Background. The prevalence of glomerular diseases differs according to geographic area, race, age and indications for a renal biopsy. This study was conducted to evaluate the distribution and changing patterns of renal diseases during the past 20 years in a large patient population in Korea. Methods. Patients aged 16 years or older who underwent a renal biopsy at Severance Hospital in the Yonsei University Health System from 1987 to 2006 were enrolled. All medical records were reviewed retrospectively. Results. In total, 1818 patients (M:F = 1.02:1) were reviewed. Glomerulonephritis (GN) comprised 85.9% of the total biopsied cases. The most common primary GN was IgA nephropathy (IgAN) (28.3%), which was followed by minimal change disease (MCD) (15.5%), membranous nephropathy (MN) (12.3%), focal segmental glomerulosclerosis (FSGS) (5.6%) and membranoproliferative GN (MPGN) (4.0%). The most common secondary GN was lupus nephritis (8.7%). The most common idiopathic nephrotic syndrome was MCD (38.5%), which was followed by MN and IgAN. Among 128 (7.4%) patients who were HBsAg-positive, MN (30.5%) and MPGN (21.1%) were the most common GN. When the incidence rates between 1987-91 and 2002-06 were compared, IgAN increased from 25.6 to 34.5%, while MCD (from 23.2 to 7.0%) and MPGN (from 6.7 to 1.7%) decreased significantly (P < 0.01). Conclusions. IgAN was the most common primary GN, and MCD was the most common cause of nephrotic syndrome. In the 5-year quartile comparison, the relative frequency of IgAN increased, while the relative frequency of MCD and MPGN decreased significantly during the past 20 years.

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/104604/1/T200903027.pdf

Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience

Elderly populations are susceptible to many non-communicable diseases, including diabetes. Lack of awareness regarding disease status and risk factors increase complications and mortality. We conducted a cross-sectional community-based study of 1633 randomly selected participants aged 60 years and above in urban and rural areas in the Kathmandu Valley of Nepal. Study goals were: (i) to determine the prevalence of diabetes in elderly subjects as diagnosed prior to and during the study, and (ii) to identify and compare the determinants of diabetes as diagnosed prior to and during the study. A structured questionnaire was used to collect information regarding prevalence and potential determinants of diabetes diagnosed during and before the survey. Anthropometric measurements, blood pressure measurements and fasting blood sugar tests were also measured. Risk factor analysis was done using multinomial logistic regression; subjects with no diabetes constituted the reference group. We detected an overall diabetes prevalence of 25.9%, 17.3% diagnosed during the survey and 8.6% previously diagnosed. Age, disturbed sleep, and family history of hypertension were marginally significantly (p < 0.10) associated with diabetes diagnosed in the survey. In contrast, education, exercise, health perception, family history of hypertension, having a caretaker at night, receiving help from friends when seeking health care and mean waist circumference were significantly (p pounds 0.05) or marginally associated with diabetes detected before the survey. The high prevalence of diabetes in the elderly population studied, and the low level of prior diagnosis, identify an important public health problem. There is a need for improved screening of diabetes and improved health care and education in the elderly. There is also need for better understanding of risk factors associated with previously undiagnosed diabetes.

/pdf/prevalence-and-determinants-of-diabetes-among-the-elderly-4h0wgc1eg4.pdf

Prevalence and determinants of diabetes among the elderly population in the Kathmandu Valley of Nepal.

Background: In India the incidence of end stage renal disease (ESRD) is increasing day by day and the option for the treatment of ESRD is dialysis or transplantation. In the present scenario, due to the cost of treatment normal people can afford only hemodialysis rather than transplantation. Since the cost of hemodialysis differs across the country, research is needed to evaluate its exact cost. Aim: This study is to analyze the healthcare cost of hemodialysis in a private hospital of South India. Materials and Methods: This is a prospective, observational study carried out in a tertiary care hospital. Patients who are undergoing routine hemodialysis in this hospital were selected for the study. Patient data as well as cost details were collected for a period of six months. Thirty patients were selected for the study and a total of 2160 dialysis sessions were studied. Patient perspective was taken for the analysis of cost. Both direct and indirect costs were analyzed. This includes cost of dialysis, investigations, erythropoietin, food, transportation, lost wages etc. Socioeconomic status of the patient was also studied. Result: The total cost per session was found to be around Rs. 4500. Fifty six percent contributes direct medical cost whereas 20% contributes direct non medical cost. Twenty four percent cost was due to indirect costs. Since the patients are paying from their own pocket, only the upper or upper middle class patient can undergo hemodialysis regularly. Conclusion: These findings are important to find out the impact of cost of hemodialysis on patients suffering from ESRD. Further studies related to costs and outcome, otherwise known as pharmacoeconomic studies, are needed to analyze the pros and cons of renal replacement therapy and to improve the quality of life of ESRD patients. Thus pharmacoeconomical studies are needed to realize that government has to take initiative to provide insurance or reimbursement for the common people.

Economic evaluation of end stage renal disease patients undergoing hemodialysis.

Background and Aim: Robust evidence about dialyzer reuse effects on mortality is not available. Our aim was to summarize the evidence for the effectiveness of dialyzer reuse compare

Dialyzer Reuse and Mortality Risk in Patients with End-Stage Renal Disease: A Systematic Review

Hemodialysis has improved the morbidity and mortality associated with end stage renal disease. In India, hemodialysis prescription is empiric, which leads to complications related to under-dialysis. Hence, adequacy of hemodialysis in Indian setting was analyzed in this study. A total of 50 patients on twice per week hemodialysis were assessed for 1 month. The number of sessions meeting standards laid out by Kidney Diseases Outcome Quality Initiatives (KDOQI) guidelines were calculated. They were divided into two groups: one in whom dialysis was monitored and session length enhanced to meet the minimum standard Kt/V of 2 and second control group; where Kt/V was not monitored. Hemoglobin (Hb) levels, albumin levels, mean arterial pressure and World Health Organization (WHO) quality of life (QoL) score were compared in the two groups after 6 months. Only 28% of hemodialysis sessions were adequate as per KDOQI guidelines. There was significant improvement in Hb levels (1.47 vs. 0.15 g/dl), mean arterial pressure levels (15.2 vs. 3.16 mm Hg), serum albumin levels (0.82 vs. 0.11 g/dl) and WHO QoL score (17.2 vs. 2.24) in study group as compared to control group. Standard Kt/V can be used as an important tool to modify twice weekly dialysis sessions to provide better QoL to the patients. However, studies with larger sample size are required to conclusively prove our results.

Adequacy of twice weekly hemodialysis in end stage renal disease patients at a tertiary care dialysis centre

Chronic Kidney Disease (CKD) 5 is defined when glomerular filtration rate (GFR) is <15.0 ml/min/1.73m2. Though nephrology service was started in Nepal as early as in 1970, we do not have data regarding CKD 5 patients till date. So this study is being undertaken to know the epidemiological profile and etiology of CKD 5 patients attending hemodialysis (HD) unit of Nepal Medical College Teaching Hospital. This is a prospective study which was carried out in HD unit over a period of one year. CKD 5 patients having GFR of <15 ml/min/1.73m2 under HD were included in the study. Among 100 patients included in the study 57 were male and mean age of the study population was 46.9+/-17.9 years. Most common cause of CKD 5 in the study was hypertension (54.0%); other causes included diabetic nephropathy (18.0%), idiopathic (13.0%) and glomerulonephritis (6.0%). Fifty percent of patients were from outside Kathmandu Valley. Around 20.0% of the study population is on regular follow up while 45.0% were lost to follow up. Twenty percent of the patient underwent transplantation and 15.0% of the study population died. Majority of patients were anemic (85.0%). Correction of anemia was done with blood transfusion in 88.0% and only 12.0% received erythropoietin. Hypertension was the leading cause of CKD 5; majority of patients (45.0%) discontinued hemodialysis most probably due to economical constrain; blood transfusion was the main modality of treatment of anemia.

/pdf/chronic-kidney-disease-5-on-hemodialysis-in-nepal-medical-5co7zvghc8.pdf

Chronic kidney disease 5 on hemodialysis in Nepal Medical College Teaching Hospital.

Reuse of dialysers is being practiced since the start of hemodialysis (HD) service in Nepal, which is cost effective as well as safe. A retrospective study was done in Nepal Medical College and Teaching Hospital. We reviewed case records of the year 2008 and retrieved required data such as pre and post urea, post dialysis weight and ultrafiltration volume from 186 sessions of dialysis of 60 patients. Dialysis sessions were divided into nine groups according to the number of use of dialyser. Out of 60 patients, 40 were male. Mean age of the study population was 45.82 +/- 15.42 yrs (range 18-78). Dialysers were reprocessed manually up to 9 times. Adequacy of dialysis was assessed using single pool Kt/v (spKt/v) and urea reduction rate (URR). Mean pre urea, post urea and spKt/v were 160 +/- 51.2 mg/dL, 71.8 +/- 28.5 mg/dL and 0.95 +/- 0.28 respectively. Mean URR was 54.82 +/- 11.24%. Out of total 186 sessions, spKt/v was > or = 1.2 in only 31 sessions (17.0%). There was no significant difference in mean spKt/v between the groups (p=0.87). When compared between the individual groups e.g. 1st vs. 7th, 1st vs. 8th and 1st vs. 9th, there was no significant difference in spKt/v. Dialysis is inadequate in most of our patients undergoing HD twice a week. Reuse of dialyser is effective in urea clearance and the practice of reuse is cost effective and safe.

/pdf/evaluation-of-dialysis-adequacy-in-patients-under-1mhmy3aybp.pdf

Evaluation of dialysis adequacy in patients under hemodialysis and effectiveness of dialysers reuses.

End stage kidney disease (ESKD) is defined by glomerular filtration rate (GFR) less than 5 ml/min. These patients need renal replacement therapy (RRT). Hemodialysis is an established form of RRT. Studies on incenter hemodialysis are very few. Here we would like to present our experience on in-center hemodialysis in Nepal Medical College and Teaching Hospital. Study period was one year (1st Baisakh 2065 to 31st Chaitra 2065). Total 33 patients (23 male, 10 female) were enrolled in the study. Average age was 42.33 +/- 15 years. Hypertension (55.0%), diabetes mellitus (24.0%), chronic glomerulonephritis (15.0%), rapidly progressive glomerulonephritis (3.0%) and others (3.0%) were the causes of ESKD requiring dialysis. Hypotension, hypertension, muscle cramps, chest pain were the common complications observed during dialysis. Average haemoglobin level was 9.44 +/- 1.88 g%. Majority of patients were physically inactive. Blood transfusion was the main modality for correction of anaemia. Approximate cost for one session of hemodialysis was Rs. 2000 (U.S. $.25) and average monthly income of study population was Rs.16312.5 (U.S. $.204) U.S. $1 = NRs.80, (4th May 2009).

/pdf/in-center-hemodialysis-for-end-stage-kidney-disease-at-nepal-260xg8gzx1.pdf

In-center hemodialysis for end stage kidney disease at Nepal Medical College and Teaching Hospital.

Malnutrition is very common in hemodialysis patients and is predisposed by many factors. Malnutrition is associated with increased morbidity and mortality. Total of 26 patients (16 males and 10 females) who were under hemodialysis in our center were included in the study. With the help of Malnutrition Score (MS) developed by Kalanter-Zadeh, nutritional status of the patients was assessed. Patients also underwent different anthropometric measurements such as Body Mass Index (BMI), Triceps skin fold thickness (TSF), Mid Arm Circumlference (MAC) and Mid Arm Muscle Circumference (MAMC) and laboratory investigations. Mean age of the study population was 42.58 +/- 16.32 years (range 19 to 74 years). Females were older than males. MS of the study population was 15.82 +/- 3.76 (range 9-24). Female patients were having higher MS than males (16.5 +/- 4.11 vs. 15.06 +/- 3.55). Based on MS, 22 patients (84.6%) had mild to moderate malnutrition, 2 (7.7%) patients were having severe malnutrition and remaining 2 (7.7%) had normal nutrition score. Females were having lower BMI, MAC and MAMC but higher value of TSF. Significant negative correlation was present between MS and weight, BMI, MAC and MAMC. Calculated Urea Reduction Ratio (URR) of study population was 57.27 +/- 10.89. URR was higher in females than in males (61.77 +/- 12.74 vs. 54.45 +/- 8.85). Only 23.0% of the study population had URR of >65.0%. Protein Catabolic Rate (nPCR) in our study was 0.77 +/- 0.28 g/kg/day. Malnutrition is very common in our center which is >90% when MS was considered. In our study it negatively correlated with weight, BMI, MAC and MAMC. Dialysis inadequacy was present in around 75.0% of our study population.

Nutritional assessment of patients under hemodialysis in nepal medical college teaching hospital.

Good vascular access is an essential component for hemodialysis (HD). Studies in patterns of vascular accesses used for HD are very few. Eighty two (male 55, female 27) patients attending HD unit of Nepal Medical College and Teaching Hospital (NMCTH) over a period of one year were enrolled for the study. Average age was 46.12 years. Seventy four patients (90.0%) were suffering from chronic kidney disease (CKD) 5 and 8 (10.0%) patients had acute renal failure. Initial vascular access used was temporary vascular access in 76 (93.0%) and arteriovenous (AV) fistula in 6 (7.0%) patients. As a first temporary vascular access femoral catheterization was used in 54 (66.0%) patients followed by subclavian and internal jugular vein catheterization in 18 (22.0%) and 4 (5.0%) respectively. Fever was observed in 9 (11.0%) patients with first temporary access. There was no complication in 65 (79.0%) cases. Other complications were poor flow, malposition, infection, thrombosis, aneurysm and self removal of catheter. Only 47 patients were analyzed for the second vascular access. Trends towards use of second vascular access was subclavian and internal jugular vein cannulation in 20 (42.5%) and 10 (21.3%) respectively, AV fistula in 13 (27.7%), and femoral catheterization in 4 (8.5%). Second vascular access was associated with fever in 7 (14.9%) and limb swelling in 1 (2.1%). Temporary vascular access was the most common access to initiate HD in CKD 5. Only 7.0% of the patient had AV fistula to start HD. Femoral vein catheterization was the most commonly used first temporary vascular access. Complications with the vascular accesses were negligible.

Pramod Kumar Chhetri

Papers

Chronic kidney disease 5 on hemodialysis in Nepal Medical College Teaching Hospital.

Evaluation of dialysis adequacy in patients under hemodialysis and effectiveness of dialysers reuses.

In-center hemodialysis for end stage kidney disease at Nepal Medical College and Teaching Hospital.

Nutritional assessment of patients under hemodialysis in nepal medical college teaching hospital.

Vascular access for hemodialysis in Nepal Medical College and Teaching Hospital.