European Journal of Molecular & Clinical Medicine

Background:To study the prevalence of Pulmonary Hypertension (PH) in patients with Chronic Kidney Disease (CKD).
Materials and Methods: The present study assessed the prevalence of PH in 50 patients with CKD, at DR.PSIMS & RF, Chinnavutpalli, Gannavaram.
Results: The commonly affected age group in study population was 31-50 years. The mean age of patients was 48.98±12.53years. Diabetes Mellitus was present in 15 (30%) and Hypertension in 48 (96%).  Majority of the patients were in CKD stage 5, i.e.,46 (92%), CKD stage 4 -3 (6%), CKD stage 3- 1(2%). The prevalence of PH in CKD is 22 (44%). PH was not found in the patient with CKD stage 3. PH was found in 2 of the 3(66.6%) patients with CKD stage 4. Out of the 46 CKD stage 5 patients, 20 (43.4%) had PH. With reference to the severity of PH with CKD, the two patients of PH  CKD stage 4 had moderate PH . Out of the 20 patients of PH with CKD stage 5, 10 patients had mild PH, 9 with moderate PH and 1 with severe PHOn Chest X ray, descending right pulmonary artery dilatation and cardiomegaly were seen in more number of patients with PH, compared to those without PH. (p<0.001). In this study, LV systolic dysfunction was present in 18 out of 50 patients (36%). Among 22 patients with PH, it was present in 13 (59.09%). Among 28 patients without PH, it was present in 5 (17.85%). LV systolic dysfunction was significantly higher among the patients with PH compared to those without PH. The mean EF of all patients with CKD is 55.62± 9.54. The mean EF of patients with PH and without PH in the study was 50.50±9.78% and 59.64±7.26% respectively. (p<0.02). LV diastolic dysfunction was present in 41 out of 50 patients (82%). Among 22 patients with PH, it was present in 20 (90.9%). Among 28 patients without PH, it was present in 21 (75%). Prevalence of LV diastolic dysfunction was significantly higher among the patients with PH, compared to those without PH. RV dysfunction was present in 1(3.6%) and in 10 (45.5%) in patients without PH and in patients with PH respectively. Significant difference was found with RV dysfunction more prominent in patients with PH than in patients without PH (p<0.001). 64%of the patients studied had CKD of less than 6 months including 24%of new cases. 16%of the patients had CKD between 6 months and 1year. 20% had CKD of more than 1yr. In relation to PH, out of the 12 new cases of CKD,7 (31.8%) had PH and 5(17.9%)were without PH. Of the 20 patients having history of CKD less than 6 months (excluding new cases), 7 (31.8%) had PH and 13 (46.4%) were without PH. Out of the 8 patients  of CKD between 6 months and 1 year,4(18.2%) had PH and  4(14.3%)were without PH. In patients having CKD of more than 1 year, 4 (18.2%) had PH and 6 (21.4%) were without PH.
Conclusion: The study showed that PH is common in patients with CKD. Left Ventricular systolic and diastolic dysfunctions are strongly related to the outcome of these patients. Unexplained dyspnoea in patients with CKD must be evaluated for PHPulmonary Hypertension, CKD, Chest X-Ray, Left Ventricle, Mortality, ECG, 2D-Echo

Background:Chronic kidney disease (CKD) is a devastating medical, social, and economic
problem for patients and their families.The present study correlated findings in pulmonary
function test with stages of chronic kidney disease.
Materials & Methods:100 confirmed cases of CKD and 40 controls were included.
Standard spirometric pulmonary function tests were performed immediately before and after
the midweek hemodialysis session.
Results: Most common age group was 31-40 years [34 (34%)] followed by 21-30years [17
(17%)] and 41-50 years [16 (16%)].Most commonly observed PFT pattern was Mild
restrictive [22 (22%)] followed by moderate restrictive [19 (19%)]. 25 patients with mild
restrictive pattern, 13 (52%)belong to stage 3, 5 (20%) belong to stage 4, 6 (24%) belong to
stage 2 and 1 (4%) belong to stage 5 CKD whereas, out of 19 patients with moderate
restrictive pattern, 9 (47.36%) belong to stage 5 and 5 (26.31%) each belong to stage 2 and 3
respectively. Out of 12 patients with moderately severe restrictive pattern 6 (50%) in each
belong to stage 4 and 5 respectively. All two severe restrictive pattern patients belong to stage
5 CKD.
Conclusion: In CKD patients there exists a significant pulmonary morbidity in restrictive
pattern. This restrictive abnormality depends on stage of CKD and worsens as the CKD stage
worsens. Most common finding was mild restrictive pattern suggesting that clinically patient
may not get debilitating symptoms due to this.

Background
Chronic Kidney Disease (CKD) is recognized as a major medical problem
worldwide. Electrocardiogram (ECG) remains an essential tool despite the development of
modern technologies, for evaluation of cardiovascular disease.
Aim
To study the electrocardiographic findings along with the associations with the laboratory
variables and prevalence of cardiac arrhythmias in patients of chronic kidney disease
undergoing haemodialysis.
Method
The study was conducted on 100 in-patients who were undergoing Haemodialysis in G.R.
Medical College, Gwalior. A standard 12 lead ECG was obtained just before and after the
haemodialysis procedure. The electrocardiograms was reviewed on descriptive reports of
variables: Rhythm, Heart rate , P wave abnormalities, LVH, QT interval/ QTc, ST segment
changes. Patient was placed on the Holter monitor for 24 hours just an hour before the
dialysis.
Result
In the study subjects , there were 51% of them who had serum creatinine of (5.1-10mg/dL)
and 2% had serum creatinine of ( > 20 mg/dL). There were 37% of the study subjects who
were Smoking and 27% of them were Alcoholics, 81% were Hypertensives , 19% were
having Diabetes Mellitus and 14 % were Obese. It was observed that 5% of the subjects
showed Atrial Fibrillation on ECG after Dialysis and 95% of them showed a Sinus
Rhythm. Changes in the ST segment and Tall T wave on ECG were observed in 25% and
35% of the study subjects. Supraventricular Ectopic findings were observed in 19% before
dialysis and 48% during dialysis and 15% after dialysis respectively. On ECHO, 60% of
subjects showed Left Ventricle Hypertrophy and 28% had Diastolic dysfunction.

Background: Chronic Kidney Disease (CKD) is a Health-Related Quality of Life
(HRQOL) deteriorating disease which is not only a public health but also a socioeconomic
problem of a country. The aim of this study to assess the health-related
quality of life among patients with chronic kidney disease who are on maintenance
dialysis.
Materials& Methods: A hospital based cross sectional study done on 100 patients with
chronic kidney disease on maintenance dialysis at Holy Family Hospital, Okhla, New
Delhi, Indiafor one year period. The techniques used for data collection were interview
and record analysis. Assessment of health-related quality of life was done by using the
KDQOL-SF 1.3 also includes a 36- item health survey (RAND 36- items Health Survey
1.0 or SF-36). Data were analysed using descriptive and inferential statistics.
Results: Among 100 patients with chronic kidney disease 74% were above the age of 50
years. Males (63%) are more affected than female (37%). Majority of them were hailed
from urban area (70%). Nearly 2/3rd of them (67%) have been undergoing dialysis for
more than 3 years. Diabetes and hypertension were the leading cause of CKD. The
overall HRQOL of CKD patients on maintenancedialysis is 35.65±7.19.The HRQOL
related to mental health composite(26.12±6.78) is the worst affected followed by kidney
disease problem composite(31.56±4.63), physical health composite(34.38±5.60),and
patient satisfaction (50.54±11.78).
Conclusion: Monitoring HRQOL is an important indicator to identify impact of CKD
onphysical, psychological and social wellbeing. So, there is a need for the health
caresystem to develop appropriate evidence-based practice guideline for the assessment
and management of HRQOL on CKD.

Aim: To evaluate the psychiatric morbidity using MINI questionnaire in patients diagnosed with
CKD.
Materials and Methods: Total 170 patients were interviewed over a period of one and a half
year starting from January 2014. Each patient was assessed twice: at the baseline and after 3
months. Patients were approached and after obtaining their consent, information was collected
about their socio-demographic details like age, sex, marital status and religion, duration of renal
illness (CKD). Each patient was then screened for psychiatric morbidity using MINI
questionnaire. Patients were then divided into two groups: those having psychiatric morbidity
and those without. The collected data was compiled in MS Excel sheet 2007. For analyses of this
data SPSS version 20 for Windows 7 was used.
Results: The study population consisted of patients between the ages of 18 to 72 years with the
mean age of 40.8(SD=14.8). There were 120 males (70.6%) and 50 females (29.4%) in the study
population. There were 134 married (78.8%), 30 single (17.6%) and 6 widowers (3.5%) in our
study population. 42 (24.70%) had a diagnosable psychiatric morbidity on Mini International
Neuropsychiatric Interview. The most common psychiatric diagnosis found in our study was
Major depressive disorder that was seen in 88.09% (n=37) patients followed by Generalized
anxiety disorder, which was seen in 3 patients (7.14%). Psychiatric morbidity was highest in the
age group of 51-60 years. Significant association was found between age group and psychiatric
morbidity (p<0.001). The impact of duration of illness and psychiatric morbidity revealed
significant association between these two factors (p<0.0001).

Chronic inflammation is a common feature of CKD and is a major cause of its associated
morbidity and mortality. Erythropoiesis is inhibited by several pro-inflammatory cytokines
such as interleukin-1, tumor necrosis factor-alpha (TNF-α) and interferon gamma (IFN-γ).12
These cytokines are particularly involved in the inflammatory process as they are directly
produced by macrophages (TNF-α, IL-1) or because their production by another cell is
induced by a macrophage cytokine (IFN-γ). Several studies have shown that markers of
inflammation are associated with a decreased response to erythropoietin. Out of these 52
patients, 12 patients couldn’t complete the study. 5 patients (2 in group A and 3 in group B)
left the study in between due to some unknown causes and 7 patients (4 in group A and 3 in
group B) expired during the study.So finally 40 patients (20 in each group) completed the
study. In group A there was a slight decrease in systolic and diastolic blood pressure from
baseline values of 153.5±12.06 and 92.3±6.06 mm of Hg to 150.4±12.62 and 89.2±5.36 mm
of Hg at 3 months, but the decrease was not significant statistically (p >0.05). In group B also
there was a slight decrease in systolic and diastolic blood pressure from baseline values of
156.2±8.72 and 92.4±6.31 mm of Hg to 149.1±18.20 and 93.6±4.75 mm of Hg at 3 months,
but the decrease was not significant statistically (p >0.05).

Chronic kidney disease (CKD) is related to poor oral health, including gingival and periodontal diseases. Poor oral health in CKD patients is an important problem, but often neglected. Oral health status also associated with the individual's Oral Health Behavior (OHB). The aim of this study is to assess the impact of OHB on gingival health status in CKD patients.

Nephrology emerged as autonomous discipline in the 1950s, after the publication of the landmark treatise of Homer Smith entitled The Kidney Structure and Function in Health and Disease (1951). The official foundation took place in 1961. For decades, during the collection of the critical mass of data that granted its autonomy, Nephrology investigated acid–base and electrolyte disorders. However, driven by biopsy, dialysis machines and transplantation its growth has been unstoppable in terms of journals, articles, books, meetings, number of specialists, clinical divisions, university chairs, and specialty schools. The most propulsive force has been, however, the switching of the focus from the care of dialysis patients to the >10% of the population who, in a country, suffer from silent or overt disease leading to chronic kidney disease, requiring a demanding and costly therapy consuming 2–3 % of the total health budget. Historical analysis disclosed that Nephrology as a specialty was born and nurtured in contact zones with other disciplines. These include chemistry, physics, pathology, immunology, pharmacology, genetics, engineering, pediatrics, geriatrics, oncology and cardiology and many more. However research focused on kidney disease, although still lush and appealing, is felt to be stagnant. Another approach based on complexity and holism rather than on strict reductionism – indispensable to provide successful care – may better serve future needs. The potential of complexity is explored along with new techniques, Big Data, and a wider use of artificial intelligence, as well as the links with philosophy, and Systems Biology, Systems Medicine, Systems Pharmacology.