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The South Asia region is facing a high burden of chronic kidney disease (CKD) with limited health resources and low expenditure on health care. In addition to the burden of CKD and kidney failure from traditional risk factors, CKD of unknown etiologies from India and Sri Lanka compounds the challenges of optimal management of CKD in the region. From the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we present the status of CKD burden, infrastructure, funding, resources, and health care personnel using the World Health Organizations building blocks for health systems in the ISN South Asia region. The poor status of the public health care system and low health care expenditure resulted in high out-of-pocket expenditures for people with kidney disease, which further compounded the situation. There is insufficient country capacity across the region to provide kidney replacement therapies to cover the burden. The infrastructure was also not uniformly distributed among the countries in the region. There were no chronic hemodialysis centers in Afghanistan, and peritoneal dialysis services were only available in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Kidney transplantation was not available in Afghanistan, Bhutan, and Maldives. Conservative kidney management was reported as available in 63% (n = 5) of the countries, yet no country reported availability of the core CKM care components. There was a high hospitalization rate and early mortality because of inadequate kidney care. The lack of national registries and actual disease burden estimates reported in the region prevent policymakers attention to CKD as an important cause of morbidity and mortality. Data from the 2023 ISN-GKHA, although with some limitations, may be used for advocacy and improving CKD care in the region.

Point-of-care ultrasonography (POCUS) has rapidly evolved from a niche technology to an indispensable tool across medical specialties, including nephrology. This evolution is driven by advancements in technology and the visionary efforts of clinicians in emergency medicine and beyond. Recognizing its potential, medical schools are increasingly integrating POCUS into training curricula, emphasizing its role in enhancing diagnostic accuracy and patient care. Despite these advancements, barriers such as limited faculty expertise and 'lack of' standardized guidelines hinder widespread adoption and regulation. The International Alliance for POCUS in Nephrology (IAPN), through this position statement, aims to guide nephrologists in harnessing the diagnostic power of POCUS responsibly and effectively. By outlining core competencies, recommending training modalities and advocating for robust quality assurance measures, we envision a future where POCUS enhances nephrology practice globally, ensuring optimal patient outcomes through informed, evidence-based decision-making. International collaboration and education are essential to overcome current challenges and realize the full potential of POCUS in nephrology and beyond. [ABSTRACT FROM AUTHOR]

Background: This study describes to the clinical features and outcomes of patients on maintenance hemodialysis infected with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) delta variant. Materials and Methods: This was a retrospective analysis of case records of patients on maintenance hemodialysis admitted for management of coronavirus disease (COVID) infection. Our teaching hospital, being a state- designated referral center, had COVID admissions from March 2020 till December 2020. Epidemiological and clinical data were collected and analyzed. Factors influencing survival and the survival curve analysis were assessed. Results: Of a total of 21,228 admissions during the period, 400 patients were referred for nephrology services. Of the 400 referrals, 226 were maintenance hemodialysis patients. Mean age of the group was 50 years, and fever was the most common presenting symptom. On multivariate analysis, factors influencing mortality were found to be older age, presence of diabetes, leukopenia, thrombocytopenia, hypoxemia, need for support, and a higher qSOFA score. The probability of survival of dialysis patients at the end of 19 days was 60%. Conclusion: During the pandemic by SARS-CoV-2 delta variant, majority of the nephrology referrals were for maintenance hemodialysis patients. Mortality was 38% in the study group, and the factors associated with mortality with a significant hazard ratio were older age and diabetes. [ABSTRACT FROM AUTHOR]

Opportunistic infections saw a rise during the COVID-19 pandemic. We report rhinocerebral mucormycosis following COVID infection in six patients with kidney disease. Though there was a variable outcome with 50% mortality, it is prudent to assess the risk factors for development of life-threatening infection. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney disease (CKD) is a global public health concern that has a significant financial impact on health-care systems. Protein energy malnutrition (PEM) in MHD patients is associated with increased in mortality, reduced quality of life and increases morbidity, hospitalization, and mortality. According to a global meta-analysis of 65 studies from 10 geographical regions, malnutrition is highly prevalent in maintenance hemodialysis (MHD) patients. The gold standard for evaluating the nutritional state of patients with ESKD is total body nitrogen. SGA tool, MIS, mini nutritional assessment (MNA) tool, Health-Related Quality of Life Short Form 36-Index (WHO HRQOL SF 36), and subjective global nutritional assessment are some of the tools that are practical, validated, and affordable questionnaires that can be utilized in the public domain. A combination of anthropometric measurements and nutritional assessment tools is the most effective way to determine nutritional status. Aim: To assess the nutritional status of maintenance hemodialysis patients in a tertiary care centre using the 7 point SGA method. Type of Study: observational study. Study Setting: Tertiary care hospital in south India. Study Population: Patients undergoing maintenance Hemodialysis in our hospital. Results: Total Number of patients included in the study is 68. Mean age is 46.78years with a standard deviation of 11.181years. Male predominance was seen in the study group 72.1% to female patients 27.9%. Hypertension is the most common associated comorbidity 67.6%, followed by Diabetes mellitus 39.7%. Majority of the study group are in the Dialysis vintage group 1-2 years. Male patients have significant association with Malnutrition (P =0.006*). There is no significant correlation with kuppuswamy socio-economic class(P =0.123). There is no significant correlation between dialysis vintage and malnutrition (P =0.35). There was significant association with serum albumin(P <0.001), Body Mass Index (P <0.001), Mid Arm Circumference (P <0.001), Mid Arm Muscle Circumference (P <0.001), Skin Fold Thickness-Triceps (P <0.001). Conclusion: Moderate malnutrition was present in majority of patients 62%. Severe malnutrition was seen in only 0.8% patients. Statistically significant association was noted between anthropometric measurements-BMI, MAMC, MAC, Skin fold thickness and malnourishment. Serum albumin has significant association. Limitations: Small sample size. SGA is subjective assessment, has inter observer variations. [ABSTRACT FROM AUTHOR]

Autosomal recessive distal renal tubular acidosis (dRTA) is associated with mutation in the ATP6B1 gene encoding the B1 subunit of H + -ATPase, one of the key membrane transporters for net acid excretion of α-intercalated cells of medullary collecting ducts. Sensori-neural deafness frequently accompanies this type of dRTA. We herewith describe a patient who had distinct features of dRTA with bilateral sensori-neural hearing loss and ATP6B1 mutation. This is a rare entity.