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Introduction: Persistent anemia is one of the most common complications seen in individuals with chronic kidney disease (CKD). The factors contributing to anemia in CKD include loss of blood, reduced lifespan of red cell, vitamin deficiencies, erythropoietin deficiency, iron deficiency, and inflammation. Erythropoietin deficiency appears to be the major cause of anemia among the CKD. It is well established that hemoglobin level tends to decrease in CKD individuals. In renal anemia, hemoglobin level is usually managed with iron therapy and or erythropoietin treatment or blood transfusion. NKF - KODOQI clinical practice recommends hemoglobin level to range from 11g/dL-12g/dL among CKD undergoing hemodialysis (CKD 5HD). Hence it is essential to maintain recommended hemoglobin level among the individuals in order to avoid the mortality rate. In India there is dearth on the database of hemoglobin trend investigated longitudinally, and hence the present study was focused in this direction. Aim: To investigate the hemoglobin trend in CKD 5HD in a tertiary care hospital. Objectives: a) To profile the hemoglobin trend among the individuals on erythropoietin alone, combination of erythropoietin and iron therapy, and individuals not undergoing any treatment. (b) To compare hemoglobin trend among the individuals on erythropoietin alone, combination of erythropoietin and iron therapy, and individuals not undergoing any treatment. Method: Retrospective observational study. A total of N=90 participants were enrolled in the study. The participants were classified into 3 Groups. Group 1 - Erythropoietin (n=30), Group 2 - erythropoietin and iron therapy (n=30) and Group 3 - No treatment (n=30). Data were retrieved from medical records who were on regular hemodialysis for more than six months. The hemoglobin level was observed for six months and documented. results: In the present study, it was observed that hemoglobin tend to increase among the Group 1 and Group 2 participants, unlike the Group 3 participants, who received no treatment. Among the groups, it was observed the mean hemoglobin level of Group 1 - 9.1g/dL was more compared to Group 2 and Group 3 - 8.7g/dL. conclusion: It was observed that individuals who were on treatment had a rising trend in hemoglobin unlike individuals with no treatment. However, it could also be observed that the mean hemoglobin was maintained appropriately among individuals with no treatment, which could be probably due to the lifestyle and other individual related factors.

Introduction: Dialysis catheters are commonly used as temporary vascular access in hemodialysis individuals. These catheters are referred to as irreplaceable tool because of their significant role in providing easy and instant access to the circulation for delivery of Hemodialysis under diverse clinical situations. The most common complications associated with dialysis catheter includes mechanical and or infectious resulting in early catheter removal, morbidity and or mortality. Although Catheter Related Blood Stream Infection (CRBSI) is reported to have an adverse impact on quality of life, survival and healthcare cost, dialysis catheters are quite frequently used for vascular access till date. It is essential for dialysis unit to have database on the CRBSI to minimize the risks of CRBSI and thereby improve life quality. Aim: To investigate CRBSI associated with non-tunnelled dialysis catheters in a tertiary care hospital. Objectives: (a) To compare infection between the types of non-tunnelled dialysis catheters (b) To compare the infection across the gender Method: Prospective observational study. A total of N=633 individuals with non tunnelled dialysis catheter, undergoing HD for the period of eight months were enrolled in the study. Participants prospectively followed up for evidence of CRBSI post insertion of catheter until the point of catheter removal or the completion of the study. Descriptive statistics was used to analyse the data. Mann Whitney U test was used as test of significance to compare between the groups with p<0.001. Result: This study had 37 CRBSI individuals. The infection rate differed across the types of nontunneled dialysis catheters and infection observed was predominant among the males as compared to females. Conclusion: It can be concluded that the incidence of CRBSI was observed more in internal jugular vein dialysis catheters as compared to femoral vein dialysis catheters possibly due to extension of the catheters in situ among the participants enrolled in the study.

Introduction: In hemodialysis patients, catheter-related bloodstream infections (CRBSI) cause significant morbidity and mortality. Objectives: We analyzed dialysis CRBSI incidence, associated factors, and the spectrum of the causative organisms. Patients and Methods: Patients aged ≥18 years either on maintenance hemodialysis or with acute kidney injury having CRBSI (NKF-KDOQI criteria) were included in this prospective Hemodialysis catheter- infection observational study and patients with other infections were excluded. Blood, catheter tip culture, and antibiogram were analyzed. All patients were initially treated with antibiotics covering both gram-positive and gram-negative pathogens. Results: Of 921 catheters (882 patients) included, 212 (23%) had CRBSI, of which 69(32.5%) and 143(67.5%) had culture-positive possible CRBSI and culture-negative probable CRBSI respectively. About 131 (61.8%) were <60 years, 133 (62.7%) were males, 177 (83.5%) had diabetes, 141(66.5%) had leukocytosis and 172(81.1%) had positive procalcitonin. In addition, 193 (91%) had uncuffed catheters and 162 (76.4%) had jugular catheters. Our study showed a CRBSI incidence of 13.39/1000 catheter days, median catheter days, and median time to CRBSI was 40 and 17.2 days respectively. Around 41(19.3%) catheters were salvaged (with antibiotic administration or guidewire exchange) and 42 (19.8%) had exit site infection. Gram-positive coagulase-negative staphylococcus aureus (n=31; 44.9%) followed by extended-spectrum beta-lactamase (ESBL) enteric gram-negative organisms (n=30; 43.4%) were common isolates and remaining had fungal etiology (n=8; 11.7%). In our study, the mortality rate was 6.6% (n=14). Conclusion: The incidence of CRBSI was high in our population. In culture-positive cases, gram-positive organisms contributed marginally higher than gram-negative organisms. Coagulase negative Staphylococcus aureus (CONS) and ESBL enteric gram-negative organisms are the commonest isolates. More than two-thirds of patients with CRBSI had diabetes mellitus and leukocytosis at presentation.

Introduction: In transplantation, accurate estimation of the donor glomerular filtration rate (GFR) is crucial. While various creatinine-based equations are in use, none are validated in Indians. Objectives: This study was conducted to judge the accuracy of creatinine-based GFR estimation equations and urinary creatinine clearance. Patients and Methods: A single-centre, observational and retrospective study at a tertiary care hospital. Adult voluntary donors GFR measured (mGFR) by technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA) were included. The primary outcome was the performance of estimated GFR (eGFR) by “Cockcroft-Gault’s formula corrected for body surface area (CG-BSA) formula”, “modification of diet in renal disease (MDRD) 4 and 6 variable equation” and “Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation”; secondary outcome was the performance of “24-hour urinary creatinine clearance (Cr Cl)”. Results: 102 kidney donors were analysed with mean age of 45.89 ± 9.98 years and 85.3% females. Mean ± SD mGFR by Tc-99m DTPA was 82.11 ± 14.32 mL/min/1.73 m2 . Mean ± SD eGFR by “CGBSA” was 99.68 ± 23.71 mL/min/1.73 m2 , by “MDRD-4 variable equation” was 98.25 ± 28.61 mL/ min/1.73 m2 , by “MDRD-6 variable equation” was 93.66 ± 19.44 ml/min/1.73 m2 and by “CKD-EPI” was 111.14 ± 31.61 mL/min/1.73 m2 . The lowest bias (2.3), highest precision (16.23), and accuracy (97.1%) were with “MDRD-6 variable equation”; “24-hour urinary Cr Cl” highly overestimated GFR (158.27 mL/min/1.73 m2 ) with the highest bias, lowest precision, and accuracy. Conclusion: The “MDRD-6 variable equation” was the most precise and accurate of the equations, whereas “24-hour urinary Cr Cl” was the least dependable. This study highlights the need for a correction factor or a new GFR estimation equation and not to consider urinary Cr Cl to assess donor GFR.