European Journal of Molecular & Clinical Medicine

The aim of the present study was to identify the lipid pattern in chronic kidney disease patients.
Methods: The study was conducted in the Department of Medicine, Government Medical College and Rajindra Hospital Patiala, India, multi-specialty, tertiary care teaching hospital. This study was done for duration of 1 year from the date of approval of plan. 100 patients of chronic kidney disease coming to the Department of Medicine, Government Medical College and Rajindra hospital was included in the study.
Results: In the present study, majority of patients, i.e. 38 (38%) belonged to the age group 45-54 years, followed by 25 patients (25%) in age group 55-64 years, 23 patients (23%) in age group 65-74 years and 14 patients (14%) in age group 35-44 years.51 patients (51%) were male and 49 patients (49%) were females. Mean value of serum Triglycerides was 161 mg/dl, serum total cholesterol was 201.5 mg/dl, serum HDL was 34.6 mg/dl, serum VLDL was 31.8 mg/dl and serum LDL was 134.7 mg/dl. The mean values of the different fractions were obtained with respect to the co-morbid conditions present in the study sample were not significant. The mean values of the different fractions were obtained in both diabetic and non-diabetic CKD patients were not significant. A similar comparison in the mean values of the lipid profile was done in patients who were on dialysis and those who were being treated conservatively and it was found non-significant.
Conclusion: This study concluded that the mean values of the lipid profile in hundred CKD patients showed a borderline high range of serum triglycerides, serum total cholesterol and LDL, and decreased HDL. There was no statistically significant difference in lipid profile of male and female CKD patients.

Background & Aim: Most of the early kidney diseases do not represent any clinical symptoms therefore left undetected. Chronic kidney disease is characteristically identified by usual testing of blood serum. Advanced cases of chronic kidney disease also manifest with some peculiar symptoms fatigue, loss of appetite, nausea, vomiting, metallic taste, inadvertent weight loss. This study was conducted to compare and correlate various clinical parameters in chronic kidney disease patients with or without hemodialysis.
Materials and Methods: The study was conducted over a year time on 80 chronic kidney disease patients. 45 male and 35 female patients in the age range of 30 to 50 years were studied in detail. Parameters and factors associated to chronic kidney disease were considered; Serum Cholesterol, Triglycerides, High Density Lipoproteins, Low Density Lipoproteins, Albumin (urine), Creatinine. Albumin is a type of proteins seen in blood normally. Group 1 patients consisted of 40 patients who underwent hemodialysis procedure. Group 2 patients consisted of 40 patients those have not undergone hemodialysis procedure. All data was forwarded for statistical analysis for further investigation and interpretations. P value less than 0.05 was taken as significant.
Statistical Analysis & Results: Statistical analysis was done by using software statistical package for the Social Sciences In group 1, mean Serum Cholesterol level was 179.41 (mg/dl) while mean Triglycerides level was 133.26 (mg/dl). P value was highly significant (0.01) for Serum Cholesterol level. In group 2, the mean Serum Cholesterol level was 201.41 (mg/dl) while mean Triglycerides level was 165.36 (mg/dl). P value was highly significant (0.02) for Serum Cholesterol level. Mean Albumin and mean Creatinine was 29.22 and 1.44 respectively. One-way ANOVA analysis of both study groups revealed highly significant p value.
Conclusion: Authors concluded that chronic kidney disease patients without hemodialysis exhibit deleterious discrepancies of tested lipid parameters (Dyslipidemia). Nevertheless, Albumin and Creatinine levels are also increased in chronic kidney disease patients (without hemodialysis). Accordingly chronic kidney disease patients without hemodialysis are at higher risk of possibility of blocked arteries and other related dilemmas.

Chronic kidney disease (CKD) is a serious global health with a high global prevalence problem leading to end-stage renal disease (ESRD) and dialysis. Retinal microvascular abnormalities are common in chronic kidney disease as diabetes and hypertension  account for more than half of all patients with renal  failure. The escalating prevalence of diabetes in India, which has already home to over 77million, is also likely to herald an increase in the onset of sight threatening Diabetic retinopathy(DR) in CKD Patients
The aim of this study is to evaluate the  sight-threatening diabetic retinopathy changes in  these CKD Patients.
Materials and Methods
This study was conducted in the Dialysis Unit, nephrology department of Govt. Villupuram Medical College Hospital  from May 2022 – Jan 2023. This was a cross sectional, non-interventional, hospital based study. Total  108 patients having end stage chronic kidney disease on maintenance haemodialysis were examined.
Results
 Datas are collected as ratio and proportions on the prevalence of diabetic retinopathy in chronic kidney disease patients undergoing dialysis. Of the 108 screened among 359 patients, 48/108(44%) were found to be Normal. Diabetic retinopathy seen in 46 of 108 screened, Hypertensive Retinopathy in 9 pts,Glaucoma in 2% of  patients, Cataracts , BRVO and others seen in (3%).
Conclusion Data shows that severe forms of diabetic retinopathy is more linked to long standing history of diabetes causing kidney damage even among those with good glycaemic control. Hence it is advisable to include ophthalmoscopy and fundus evaluation as the screening tool in all CKD patients, so that we can predict the development of diabetic retinopathy and treat them in early stages

Chronic kidney disease (CKD) is a major problem on the healthcare system because of its high increasing prevalence and poor morbidity. Artificial Intelligence peculating its role in every field of research including healthcare and diagnosis of diseases. Recently, machine learning approaches are applied to raise consciousness about key health hazards including chronic kidney disease (CKD). When kidneys are damaged, they are unable to perform their normal role of filtering blood. Therefore, it is tough to anticipate, recognize, and prevent such a sickness, which may result in long-term health repercussions. Machine learning methods aid in more precise forecasting to tackle this problem at an early stage. With the increase of technology aids, it makes an ambiguity on which algorithm to apply for prediction of CKD. To address these issues several machine learning algorithms such as Logistic Regression, Naive Bayes, and Decision Tree are applied. Experiments are conducted utilizing the rich set of data in a MATLAB environment. Logistic Regression shows potential for reducing mortality from chronic kidney disease by enhancing prognosis and diagnostic accuracy at an early stage

Chronic Kidney Disease (CKD) is the 12th  most common  cause of mortality and the 17^thmost frequent cause of disability across the globe. It has a remarkable effect on the quality of life. But, the burden of CKD continues to be an underestimation  as the mortality in CKD patients is  more probably due  to cardiac complications  caused due to  reduced renal function before they reach to End Stage Renal Disease  (ESRD ).¹  Areas of  main  pathologies in native kidneys of patients who undergo dialysis, includes acquired renal cystic  disease with recurrent malignant change.
Aim and objectives: To study the Ultrasonographic findings of patients undergoing hemodialysis.
Methods: This research was conducted out in the Department of Medicine of Maharishi Markandeshwar College and Hospital, Solan. A total of 50 patients undergoing hemodialysiswere enrolled to study the Ultrasonographic findings.
Results: USG findings suggested  raised cortical echogenicity of left kidney  in 24 (48%) patients and 31 (62 %) had raised cortical echogenicity of right kidney .Atleast one kidney was involved in 42(84%) patients  while 13 (26 %) patients had bilateral  raised cortical echogenicity.Polycystic Kidney Disease was present in 2 (4 %) patients,small sized kidney was present in 26 (52 %) patients among which 14 were females and 12 were males.Cholecystitis was a rare presentation in 1 (2%) patient.
Conclusion: Ultrasound findings revealed raised cortical echogenicity of either  left or right kidney (84 % patients ) and small  size of either kidneys (52 % patients) to be the most common findings in patients who   underwent hemodialysis at  Maharishi Markandeshwar Medical College and Hospital, Solan.

Introduction: Obesity has become the leading global health problem. In numerous large population-based studies-Higher BMI associated with presence and development of low estimated GFR and many other renal diseases.
Objective: To study the renal functions in obese adults of rural area.
To do comparative analysis of renal functions with age and sex matched non obese adults.
Material and Methods: The present cross-sectional study was carried out in the General Medicine OPD of BPS GMC for Women, Khanpur Kalan, Sonipat, Haryana. A sample of convenient 100 obese patients were taken. A total of 200 patients attending General Medicine OPD were taken, out of which 100 were obese and 100 were non obese.
Results: Statistically significant P values were obtained for Blood Urea, Serum Creatinine, Serum Calcium, Serum Phosphorus, and urine albumin among obese and non-obese adults. Study shows no significant gender differences between obese and non-obese. Statistical analysis shows some age-related differences among obese and non-obese large population studies-showing positive association of BMI with chronic kidney disease.

Literature proves that various sets of intradialytic stretching exercises are a useful strategy for preventing and treating muscle cramps during hemodialysis. Hence, the researcher decided to evaluate the effectiveness of a set of intradialytic stretching exercises on the reduction of muscle cramps among patients undergoing hemodialysis at a selected hospital, Navi Mumbai. The research design used for the study was a quasi-experimental one-group pretest and post-test group design. A non-probability purposive sampling technique is used to select 50 samples according to the inclusion criteria. The same samples are used in both experimental and control groups at two different times. Intradialytic stretching exercises were performed when the respondents suffered from muscle cramps during hemodialysis. The muscle cramp was assessed with the help of a Numerical Pain Scale, a Modified Ashworth Scale, and a Penn Muscle Cramp Frequency Score.The study results reveal that the mean difference between the experimental and control groups is as follows: the numerical pain score is 1.14, the modified Ashworth score is 3.98, and the Penn muscle frequency score is 0.66. Wilcoxon's signed-rank test scores for each scale are 6.459, 6.249, and 5.291, respectively, which is significant at 5% with a p-value of 0.000. Hence, intradialytic stretching exercises are effective in the reduction of muscle cramps during hemodialysis compared to the control group of respondents.

Background: Chronic kidney disease (CKD) is characterized by progressive decline in glomerular filtration rate (GFR). The present study was conducted to assess prescribing patterns of medicines in chronic kidney disease (CKD) patients.
Materials & Methods: 78 patients of CKD of both genders were assessed for clinical profile, drug usage patterns, and medication-related problem. Suspected adverse drug reactions (ADRs) were recorded.
Results: Out of 78 patients, males were 30 and females were 48. Cardiovascular drugs used by patients was diuretics in 24, ACE inhibitors in 10, calcium channel blocker in 8, beta blockerin 6, gastrointestinal drugs such as H2 blockers in 12, proton pump inhibitor in 4, Hematopoietics such as iron in 2, folate in 3 and erythropoietinin 4, antibiotics such as cefoperazone          in 2, levofloxacin in 1 and ceftriaxone in 2 patients. The difference was significant (P<0.05). Adverse drug reactions observed were hyponatremia in 25%, hypokalaemia in 14% and hypoglycaemia in 8% patients. The difference was significant (P< 0.05).
Conclusion: Common administered drugs in patients with chronic kidney disease was cardiovascular drugs followed by gastrointestinal drugs, hematopoietics and antibiotics. Common adverse drug reactions observed were hyponatremia, hypokalaemia and hypoglycaemia.

declining glomerular filtration rate (GFR) in Chronic kidney disease. It is also the single most
powerful predictor of cardiovascular (CV) disease and mortality. ABPM allows a serial BP
measurements at specified time intervals throughout a 24-hour period, thereby providing a
better assessment of the normal fluctuations in BP levels associated with a person’s daily
activities and sleep. Hence, ABPM is particularly useful in evaluating the patient with highly
variable BP with wide discrepancies between the BP readings obtained in and outside office.
The association between masked hypertension and lower eGFR was observed only in those
participants with elevated night-time BP. In this study, we aimed to determine the effect of
circadian rhythm over hypertension in CKD and non-CKD patients and the associated
prognostic value by assessing the target organ damage.
MATERIALS AND METHODS:
This is a prospective observational study after enlisting inclusion and exclusion criteria
conducted at a tertiary care centre on 60 patients after obtaining written consent, of whom 30
had CKD and 30 controls were hypertensives not having CKD. ABPM machine
was tied to the case and control and blood pressure was measured at intervals of every 30
minutes during the morning hours and hourly during the night.
OBSERVATIONS:
Out of the total 60 patients included in this study, the CKD group showed 53.33% were reverse dippers, 33.33% non-dippers, 13.3% were dippers while the control group showed 76.6%% were dippers, 16.7% were non-dippers, 6.7% being reverse dippers. The Mean SBP being 157.03 + 16.89 in the case group, while it was 136.33 + 10.75 in the control group (p value>0.001), Mean DBP being 85.57 + 13.09, and in the control group being 82.50 ­(p value<0.331). The mean systolic and diastolic pressure was found to be more in the passive period than in the active period.
CONCLUSION:
ABPM has enabled a more comprehensive estimate of a patient and true BP and its adverse
outcomes. Nocturnal BP is superior to day-time BP in predicting CVD outcomes. This study
shows both systolic and diastolic pressure variability over 24hrs maximum during night hours
(nocturnal hypertension) and non-dipping of early morning BP in CKD. Both Reverse and
non-dipping status are associated with increased risk of target organ damage and CV risk

Background: Pulmonary hypertension is a recognised complication of chronic kidney disease, especially in end stage renal disease. It has prevalence estimates of 30-50%.  Present study aimed to study magnitude of pulmonary artery hypertension in chronic kidney disease patients
Material & Method: This observational analytical cross sectional study was conducted among the adult more than 18yrs of age with CKD attending department of general medicine. After obtaining informed and written consent from the patients, detailed history, clinical assessment and laboratory diagnosis to be done. (Blood urea, Serum creatinine, Serum uric acid, Serum electrolytes, Urine Routine, Complete hemogram, Liver function tests)
Result: The mean age of the patients was found to be 49.45±8.97yrs, with majority of the patients in age group of 41-60yrs. On gender assessment majority of the patients were male (68%), with male preponderance.  There is 18.4% of patients presented with pulmonary hypetension. There is a significant higher incidence of the pulmonary hypertension among the patients with stage 3 (30.4%) and stage 4 CKD (60.9%) patients.
Conclusion: CKD patients have a higher prevalence of pulmonary hypertension. The prevalence of pulmonary hypertension is high in stage 5 CKD patients, and it is also higher in dialysis patients. In CKD patients, there is no gender difference in the development of pulmonary hypertension.

Background: Chronic Renal Disease is a fast-growing disease worldwide achieving the endemic levels. The use of NSAIDs has been associated with renal function deterioration through variable mechanisms. Present study was aimed at pharmacovigilance analysis of nonsteroidal anti-inflammatory drugs-induced chronic kidney disease at a tertiary hospital. Material and Methods: Present study was retrospective, case record-based analysis conducted in case records of patients admitted & diagnosed as nonsteroidal anti-inflammatory drugs-(NSAID) induced chronic kidney disease. Results: In present study, 48 case records evaluated. Majority patients were from 51-60 years (37.5 %) & 41-50 years age group (27.08 %), were male (68.75 %) & labourer by occupation (52.08 %). Common co-morbidities noted were hypertension (77.08 %), bone and joint disease (33.33 %), diabetes (31.25 %), cardiovascular disease (29.17 %) & malignancy (4.17 %). Among 48 patients, common CKD stage was Stage 3a (39.58 %) followed by Stage 3b (29.17 %), Stage 2 (22.92 %) & Stage 4 (8.33 %). Treatment receiving were Hemodialysis (54.17 %), Only medicine (22.92 %), Peritoneal dialysis (10.42 %) & Kidney transplantation (12.5 %), Common NSAIDs used was Diclofenac/Aceclofenac (45.83 %), Paracetamol (39.58 %), Ibuprofen (27.08 %), Ketorolac (4.17 %) & Nimesulide (4.17 %). Oral Route of administration was common (77.08 %). Though majority of patients using 1 NSAID (47.92 %) followed by 2 NSAIDs use (35.42 %), ≥3 NSAIDs use (16.67 %). Common purpose of use was headache (60.42 %), generalized pain (45.83 %), joint pain (33.33 %), dental pain (14.58 %), menstrual pain (12.50 %) & renal colic (8.33 %). Conclusion: Non-steroidal anti-inflammatory drug induced nephrotoxicity should be considered as significant adverse effect. Physicians & general practitioners should discourage on the counter use of NSAIDs.

Introduction: Chronic kidney disease (CKD) is associated with a complex array of cutaneous
manifestations caused either by the disease or by treatment. Cutaneous manifestations in chronic kidney
disease are polymorphic and diverse. Most patients with severe CKD progress to end stage renal disease
(ESRD) with significant morbidity and mortality. The Aim of our study was to evaluate the prevalence
and pattern of cutaneous disorders among patients with chronic kidney disease.
Materials and Methods: One hundred patients of chronic kidney disease above the age of 18 years with
dermatological manifestation were enrolled in the study. A detailed physical examination and
dermatological examination was done and findings recorded. Relevant investigations including complete
haemogram, diabetic profile, ANA, renal function tests, Liver function tests, electrolytes, viral markers,
serum calcium, phosphorous and PTH (parathormone) levels, KOH mount, culture & sensitivity, woods
lamp examination, biopsy was done if indicated.
Results: In our study we included 100 patients of CKD with cutaneous manifestations. The most
common cause of CKD in our study was found to be diabetic nephropathy which was seen in 47% (n=47)
patients. Pruritus was the most common dermatological manifestation seen in 73% (n=73) of the total
study population followed by xerosis in 68% (n=68). More than 50% of the study population had more
than one dermatological manifestations. Nail and hair changes was seen in 43% and 58% respectively.
Conclusion: Patients with end stage renal disease (ESRD) may present with variety of skin abnormalities
and the most common being pruritus and xerosis as seen in our study. An inter-disciplinary approach
involving dermatologists and nephrologists is essential to improve the quality of life of patients with
ESRD.

Introduction: Neutralization of a key Wnt inhibitor elevated in the circulation in CKD, Dkk1, and inhibited CKD induced vascular dedifferentiation, vascular calcification, and renal osteodystrophy. This effect was surprising since Wnt signalling in the vascular smooth muscle is implicated in stimulating osteoblastic transition and vascular calcification. However, recent studies demonstrate that Dkk1 mediated inhibition of aortic Wnt7b stimulates smad mediated aortic endothelial-mesenchymal transition (EndMT) and vascular calcificatio. EndMT is a developmental physiologic process involved in the development of the cardiac valves, the cardiac septum and the aortic root, and it may or may not contribute to cardiac fibrosis in various adult disease states.
Methodology: This is an observational study with no interventions carried out on any subject. Furthermore, all the CKD individuals were divided in to two groups based on the dialysis. Finally, the statistical analyses were performed between the predialysis, dialysis and control population to find the possible or potential diagnostic marker for CKD-MBD. Results: A total 68 individuals were genotyped for this study which includes 19 control subjects, 25 Non Dialysis patients and 24 Dialysis patients. The distribution of OPG gene polymorphisms among the control, Non dialysis and dialysis group were documented. Of the 19 studied control subjects 17 (85%) TT, 2 (10% TC) and 1 (5%) TC genotypes were observed.
Conclusion: Among the 25 non dialysis patients the observed genotypes are 15 (60%) TT, 6 (24%) and 4 (16%)TC. The Dialysis group 11 TT (45.8%), 8 TC (33.3%) and 5 TC (20.8%) genotypes were observed.

Background: Abnormal thyroid function tests are frequently observed in patients of
chronic kidney disease. Kidneys plays a significant role in thyroid hormone metabolism
by conversion of T4 to T3 (the active metabolite). Low plasma free T3 in ESRD is a
marker of the inflammation and endothelial activation; and is known to predict all
cause mortality. The present study was done look for the biochemical abnormalities of
thyroid function tests in chronic kidney disease and to correlate the severity of CKD
and alterations of thyroid indices.
Materials and Methods: In a cross sectional study, thyroid function test [TT3, TT4,
FT4, TSH] were estimated by CLIA in 50 patients of chronic kidney disease who were
in various stages. Symptoms of hypothyroidism, thyroid hormone abnormalities and
CKD stage were analyzed using Chi square test and ANOVA tests.
Results: Among the mean age was 48.8 ± 12.2 years of which 33 were male and 17
females. The mean value of TT3 in CKD stage 3, 4, 5 were 1.01±0.39; 1.05± 0.6;
0.95±1.09 μg/mL respectively. (p= 0.02 Significant). The mean value of TT4 in CKD
stage 3, 4, 5 were 6.3± 2.4; 5.5± 1.5; 5.11 ± 1.01 μIU/ml respectively. (p=0.71 Not
significant).
Conclusion: Total T3 and total T4 were found to be progressively decreased as stage of
CKD increased. There was no significant correlation between TT4 and CKD stage.
There was a significant correlation between the prevalence of thyroid dysfunction and
the stage of chronic kidney disease.Higher the degree of renal insufficiency, the higher
was the prevalence of thyroid hormone abnormalities, the levels of thyroid profile i.e
T3, T4 decreases and TSH increases as severity of renal failure increases. Thyroid
hormone abnormalities could represent a risk factor for cardiovascular disease and
might also be implicated in kidney disease progression.

Background: Many newer tests are now available to diagnose iron deficiency in CKD but these tests are not widely used in India as these tests are expensive and patients cannot afford these tests. Hence the traditional tests serum ferritin and transferrin saturation are needed to be studied more thoroughly to infuse IV iron to patients with iron deficiency anemia in CKD as many cannot afford ESAs and blood. Ferritin is an important indicator of iron overload as well as an acute phase reactant which increases in inflammatory conditions. Serum ferritin getting raised both in iron deficiency anemia and inflammatory states complicates our diagnosis. In this scenario TSAT plays important role in ruling out iron overload and inflammation is ruled out by inflammatory markers.
Objective: To study the effect of IV iron in patients with serum ferritin >1000ng/ml and TSAT <20%.
Methodology: This study was conducted at Department of Medicine, M.L.B. Medical College; Jhansi from March 2020 to November 2021, after seeking clearance from ethical committee and obtaining written informed consent from patient.
Result: It was seen than 18 patients showed improvement and had increase in Hb by 1g/dl. 1 patient had a reaction and transfusion was stopped immediately and 1 patient was lost to follow up.
Conclusion: Against the popular belief that infusion of iron in patients with raised serum ferritin should not be given, this study showed that after ruling out other causes of raised serum ferritin and iron overload by calculating TSAT, IV iron can be given to patients with raised serum ferritin as it shows improvement in anemia.

Background: The present study aimed to evaluate the levels of serum iron, total iron
binding capacity (TIBC), transferrin saturation and serum ferritin in diagnosed cases of
chronic kidney disease due to any aetiology not undergoing dialysis. Study also aimed to
determine the correlation between serum creatinine and serum iron levels in chronic
kidney disease in this group of patients.
Materials and Methods: The present study was conducted in the city of Dibrugarh and
which also included patients belonging to adjoining districts of Upper Assam from 20th
October 2018 to 19th October 2019 for a period of 1 year. A clinico-hematological study
was undertaken to evaluate the levels of serum iron, total iron binding capacity (TIBC),
transferrin saturation and serum ferritin in diagnosed cases of chronic kidney disease
(not on dialysis) due to any aetiology. Study included 110 old and newly diagnosed cases
of CKD attending the out–patient department not on dialysis. A cut-off off Hemoglobin
<13 g/dl in men and <12 g/dl in women was used to make the diagnosis of anemia.
Results: Prevalence of anemia among CKD cases was observed as 74.6% with Hb level
<6 gm% was observed in 6.4% cases. Normocytic normochromic picture was observed
in 53.6% cases. Decreased level of serum iron, ferritin, TIBC and transferrin saturation
was seen in 99.1%, 16.4%, 52.75 and 78.2% cases respectively. Mean levels of
haemoglobin, RBC and iron indices (except for TIBC levels) decreased significantly
with increase in the CKD stage. A significant positive correlation was observed between
eGFR levels with haemoglobin and iron indices (except TIBC) while an inverse
correlation was observed with creatinine levels.
Conclusion: Anemia among Pre dialysis-CKD cases is mostly normocytic and moderate
in severity. Functional iron deficiency was the predominant form of iron deficiency in
these patients. Both hemoglobin and other iron indices worsens with progressive loss of
kidney functions.

cholesterol (HDL-C) are usually decreased. However, enough data assessing this relationship
is scarce in different literature commenting on kidney disease progression in patients having
chronic kidney disease
Aim: The present study was conducted to assess the correlation between the progression of
chronic kidney disease and serum high-density lipoprotein cholesterol levels to provide an
alternative to urinary albumin-creatinine ratio (UACR) measurement.
Methods:The present study assessed the relationship between the progression of chronic
kidney disease and serum high-density lipoprotein cholesterol levels in 542 subjects with
diagnosed chronic kidney disease. The primary and secondary outcomes assessed were a 50%
reduction in the estimated GFR (Glomerular Filtration Rate) from the baseline values or the
onset of end-stage renal disease (ESRD). The secondary outcomes assessed were the
development of end-stage renal disease.

With increasing life expectancy and prevalence of life style diseases, United States (US) has
seen a 30% increase in prevalence of chronic kidney disease (CKD) in the last decade.
Unfortunately, from India there is no longitudinal study and limited data on the prevalence of
CKD. Chronic Kidney Disease was diagnosed when at least one of the evidence of chronicity
like documented renal failure for >3 months, bilateral small kidneys, histological evidence of
chronicity or GFR < 30 ml/min for 3 or more months was present.A pre informed written
consent was obtained from every case before inclusion in the study. The clinical and
demographic profile was recorded in a specially designed proforma. On ultrasonogram
bilateral kidneys of group A, 12 patients had bilateral contracted kidneys which correspond to
60% of the study patients indicative of ESRD. 6 patients had normal or slightly enlarged
kidney size suggestive of diabetic nephropathy (30%). Findings of ultrasonogram bilateral
kidneys in group B revealed 11 patients had bilateral contracted kidneys which correspond to
55% of the study participants indicative of ESRD. 5 patients had normal or slightly enlarged
kidney size (25%) and 1 patient was having bilateral enlarged kidneys with multiple cysts of
varying sizes suggestive of autosomal dominant polycystic kidney disease (5%).

Introduction: Arteriovenous fistula (AVF), permanent catheter (PC), and vascular graft are three vascular access types used for hemodialysis (HD) procedure. Due to insufficient reliable information on the comparison between AVF and PC.  This study was conducted to compare AVF and PC regarding adequacy of dialysis.
Material and Methods: This prospective study was carried out in tertiary care center over 6 months (Jan 2021 to June 2021). In this study, 100 HD pts were enrolled and assigned to two unequal groups of AVF and PC. Before and after the dialysis session, blood samples were taken for laboratory examinations and measurement of urea reduction ratio and Kt/V. The patients were followed up for six months, and then laboratory examinations were repeated.
Results: Out Of the 100 HD pts, 40 had AVF and 60 patients on PC. During the 6-month follow-up, 30 patients in PC group but only two  patient in AVF group showed infection (P = 0.050), while in each group,  thrombosis were seen in 6 patients on PC and 4 patients of AVF (P = 0.50). Catheter dysfunction was seen in 15 patients of PC group and one patients of AVF group (P = 0.0001).There was no difference between the two groups in Kt/V and URR at the beginning of the study; however, after six months, Kt/V and URR were greater in AVF group (P< 0.05).
Conclusion: We found better dialysis adequacy in AVF group & there were some advantages of AVF over PC, such as lower rate of infection and thrombosis. We recommend that AVF be created in all of patients with chronic kidney disease who are candidates for HD.

Background: Normal kidney secretes nitrogenous waste product, regulate volume and
acid /base balance of plasma and synthesize erythropoietin, 25-(OH)2- cholecalciferol
and renin. Chronic kidney disease (CKD) is caused by a progressive and irreversible
decline in the number of nephrons. A wide variety of oral manifestations occurs in CKD
patients. Determination and identification of these manifestations will improve the
quality of life in these patients.
Methods: Thus, this cross-sectional study was conducted in the Department of
Medicine, Sanjay Gandhi Memorial Hospital (SGMH), associated with Shyam Shah
Medical College (SSMC), Rewa, in the Vindhya region between February 2019 and
August 2020.
Results: Out of 127 patients, maximum prevalence of oral manifestations occurring was
pallor (93.70%), xerostomia (84.25%), halitosis (72.44%), sore throat (64.56%), lip
pigmentation (63.77%), periodontitis (48.81%). High Urea levels were found to be
highly significant when correlated with halitosis (p<0.00052). Xerostomia was found
significant when correlated with duration of dialysis (<1 year) with p<0.032.
Conclusions: Manifestations of CKD are common during the progression of uremia. In
the patients studied, the impact of CKD on the oral cavity was evidenced by significant
changes, which pointed to an inter-relationship between oral health and CKD.

Introduction-Chronic kidney disease (CKD) is a condition in which there is structural or
functional damage to the kidneys and they are unable to function properly. Recent studies
have shown that patients with CKD have three times more of depression thanthose in the
general population. Depression in CKD patientsis also associated with poor quality of life
andadverse clinical outcome. Therefore, this study was conducted to evaluate the prevalence
of depression and factors affecting them. Materials & Method-A total of 62 patients of
either gender and aged ≥18 years diagnosed with CKD were enrolled. These patients were
analysed for demographic parameters, stage of CKD, its duration, their co-morbidities and
serum creatinine levels. Diagnostic and Statistical Manual (DSM)was used to screen
depression. Montgomery–Asberg Depression Rating Scale (MADRS) was used to rate
severity of depression. Suicidal ideations were assessed using the modified scale for suicidal
ideation. Result-The mean age of the patients was 52.4 years. Among them 59.6% were male
and 40.3% were females. In age group based analysis, majority (43.5%) of patients were
found to be elderly. The prevalence of depression was more (62.4%) in the age group of 40–
60 years. Among them 45.1 % of them were in CKD stage V and 58% of the patients were
having CKD for ≤ 3 years. Among these patients 46.7% had at least two or more
comorbidities in which 55.1% were suffering from hypertension, diabetes Mellitus &
dyslipidaemia. The level of serum creatinine showed that 51.6% had their levels <5 mg/dl.
Further, we found that 45.1 % of patients among which 37% had severe depression.
However, we found that majority of patients (56.4%) had low suicidal ideations.Conclusion-
The findings of our study suggest that CKD patients should be concurrently evaluated for
depression so that an early diagnosis of depression could be done which may help in
improving the quality of life of CKD patients. Moreover, a standard rehabilitation program
can also be designed which may be important and clinically beneficial for them.

Background: Anemia is a common complication in Chronic kidney disease (CKD) patients. It has a multi-factorial pathogenesis. Replenishing iron stores and giving ESAs are the main lines of treatment. There is a general agreement on the optimal route for iron supplementation in ESRD patients with the IV route but there is no such agreement on the optimal route for iron supplementation in pre-dialysis CKD patients. Erythropoiesis stimulating agents (ESAs) treatment represent an economic burden and has been linked to possible cardiovascular side effects. This study amid to assessing the efficacy of erythropoietin in treatment of anemia in CKD patients. Methods: A prospective cohort study was conducted in chronic kidney disease patients who had undergone hemodialysis in Met-Ghamr hospital of nephrology from February 2019 to July 2019. Included 50 patients on maintenance hemodialysis, we tested the efficacy through comparing the efficacy low fixed ESA dose (4000 IU IV once weekly) versus high fixed dose (4000 IU IV three times weekly). We divided group into two groups, group A and group B. group A were put on a fixed dose of 4000 IU Epoetin alfa once weekly and group B were put on a fixed dose of 4000 IU Epoetin alfa three times weekly. Results: After 6 months, We found a significant difference in hemoglobin response of the two subgroups in favor of subgroup IID (P = 0.004). Conclusion: That low dose ESAs is less effective in correction of anemia in dialysis patients than high dose ESAs.

The purpose of this study was to determine the relationship between individual characteristics and discharge planning implementation with the compliance level of chronic kidney disease patients undergoing hemodialysis.A cross sectional designduring July - September 2020 with 105 respondents using simple random sampling. The independent variables were individual characteristics and implementation of discharge planning and the dependent variable was adherence.Data were collected using a questionnaire that was tested for validity and reliability, then data were analyzed using Chi Square test with a significance value P <0.05. Respondents with the highest adherence were women (88.9%; P = 0.015), age range 46 - 55 years (87.8%; P = 0.033), married status (81.1%; 0.031), working (89.5%; P = 0.028), Secondary education level (84.2%; P = 0.043), good knowledge (85.1%; P = 0.026), long hemodialysis> 5 years (93.3%; P = 0.016) and had a history of diabetes mellitus (90.9%; P = 0.035).The discharge planning element also has significant relation (all P <0.05), including sufficient medication (90.0%), a good environment (88.9%), good treatment (100.0%), good health teaching (87.0%), good outpatient referral (100.0%) and good diet (86.7). The level of compliance of hemodialysis patients is very important to improve the quality of life of patients, patient compliance is influenced by the demographic characteristics of the individual and discharge planning in the hospital.

The aim of the study was to review the features of the functional state of the kidneys in patients with cardiopathy, betting on the presentation of the components of the metabolic syndrome. For the research we examined 197 male patients with chronic heart condition (CHF) of ischemic genesis of II-III functional class (FC) in line with NYHA. Metabolic syndrome in patients with chronic heart failure HFmrEF exacerbates impaired renal function, which has developed together of the most pathogenetic links in chronic heart condition. it's been established that because the metabolic syndrome progresses (attachment of T2DM to other components of the metabolic syndrome), the phenomena of functional kidney failure increase. Evidence of the importance of the metabolic syndrome within the nature of the clinical manifestations of chronic coronary failure HFmrEF is that the established dependence of the identified disorders on the severity of the metabolic syndrome.

Purpose of the study: to check some indicators of the immunohemogram in patients with community acquired respiratory disorder on the background of CKD.
Materials and methods. one hundred twenty patients with community-acquired respiratory disorder were examined: forty patients with respiratory disorder (group Pn) and eighty respiratory disorder, that developed against the background of chronic nephrosis (group Pn+ CKD). The management cluster (CG) consisted of twenty healthy individuals. The study found that the amount of leukocytes was exaggerated within the Mon + CKD cluster by 162.24% than in the CG (p <0.001), within the Mon cluster 263.14% on top of within the CG and twenty seven.79% than within the cluster Mon + CKD (p <0.001). In patients with Mon, the quantitative relation of the amount of neutrophils to lymphocytes significantly exaggerated (p <0.001 compared with the CG and also the Mon + CKD group), reflective the shift of the formula to the left, and within the Mon + CKD cluster this quantitative relation remained unchanged, despite the increase within the absolute variety of leukocytes. In patients with respiratory disorder with background CKD, a marked increase in T-lymphocytes was determined because of a population of CD8 and CD95 cells (p <0.001 compared with CG and also the Mon group). a rise in IgM concentration prevailed within the pneumonia cluster, and a rise in immune serum globulin prevailed within the PN + CKD cluster (p <0.001).
Conclusion. Respiratory disorder related to CKD is related to associate active general inflammatory response involving non-specific immunity and also the depletion of its cellular part, as well as activation of immunity because of chronic inflammation and chronic matter stimulation.

Background: Chronic kidney disease (CKD) is an emerging public health problem that affects 5–10% of the world population. With the availability of recent treatment modalities including renal replacement therapy, the survival of CKD patients has increased considerably which has led to an increased focus on health-related quality of life (HRQoL). Health-related quality of life represents the impact of the disease or its treatment on the subjective feelings of patients about their physical, mental, spiritual, emotional, social, and functional wellbeing. Quality of life among dialysis patients has been shown to be lower as compared to pre-dialysis CKD patients and is an independent risk factor for mortality in dialysis patients. Family support is an important factor that serves as a support system for the patients to face health problems.
Purpose: To examine levels of family support and the correlation of family support and quality of life (QoL) among CKD on hemodialysis (HD) patients.
Methods: This cross-sectional observational study was conducted in August-November 2020 and recruited chronic HD patients from Wahidin Sudirohusodo Hospital in Makassar, Indonesia. The demographic data of HD patients were collected. Quality of life was assessed using the validated Indonesian version of the Short Form-36 (SF-36) questionnaire which consists of Physical Component Summary (PCS) and Mental Component Summary (MCS) and family support that was assessed using the validated “Dukungan Keluarga” questionnaire. The data were analyzed using SPSS version 22.0 statistical software.
Results: A total of 60 subjects (39 males and 21 females) were included. The mean age was 48.9±12.1 years old. About 55% of the subjects was graduated from college. About 86.7% subject was married. About 55% of the subject is not working. About 53.3% of subjects have a family income lower than the regional minimum wage. The mean duration of HD was 22.1±28.6 months. The mean score of family support was 53±8,2. Family support score has a significant positive correlation with each domain of PCS and MCS, the higher score of family support is in accordance with higher score of PCS and MCS.
Conclusion: CKD on HD patients’ quality of life was significantly affected by family support

This article describes the features of the clinical course of the disease, assesses the quality of life, diagnostic criteria for the disease, modern classification and tactics of hypotensive therapy in patients with chronic kidney disease, Pathogenetic mechanisms of chronic kidney disease, Correspondence of the stages of chronic kidney disease to the ICD-10 coding.
Various modern studies are described to assess the quality of life of patients using the SF-36 questionnaire, which includes 8 scales: physical functioning, role functioning due to physical state, pain intensity, general health, vital activity, social functioning, role functioning due to emotional state and mental health.

Objective: to investigate the characteristics of the clinical course of community-acquired pneumonia in patients with constant kidney infection. The ponder included 120 patients with pneumonia: 40 patients had no history of renal pathology (group M), 80 patients endured from inveterate kidney infection (GFR for 3 months some time recently the improvement of pneumonia 30-60 ml / min / 1.7 m2, group M + CKD ). Confirmation of the determination was carried out on the premise of chest X-ray, the detailing of the conclusion included deciding the sort of pneumonia - croupous or central intersecting.
In a comparative evaluation of the X-ray picture within the explored groups, it was famous that in patients with pneumonia against the foundation of CKD, lobar and central intersecting pneumonia with a huge penetrate volume were altogether more frequent (p <0.001). Within the flow of follow-up, the larger part of patients (78 out of 120 patients, 65%) appeared positive clinical and radiological elements, 20 patients (16.67%) appeared no critical elements, and 22 patients (18.33%) had clinical and radiological elements. negative. Negative clinical and radiological flow was more frequently watched within the group of patients in whom pneumonia developed against the background of CKD (p <0.01).

Patients with Chronic Kidney Disease (CKD) develop a tendency to bleed and
thromboembolism, so the indication for anticoagulants at the attachment of atrial
fibrillation (AF) is complex. AF is the most common chronic heart arrhythmia, and
thromboembolism and ischemic stroke in particular are the main complications. In recent
years, new oral anticoagulants have been developed and they have shown superiority over
the classic antivitamin K anticoagulants in preventing the risk of stroke, systemic embolism
and bleeding, providing an effective alternative to these resources

The study explores theory of relativity of acid levels with nephritic function, moreover as its role as a prognostic marker of cardio tube risk in chronic excretory organ diseases within the course of variable regression analysis, taking into consideration the adjustment of potential risk issues, the amount of uric acid was found to be a major factor influencing calculable capillary vessel filtration rate. The results of this study showed that elevated humor uric acid levels are related to the next risk of kidney malfunction.

The research describes the concept of healthiness of the physical activity for patients with chronic kidney disease, moreover because the effect of 12-week physical training on physical activity in patients with chronic disease of stage 3-4 who are on a low-protein diet.
At the identical time, patients with variety of chronic diseases aside from CKD also suffer from poor physical performance and muscle atrophy, but more evidence has been accumulated of the positive effect of exercise in such patients [3].
Increased physical activity is related to improved ability to perform everyday activities, professional tasks. Therefore, regular exercise is usually recommended for such patients within the DOPPS study, patients who performed regular physical activity had the next quality of life related to health, good fitness and sleep quality indicators, with fewer patients with limited physical activity and lack of appetite [4].

Background: Chronic kidney disease (CKD) is an independent risk factor and caused high morbidity and mortality for coronary artery disease (CAD). Several scoring systems can be used in assessing the severity of CAD, one of which is using the SYNTAX score (SXscore). Smoking is one of the risk factors for the progression of CAD and CKD. Several observational studies have under-reported the smoking factor influencing the rela-tionship between eGFR and SXscore.
Methods: This research is an observational study with a cross-sectional approach conduct-ed at the Wahidin Sudirohusodo Hospital Makassar from July-August 2020. This study involved 62 CAD and CKD patients undergoing angiography. The estimated glomerular filtration rate was based on chronic kidney disease epidemiology collaboration (CKD-EPI).
Coronary angiography results were converted to SXscore and smoking grade based on the Brinkman index.
Results: This study involved 62 CAD and CKD patients male (71%), aged ≥ 55 years (77.4%), hypertension (71%), diabetes (35.5%), smoking (50%), eGFR G3a & G3b (53.9. %) and SXscore medium-high (50%). The results showed that lower eGFR could increase the SXscore (p < 0.001), especially in smoking subjects (p < 0.001). Multivariate analysis showed that gender was the most significant factor contributing to the relationship between eGFR and SXscore
Conclusion : The lower eGFR could increase the SXscore, where this correlation was more significant in smoking patients. Multivariate analysis showed that gender was the most significant factor contributing to the relationship between eGFR and SXscore.

Chronic kidney disease (CKD) is an overall medical issue, influencing a huge number of people. Magnesium (Mg ++) is the fourth most abundant and second most important intracellular extract in the body. In patients with CKD and end stage renal disease (ESRD), Mg ++ homeostasis may change. The present study is to assess the levels of serum magnesium in chronic kidney disease patients. The current cross-sectional study was performed to assess serum magnesium levels in cases with CKD and to detect the correlation of serum magnesium with clinical features and severity of renal impairment. The serum magnesium among patients with CKD had hyper magnesium. The serum magnesium level rises as kidney function deteriorates. There is significant fall in serum magnesium level after dialysis. Its estimation helps in evaluating conservative treatment and dialysis in CKD. Hence early evaluation and treatment of underlying cause for CKD is necessary to prevent further complication and kidney damage.

The study of various aspects of the problem of common hypomicroelementosis caused by a deficiency of essential trace elements copper and zinc, in particular among women of fertile age, in the population is extremely relevant and important, taking into account the social significance and importance of this population for society , because of what the condition will be health in a given population depends on the state of such important socially significant processes as the healthy development of future generations