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Introduction: The escalating longevity facilitated by medical advancements has led to a surge in elderly individuals grappling with chronic kidney disease (CKD) and progressing to end-stage renal disease (ESRD). Objectives: Our study addresses the paucity of research on octogenarians undergoing dialysis, a highly co-morbid and frail subset, particularly in the context of a resource-limited setting like India. Patients and Methods: A retrospective observational study at Kasturba Medical College and Hospital in Manipal, India, examined 18 octogenarian dialysis patients from 2017 to 2022. Clinical details, including age, co-morbidities, dialysis patterns, and laboratory data, were collected. The Coxproportional hazards model assessed factors influencing survival. Results: The majority-initiated dialysis in emergencies (72%), predominantly via central venous catheters. Hospitalizations post-dialysis were common (median 2.5). Survival rates at 1, 3, and 5 years were 61%, 54%, and 44%, respectively. Sudden cardiac death (64%) emerged as the predominant cause, with a significant impact of a higher Charlson comorbidity index on survival (HR 3.11; 95% CI [1.21-7.89]; P = 0.018). Conclusion: Octogenarian dialysis patients, marked by substantial co-morbidities, exhibit reduced survival, particularly with higher comorbidity scores. Hospitalizations contribute significantly to morbidity. Our study underscores the need for nuanced care strategies tailored to this vulnerable population. [ABSTRACT FROM AUTHOR]

Patients with chronic kidney disease (CKD) are at increased risk of developing tuberculosis (TB). These patients may also be at higher risk of developing antitubercular treatment (ATT)-associated adverse drug reactions (ADRs). Although dose modification has been recommended, data regarding the impact of impaired kidney function on ATT-associated ADRs is sparse. We studied the incidence and profile of ATT-associated ADRs in patients with CKD and compared them with those with normal kidney function. This retrospective study analyzed all patients initiated on ATT from January 2016 to August 2019. Patients were grouped into CKD and normal kidney function based on their eGFR. Data on ATT-associated ADRs were collected from medical records. Predictors of ADRs were assessed using univariable and multivariable logistic regression. Additionally, Propensity score matching and analysis were done for CKD and normal kidney function in 1:3 ratio. Of 1815 patients on ATT, 75 (4.1%) had CKD. ADRs were more frequent [36/75 (48.0%) vs. 239/1740 (13.7%), p ≤ 0.0001] and more severe [15/46 (32.6%) vs. 43/283 (15.1%), p = 0.010] in CKD than those with normal kidney function. The most common ADRs were hepatobiliary [23/75 (30.6%) vs. 156/1740 (8.9%), p ≤ 0.0001], neuropsychiatric [8/75(10.6%) vs. 21/1740(1.2%), p ≤ 0.0001], renal [4/75(5.3%) vs. 8/1740(0.4%), p = 0.001], and gastrointestinal [5/75(6.6%) vs. 34/1740 (1.9%), p = 0.020]. CKD was an independent predictor for ADRs (OR −4.96, 95% CI: 2.79–8.82; p ≤ 0.0001). The matched cohort showed similar results. ATT-associated ADRs were more common and severe in patients with CKD, despite drug dose modifications. Optimal dosing of ATT in CKD needs to be further evaluated. [ABSTRACT FROM AUTHOR]

Introduction: Chloride is the most abundant extracellular anion; however, abnormalities of serum chloride (dyschloremia) are often overlooked. This study aimed to study the association of dyschloremia with AKI and major adverse kidney events at Day 30 (MAKE30) in critically ill patients with sepsis. Materials and Methods: This prospective single‐center cohort study included adult patients with sepsis admitted in a tertiary care hospital in India. Patients with advanced chronic kidney disease, requiring dialysis at admission, or with hospital stay of less than 72 h were excluded. Hyperchloremia and hypochloremia were defined as chloride levels of > 110 mEq/L and < 95 mEq/L, respectively. The primary outcome measure was MAKE30—a composite of death, need for dialysis, or sustained loss of kidney function at Day 30. Results: In a cohort of 400 patients with a mean age of 60 (±15) years, AKI was seen in 301 (75.2%) and MAKE30 in 171 (42.8%). Hyperchloremia and hypochloremia were seen in 19.3% (n = 77) and 32.3% (n = 129), respectively, in the first 72 h of ICU stay. Hypochloremia, but not hyperchloremia, was independently associated with both MAKE30 (OR: 2.56, 95% CI: 1.13–5.79; p = 0.024) and new‐onset or worsening AKI (OR: 2.52, 95% CI: 1.17–5.41; p = 0.019). There was no association between hyperchloremia and either MAKE30 (OR: 1.07, 95% CI: 0.43–2.69; p = 0.882) or new‐onset/worsening AKI (OR: 0.89, 95% CI: 0.38–2.09; p = 0.781). Conclusion: Hypochloremia, but not hyperchloremia, was associated with MAKE30 in this cohort of critically ill patients with sepsis. Trial Registration: Clinical Trial Registry identifier: CTRI//2022/02/040519 [ABSTRACT FROM AUTHOR]

Introduction: Rapid progression of diabetic kidney disease (DKD) is a significant concern, particularly in developing countries. It remains uncertain whether histopathological parameters, in addition to clinical factors, can predict DKD progression. Objectives: To evaluate renal histopathological and clinical parameters in predicting rapid progression to end-stage kidney disease (ESKD) in type 2 diabetes mellitus (Type 2 DM) patients with biopsyproven DKD. Patients and Methods: This was an observational retrospective study that included 49 biopsy-proven DKD from January 2018 to December 2022. Those with less than six months of follow-up and CKD stage 5 were excluded. The outcomes studied were rapid progression and progression to ESKD. Patients were categorized into rapid progressors and non-progressors based on the estimated glomerular filtration (eGFR) decline of > or <10 mL/min/1.73 m2/year, respectively. The association of histopathological factors and clinical parameters with rapid progression and independent risk factors for progression to ESKD were analysed using SPSS 22. Results: In a median follow-up of 1.6 years, 57% were rapid progressors, and 42.9% were nonprogressors, with a median eGFR decline of 21 mL/min/1.73 m2/year and 5 mL/min/1.73 m2/year, respectively. Among histopathological factors, global glomerular sclerosis (class 4) predicted rapid progression (P = 0.03), since among clinical factors, hypertension (89.3%) elevated hemoglobin A1c (HbA1c) (9.6%), and massive proteinuria (75.1%) were significant parameters associated with rapid progression (P < 0.05). In Cox regression analysis, the progression to ESKD was independently associated with global glomerular sclerosis (HR 1.1, CI 1.0-1.4, P = 0.04) and massive proteinuria (HR 1.6, CI 1.0-2.1, P = 0.01) Conclusion: In our cohort, hypertension, high HbA1c, severe proteinuria, and global glomerular sclerosis (Class 4) were associated with rapid progression. Severe proteinuria and global glomerular sclerosis were independent risk factors for progression to ESKD. This highlights the need for large prospective studies in identifying the factors predicting rapid progressors in DKD; therefore, timely intervention can be considered. [ABSTRACT FROM AUTHOR]

Author(s): Narayan Prasad [sup.1] , Dharshan Rangaswamy [sup.2] , Manas Patel [sup.1] , Sanjeev Gulati [sup.3] , Dharmendra Bhadauria [sup.1] , Anupama Kaul [sup.1] , Amit Gupta [sup.1] Author Affiliations: [...], Background Peritoneal dialysis (PD) is the preferred modality of dialysis among children with end-stage renal disease. Methods To study the incidence of technique failure and survival among children with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), we included children younger than 18 years of age who commenced and continued PD for more than 3 months as their primary form of dialysis between 1st January 2005 and 31st December 2016. Kaplan-Meier survival analysis was applied to analyze the CAPD outcomes. Results A total of 68 Tenckhoff (58 double cuffs, and ten single cuffs) catheters were inserted in 66 patients (mean age 12.3 ± 3.91 years) during the study period. Of the 66 children, 31 (47%) experienced 45 episodes of peritonitis. The total duration on CAPD was 107.58 years with a peritonitis rate of 0.42 episodes per year. Overall, the mean patient survival was 41 (95% confidence interval (CI) 29-54) months, with mean patient survival of 72% at 12 months, declining to 30% at 36 months and then remaining stable until the end of follow-up (106 months). The overall mean technique survival was 55 (95% CI 40-69) months, with mean technique survival of 69% at 12 months, declining to 44% at 36 months and then remaining stable until the end of follow-up (106 months). Conclusion CAPD is a viable option for end-stage renal disease in children from developing countries with a lack of access to automated PD and pediatric hemodialysis centers.

The cytosolic capping protein, Arp2/3 and myosin-I linker protein 2 or CARMIL2 plays an important role in T/B/NK cell function. Biallelic disease causing variants in CARMIL2 are known to cause immunodeficiency 58. We report a 13-year-old girl with recurrent infections, dermatitis and nephrotic syndrome since childhood. Her renal biopsy was suggestive of membranous nephropathy. Exome sequencing showed a homozygous novel stopgain variant, c.520C>T in CARMIL2 (NM_001013838.3). We expand the phenotypic spectrum of CARMIL2 related immunodeficiency to include membranous nephropathy secondary to probable immune dysregulation. [ABSTRACT FROM AUTHOR]

The term chronic kidney disease of unknown aetiology (CKDu) refers to chronic kidney disease (CKD) in the absence of diabetes, long‐standing hypertension, glomerulonephritis, obstructive uropathy or other apparent causes. An increasing number of CKDu cases have been reported from Latin America, Sri Lanka, India and others over the last two decades. These regional nephropathies share the following common attributes: (a) they affect low‐to‐middle income countries with tropical climates, (b) involve predominantly rural agricultural communities, (c) male predilection, (d) absence of significant proteinuria and hypertension, and (e) chronic tubulointerstitial nephritis on kidney biopsy. The current body of literature suggests that CKDu may be caused by heat stress, agrochemicals, contaminated drinking water or heavy metals; however, considerable regional disparities in CKDu research make it difficult to establish a common causal link. In the absence of a definite aetiology, specific preventive and therapeutic interventions are lacking. Improvement of working conditions of farmers and labourers, provision of safe drinking water and changes in agricultural practices are some of the measures that have been implemented; however, there is lack of data to assess their impact on the incidence and progression of CKDu. There is a need for a concerted global effort to address the current knowledge gaps, and to develop effective and sustainable strategies to tackle this devastating disease. [ABSTRACT FROM AUTHOR]