Aasim Ahmad

Comparison of total direct cost of conventional single use and mechanical reuse of dialyzers in patients of end-stage renal disease on maintenance hemodialysis: A single center study.

Reusing dialyzers is almost universal in developing countries to reduce the cost of hemodialysis (HD). Economic benefits of dialyzer reuse, when estimated only on the basis of the dialyzer and its consumables are very significant and attractive. In this study, we compared the cost of mechanical reuse of dialyzer considering all of the direct costs (medications, dialyzer, and its consumables, disinfection fluid, and hospitalization if any) in HD treatment, which if significantly different between single use and reuse, can nullify the obvious cost benefits. A total of 70 adult patients of any gender on maintenance HD at The Kidney Centre Post Graduate Training Institute for more than three months were included. Equal numbers of patients were on single use (Group A) and reuse of dialyzer (Group B). Both groups were compared for total direct costs of HD over a six months period. Average six monthly total direct cost per patient of Group A was significantly high as compared to Group B, the United States Dollar (USD) 1750.67 ± 135.31

Morbidity and mortality associated with Plasmodium vivax and Plasmodium falciparum infection in a tertiary care kidney hospital.

vs. USD 1488.50 ± 132.23

The Causes of Chronic Kidney Disease in Adults in a Developing Country

); difference USD 262.18

Reasons For Removal Of Non-tunneled Double Lumen Catheters In Incident Dialysis Patients

(P <0.001). The total cost saving being 14.97% in Group B. Our study shows that dialyzer reuse provides a significant economic benefit and remains a means of reducing the cost of HD.

Analysis of renal diseases detected in renal biopsies of adult patients: A single-center experience

Malaria is a disease of tropical regions and both types of plasmodia, i.e. Plasmodium falciparum and Plasmodium vivax, cause significant morbidity and mortality. P. vivax was thought to be benign and cause less morbidity and mortality. Many reports showed the devastating effect of vivax malaria too. We compared the clinical symptoms, laboratory markers, treatment and outcome of both the plasmodia. This is a retrospective analysis of 95 patients admitted to The Kidney Center, Karachi in a duration of 15 years (1997-2012); 45 patients with falciparum malaria and 50 patients with vivax malaria, and compared the clinical presentation, laboratory workup, treatment and outcome in both groups. The two groups constitute a mixed population of diabetes, chronic kidney disease (CKD) and hemodialysis patients. Both plasmodia have an equal clinical impact in terms of fever and rigors, anorexia, nausea, feeling of dyspnea, change in the mental status, changes in the urine color, diarrhea, volume depletion and pedal edema. However, patients with falciparum had significantly more vomiting (P = 0.02), oliguria (P = 0.003) and jaundice (P = 0.003). Laboratory parameters also showed a severe impact of falciparum, as there was more severe anemia and kidney and liver dysfunction. More patients were treated with dialysis and blood transfusion in the falciparum group. The outcome in the two groups was not significantly different in terms of death and days of hospitalization. Falciparum malaria has a higher clinical impact than the vivax malaria, but vivax is not as benign as it was once thought to be. It also has devastating effects on vulnerable populations like patients with CKD and diabetes.

Clinical variables differentiating diabetic from nondiabetic kidney disease in patients with diabetes: A single-center study

Introduction: Diabetes mellitus (DM) and hypertension (HTN) are considered as the leading causes of CKD all around the world. But the causes of CKD differ from region to region. In developing countries the population is heterogeneous therefore regional causes of CKD need to be evaluated. Material and method: This cross sectional study included all adult CKD patients, who visited to nephrology service in two tertiary care hospitals in metropolitan city Karachi in Pakistan. The sociodemographic data was collected by interview through a structured questionnaire while laboratory data was collected from patients records. Results: Diabetic nephropathy (DNP) was the main cause of CKD (37.5%) followed by hypertensive nephropathy (17.1%) and obstructive nephropathy (ONP) (12.7%). ONP and hereditary disorders (HD) were more prevalent in males than females (70. 1% vs. 29.9%) and (75% vs. 25%) respectively, while urinary tract infection (UTI), drug induced kidney disease and tubulointerstitial nephritis (TIN) were more common in females than in males (87.5% vs. 12.5%), (75.8% vs.24.2%) and (64.7% vs. 35.3%) respectively. Gender, area of residence and socioeconomic status were the factors which affect the cause of CKD (p ≤ 0.05). Conclusion: DNP and hypertensive nephropathy were more prevalent in urban, educated males with high socioeconomic background. On the other hand CKD of unknown etiology and stone diseases were more common in rural, uneducated, males with low socioeconomic background.

The Contemporary Scope of Renal Histopathology in Diabetic Patients- Analysis of Kidney Biopsy in Single Centre

OBJECTIVE To evaluate the reasons of removal of non-tunneled double lumen catheters (NTDLC) in incident hemodialysis (HD) patients in a tertiary renal care hospital. STUDY DESIGN Observational retrospective study. PLACE AND DURATION OF STUDY Department of Nephrology, The Kidney Centre Postgraduate Training Institute (TKC PGTI), Karachi, from June 2015 to May 2016. METHODOLOGY All patients were selected who had naive NTDLC placement at TKC PGTI either in Emergency Room (ER) or Intensive Care Unit (ICU) during the study period. The reason for removal were observed. Data was analysed by SPSS 21 and mean, percentages and frequencies were calculated. Cross tabulation between variables was done to find significance. RESULTS A total of 429 NTDLCs were inserted in the study period, out of which 296 catheters were inserted for incident HD. One hundred and twenty-seven (42.9%) catheters were removed prematurely due to malfunction, and 50 (17%) due to catheter-related blood stream infection (CRBSI). Methicillin resistant Staphylococcus aureus was the commonest organism responsible for CRBSI. One hundred and five (35.47%) catheters were removed because the permanent vascular access (PVA) became usable. CONCLUSION Catheter malfunctions and infections frequently occurred in NTDLC used for HD, which culminated early removal of catheter. Early creation of PVA should be encouraged to reduce the complications in already immunocompromised patients.

Factor causing late referral of CKD patients to Nephrology care

Renal biopsy is crucial while evaluating for the diagnosis of glomerular, vascular, tubulointerstitial, and genetic diseases. It gives vital information which helps in estimating the disease prognosis, progression, and management. This is the retrospective analysis of all adult patients aged above 18 years, who underwent percutaneous renal biopsy at The Kidney Center Post Graduate Training Institute, Karachi, over a duration of 18 years, i.e., January 1, 1996, to December 2013. Renal graft biopsies and those which were inadequate were excluded from analysis. Of the1962 biopsies performed, we included 1521 biopsies in our assessment. The mean age of the population was 38 ± 15.26 years (range 18-88 years). There were 920 (60.5%) males and 601 (39.5%) females. The most common clinical indication of kidney biopsy was nephrotic syndrome, i.e., 741 (45.7%), followed by chronic kidney disease, 253 (16.6%); acute renal failure, 184; (12.1%) and rapidly progressive glomerulonephritis (GN), 124 (8.2%). Primary GN was found in the majority of the patients, 984 (64.7%), followed by secondary GN in 249 (16.4%), tubulointerstitial disease in 224 (14.7%), and vascular disease in 64 (4.2%). In primary GN, focal segmental glomerulosclerosis was the most common histopathological diagnosis in 297 (19.5%) patients, followed by MGN in 224 (14.7%), chronic GN in 98 (6.4%), crescentic GN in 93 (6.1%), minimal change disease in 87 (5.7%), membranoproliferative glomerulonephritis in 58 (3.8%), and postinfection glomerulonephritis in 53 (3.5%) patients. This study shows that focal segmental glomerulosclerosis is the most common lesion in renal biopsy in the young age group followed by membranous nephropathy. Diabetic nephropathy and chronic interstitial nephritis were dominant secondary pathological lesions in older age group, whereas lupus nephritis was the most common secondary disease in young age females.

TREATMENT OF HYPERKALEMIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A COMPARISON OF CALCIUM POLYSTYRENE SULPHONATE AND SODIUM POLYSTYRENE SULPHONATE

Patients with diabetes may have kidney diseases other than the diabetic kidney disease. Kidney biopsy is the investigation of choice when this is suspected. This retrospective analysis included all patients known to have diabetes mellitus (DM) and who had a kidney biopsy at our center between 1998 and 2014. The aim of this study was to assess if an association exists between the clinical factors on the presence or absence of diabetic nephropathy (DNP). A total number of 206 patients were included in our study. The association between the diabetic retinopathy (DRP) and DNP was high (P = 0.001). We found that the DRP is highly specific for the presence of DNP [89.7% (78 out of 87)] whereas sensitivity of DRP for DNP was 56.3% (67 out of 119). Among other factors, only duration of DM showed a significant association (P = 0.005) (odds ratio: 1.1085 and confidence interval: 1.025-1.149) with the development of DNP. We conclude that the absence of DRP is strongly associated with the presence of nondiabetic renal disease while the presence of DRP has a low sensitivity for the presence of DNP.

Giant renal angiomyolipomas and pulmonary lymphangiomyomatosis

Objective: The aim of the study is to form an impression about the spectrum of non-diabetic kidney disease and evaluate the factors which can differentiate the two. Methods: A descriptive study, conducted in Nephrology unit, The kidney center Karachi, from January 1998 till December 2015. The study included 212 diabetic patients. Those who do not have complete record and eye examination were excluded. Results: The study included 212 diabetic patients who underwent kidney biopsy at the kidney centre. Those who do not have complete record and eye examination were excluded. The mean age was 52.4 ± 11.96 SD. There were total 128 (60.4%) male and 84 (39.6%) female with a male to female ratio of 1.5:1. The patients with DKD were 76 (35.8%) NDKD were 91 (42.9%) and NDKD + DKD were 45 (21.2%) Among different NDKD, the frequency of different lesions found alone were FSGS 22(16.2%) which was the most frequently occurring lesion followed by chronic TIN 13 (9.6%), chronic GN10 (7.4%), Crescentic GN 8 (5.9%), MGN 7 (5.1%), acute TIN 5 (3.7%) and Amyloidosis 4 (2.9%), were most common non diabetic kidney diseases. On the other hand among NDKD superimposed on DKD The most frequent lesion was chronic TIN 10 (7.4%) followed by MGN 6 (4.4), chronic GN 5 (3.7%) and CGN 4 (2.9%). Conclusion: Focal segmental glomerulosclerosis and Tubulointerstitial nephritis were the most common biopsy findings in this cohort, while shorter duration of diabetes mellitus and absence of diabetic retinopathy were important factors to diagnose non diabetic kidney disease.