialysis was less than 4 h in 324 (61.2%) sessions and greater than 6 h in 118 (22.5%) sessions. The percentage of 30-day survival was 30%. Intermittent hemodialysis customized to renal support needs of ICU patients is an appropriate option in resource-limited settings.