Archives of Nephrology and Urology is an open access, peer reviewed biannual journal publish articles related to the ever expanding research on the Nephrology and Urology. Our journal provides a wide range of knowledge for researchers, students in the field of Nephrology, Dialysis and Transplantation.
Pattern of Bone Mineral Density at Optimal Skeletal Measurement Site among Patients on Maintenance Hemodialysis
Background: Chronic Kidney Disease (CKD) and Mineral-Bone Disorders (MBD) are important health problems. According to the KDIGO CKD-MBD guideline, bone loss and fracture risks are higher in CKD patients than in age-matched controls throughout all the stages, with the highest incidence among dialysis patients. Bone densitometry (BMD) is a preferred method for diagnosing osteopenia/osteoporosis. Interpreting bone densitometry in End-Stage Renal Disease (ESRD) patients requires careful assessment. Aim of the study: To determine the pattern of bone mineral density in optimal skeletal measurement sites in patients of both genders on maintenance hemodialysis using the DEXA method. Methods: This cross-sectional study was carried out in the Nephrology department of Dhaka Medical College Hospital from October 2020 to October 2021. A total of 60 ESRD patients (Group A, 30 male and Group B, 30 female patients) fulfilling the selection criteria were included in this study. All the subjects were evaluated clinically, and relevant data were recorded in a structured questionnaire. Bone Mineral Densitometry (BMD) test was done in every study population. Laboratory data was collected after measuring serum calcium, phosphate and iPTH levels. Statistical analysis of the clinical, densitometric and laboratory data was obtained using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-23). Results were expressed in various tables. Results: The mean age of group A (male) was 43.24±10.92 years, and group B (female) was 41±12.6 years. The mean BMI was significantly higher in females (27.19±5.98 kg/m2) than in males (23.71±4.42 kg/m2). The mean duration of dialysis was higher in males than females. The mean total BMD value expressed as gm/cm2 was almost similar, 1.04±0.22 (g/ cm2) in group A and 1.05±0.18 (g/cm2) in group B, and no statistically significant (p>0.05) difference was observed between two groups. Considering conventional BMD sites (lumbar spine, left hip), 28(46.7%) patients had normal bone mass, 22(36.7%) patients had osteopenia, out of which 13(43.3%) were male and 9(30.0%) were female. Total 10(16.6%) patients had osteoporosis, out of which 4(13.4%) male and 6(20.0%) female. The difference between the two groups was insignificant (p>0.05). While considering left forearm BMD, it was found that 33.3% of males had osteopenia and 66.7 % of males had osteoporosis; on the other hand, in females, 20 % had osteopenia, and 53 % had osteoporosis. Regarding the skeletal site, the mean Total T score differences in the left hip (neck, G.T, inter) were statistically significant (p<0.05) between males and females. According to the Z score, low bone density was also higher in males; the prevalence of low bone density (Z score <-1) was between 20 and 40 %, while 13.3% to 20% in females. Again, the Z score below the expected range for age (Z score <-2.0) was between 13.3% to 80 % in males and 13.3% to 40 % in females. The mean calcium and phosphate level difference was not statistically significant between male and female patients, but the iPTH level was higher in male patients. Different Correlations between BMD of measurement sites and laboratory and clinical parameters, expressed as a coefficient of correlation (r), were also found in male and female patients, with better correlation of skeletal sites in female patients. Conclusion: Regardless of limitations, this study showed reduced bone mass in HD patients and different reductions of bone mass in different skeletal sites (both central and peripheral) in male and female patients.
Copyright (c) 2026 Archives of Nephrology and Urology
Vitamin D Level in SLE Patients with or without Renal Involvement and its Relationship with Disease Activity (SLEDAI)
Abstract Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement, with lupus nephritis (LN) being a major complication. Vitamin D, known for its immunomodulatory properties, has been implicated in SLE pathogenesis, with deficiency potentially contributing to increased disease activity. Aim of the study: This study aimed to evaluate serum vitamin D levels in SLE patients with and without renal involvement and investigate their correlation with disease activity, as measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Methods: A cross-sectional study was conducted at Dhaka Medical College Hospital, Bangladesh, over one year (April 2018–March 2019). A total of 130 participants were enrolled, including SLE patients with nephropathy (n=50), SLE patients without nephropathy (n=50), and healthy controls (n=30). Serum vitamin D levels were measured and compared across groups, and correlations with disease activity were assessed using statistical analyses. Result: Vitamin D levels were significantly lower in SLE patients with nephropathy (14.92 ± 3.76 ng/mL) compared to those without nephropathy (19.65 ± 6.15 ng/mL) and healthy controls (23.95 ± 8.81 ng/mL) (p<0.001). A negative correlation was observed between vitamin D levels and SLEDAI scores, indicating that lower vitamin D levels were associated with higher disease activity. Conclusion: SLE patients, particularly those with renal involvement, exhibit significant vitamin D deficiency, which correlates with increased disease activity. These findings highlight the potential need for routine vitamin D screening and supplementation in SLE management to mitigate disease progression.
Efficacy of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) – A Randomized Controlled Trial
Background: Percutaneous Nephrolithotomy (PCNL) is commonly used to remove large renal stones but often requires nephrostomy tubes, which can increase postoperative pain and hospital stay. Tubeless PCNL, which omits the tube, may reduce discomfort and speed recovery, though its clinical advantages over standard PCNL remain uncertain. Methods: A randomized controlled trial was conducted at Bangladesh Medical University, enrolling 100 adult patients with renal stones greater than 2 cm. Patients were randomly assigned to either the Tubeless PCNL or Standard PCNL group. Primary outcomes included postoperative pain (measured by the Visual Analog Scale), hospital stay duration, complication rates, and stone-free status (assessed by imaging at 3 months). Statistical analyses included descriptive statistics, independent t-tests, and chi-square tests. Result: The Tubeless PCNL group had significantly lower postoperative pain (p < 0.001), shorter hospital stay (1.6 vs. 3.2 days, p < 0.001), and fewer complications, including urinary leakage (p = 0.03) and overall complication rate (14% vs. 44%, p = 0.002). Stone-free rates at 3 months (88% vs. 84%, p = 0.57) and 12-month recurrence rates (6% vs. 10%, p = 0.44) were comparable between groups. Conclusion: Tubeless PCNL appears to be a safe and effective alternative to Standard PCNL, offering less pain, shorter hospitalization, and fewer complications while maintaining comparable stone-free and recurrence outcomes, though larger and longer studies are still needed to validate these findings.
Copyright (c) 2025 Archives of Nephrology and Urology
Postoperative Pain and Recovery Outcomes Following Tubeless versus Standard PCNL
Background: Urinary stones are a common urological condition that can impair renal function and pose a significant public health concern, with prevalence rates ranging from 1% to 20% and higher rates (>10%) in developed countries. The purpose of this study is to compare postoperative pain and recovery outcomes between tubeless and standard percutaneous nephrolithotomy in our patient population, addressing a critical gap in current clinical evidence. Methods: This prospective RCT at the Department of Urology, Bangladesh Medical University Hospital, Dhaka, enrolled 100 adults with large renal stones (>2 cm) to compare Tubeless and Standard PCNL. Outcomes included postoperative pain, hospital stay, 30-day complications, stone-free status at 3 months, and recurrence at 12 months. Data were collected by blinded assistants, analyzed using appropriate statistical tests (p < 0.05). Results: In 100 patients, baseline characteristics were comparable. Tubeless PCNL showed lower postoperative pain (VAS 3.9–1.8 vs 5.8–3.1, 6–48 h), shorter hospital stay (1.6 ± 0.8 vs 3.2 ± 1.1 days, p < 0.001), and fewer overall complications (14.0% vs 44.0%, p = 0.002), with significantly less urinary leakage (2.0% vs 14.0%, p = 0.03). Conclusion: Tubeless PCNL provides faster recovery, less postoperative pain, and fewer complications than standard PCNL.
Pattern and Predictors of Cardiac Rhythm Disturbances in Patients on Maintenance Hemodialysis
Background: Sudden cardiac death (SCD) is the major cause of death among patients on maintenance hemodialysis. It is closely associated with cardiovascular and metabolic changes occurring in patients undergoing hemodialysis. Cardiac arrhythmias were frequently observed in these dialysis patients. Aim of the study: To detect the pattern and predictors of cardiac rhythm disturbances in maintenance hemodialysis patient. Methods: This cross-sectional study was conducted in the Department of Nephrology at BSMMU, Dhaka. A total of 49 patients on maintenance hemodialysis were included based on selection criteria. After inclusion, ECG & echocardiogram were performed on non-dialysis day. On dialysis day, 24-hour Holter ECG monitoring, selective pre & post dialytic laboratory investigations were carried out. The sampling method used was purposive sampling. Data were collected using a predesigned data collection sheet, including patient history and clinical examination. Statistical analyses of the results were performed using software with SPSS-26. Result: The mean age of the study cohort was 42.1 ± 12.3 years, with a predominance of male patients (73.5%). The primary etiology of renal failure was glomerulonephritis (46.9%), followed by diabetes mellitus (36.7%) and hypertension (16.3%). Echocardiographic assessment revealed a mean left ventricular mass index (LVMI) of 130.6 ± 43.7 g/m². Pulmonary artery systolic pressure (PASP) was significantly elevated in patients with tachyarrhythmia (37.7 ± 15.1 mmHg) compared to those without (29.4 ± 13.3 mmHg, p<0.05). Supraventricular arrhythmias were frequent, with premature atrial contractions (PACs) observed in 77.6% of patients; PAC burden averaged 2.49 ± 8.60 per hour, and 8.2% had >70 PACs/day. Ventricular arrhythmias, predominantly premature ventricular contractions (PVCs), occurred in 71.4%, with a mean rate of 0.61 ± 1.22 per hour; 5.7% exhibited a PVC burden between 5–10%. Bradyarrhythmias and tachyarrhythmias were present in 59.2% and 65.3% of patients, respectively. Logistic regression identified significant associations of PACs with post-dialysis magnesium levels, and PVCs with post-dialysis potassium, magnesium, LVMI, and PASP. No correlation was found between arrhythmias and dialysis access type or frequency. Conclusion: Arrhythmias including significant abnormal rhythms, were common but their burden was less. Tachyarrhythmias occurred more often during and immediately after dialysis where bradyarrhythmias were less prevalent in initial period & increased with time. Further study is needed to determine their impact on clinical outcomes.
Correlation of Serum Phosphate, Calcium and Parathyroid Hormone Level with Carotid Intimal-Medial Thickness in Patients on Maintenance Hemodialysis
Background: Cardiovascular disease is a leading cause of mortality and morbidity in hemodialysis patients. Disordered calcium-phosphorus metabolism is a major contributor to vascular calcification. This study investigates the correlation of serum phosphate, calcium, and parathyroid hormone (PTH) levels with carotid intimal-medial thickness (CIMT), a marker of atherosclerosis. Aim of the study: To assess the correlation between serum phosphate, calcium, and PTH levels with CIMT in patients on maintenance hemodialysis. Methods: This cross-sectional study included 80 maintenance hemodialysis patients at the Department of Nephrology in Dhaka Medical College Hospital, Dhaka, Bangladesh, for one year from May 2021 to April 2022. Clinical data were recorded using a structured questionnaire. CIMT was measured via B-mode ultrasonography, and serum phosphate, calcium, and intact PTH levels were analyzed. Data were statistically analyzed using SPSS 26.0. Result: The mean age of participants was 43±11.3 years, with a male predominance (1.42:1). The mean CIMT was 0.59±0.11 mm and was significantly higher in males (p=0.030) and diabetic patients (p<0.001). CIMT positively correlated with age, BMI, serum phosphate, and serum calcium levels but not with iPTH. Conclusion: CIMT in hemodialysis patients positively correlates with serum phosphate, calcium, age, and BMI. Emphasis on correcting hyperphosphatemia may help prevent vascular calcification and progression of arteriosclerosis.
The Role of Restage Transurethral Resection of Urinary Bladder Tumor in Patients with High-Risk Non- Muscle Invasive Bladder Cancer-Our Experience in Mugda Medical College Hospital, Dhaka, Bangladesh
Background: Transurethral resection of bladder tumor (TURBT) is the cornerstone for diagnosis and initial management of non-muscle invasive bladder cancer (NMIBC). However, in high-risk NMIBC, a significant proportion of patients harbor residual tumor or are under-staged following initial TURBT. Restage TURBT (re-TURBT) has been recommended to improve diagnostic accuracy and oncological outcomes. Objective: To evaluate the role of re-TURBT in high-risk NMIBC patients and to share our institutional experience at Mugda Medical College Hospital. Methods: This prospective observational study included 100 patients with high-risk NMIBC (Ta high-grade, T1, and/or carcinoma in situ) treated between January 2020 and December 2024. All patients underwent initial complete TURBT, followed by re-TURBT within 2–6 weeks. Residual tumor detection rate, tumor upstaging, recurrence, and complications were analyzed. Results: Among 100 patients, 62% had residual tumor detected on re- TURBT. Tumor upstaging to muscle-invasive disease occurred in 14%. Residual tumor was most common in T1 high-grade lesions (71%). Re- TURBT led to change in management plan in 28% of cases (early radical cystectomy or intensified intravesical therapy). Perioperative morbidity was minimal, with no major complications. Conclusion: Re-TURBT significantly improves staging accuracy and therapeutic planning in high-risk NMIBC. Our study supports the routine use of re-TURBT as a standard of care in high-risk cases to optimize longterm oncological outcomes.
Clinical Presentation and Complications of Autosomal Dominant Polycystic Kidney Disease: Experience from a Tertiary Care Center
Background: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most prevalent type of genetically inherited kidney diseases. It is one of the leading causes of end-stage renal disease (ESRD) and is responsible for a considerable portion of patients receiving hemodialysis globally. Treatment focuses on symptom management, blood pressure control and delaying the progression of the disease. Objective: To determine the pattern of clinical presentation and complications of ADPKD at a Tertiary Care Hospital in Bangladesh. Methods: A total of 100 patients with ADPKD were evaluated at a Tertiary Care Hospital, Dhaka, Bangladesh. Strict clinical criteria (Ravine’s criteria) were used to identify ADPKD patients. Their demographic profile, initial presenting complaints, co-morbidities, family history of ADPKD, any palpable mass on abdominal examination, cardiac assessment for any abnormal findings and usage of antihypertensive medications were all reviewed and documented. Relevant laboratory tests were done accordingly. Results: Total 100 patients with ADPKD were enrolled, of them 60 were male and 40 were female, a male to female ratio was 1.5:1; their mean age was 36±12 years. We found that cyst burden was rises with increasing age. Hypertension (40%) and pain (45%) were the most common clinical presentation. Ballotable kidneys were found in 30% of ADPKD patients; while dysuria, asymptomatic microscopic hematuria and gross hematuria were present in 30%, 20% and 10% cases respectively. Regarding complications: acute pyelonephritis (12%), acute kidney injury (11%), cyst infection (10%) and salt loosing nephropathy (10%) were the most common. In this study; majority (55%) of ADPKD patients were in early stages of CKD (stage I and stage II); whereas 45% participants were in advanced stages of CKD (stage III to stage V). Among the study participants; diabetes mellitus was the most common (25%) co-morbidities, followed by hypothyroidism, chronic obstructive pulmonary disease, cholelithiasis, congestive heart failure and chronic liver disease. Acute pyelonephritis, cyst infection, septicemia and pyonephrosis were the most frequent infections observed in study cases. Escherichia coli (E-coli) was the major bacterial pathogen for these infections, other pathogens include Pseudomonas, Klebsiella, Enterobacter, Proteus, Acenetobacter and Candida. Conclusion: This study highlights the clinical heterogeneity and systemic involvement of ADPKD. Hypertension, CKD progression, and cystrelated complications dominate the clinical spectrum. Blood pressure, renal function and relevant clinical evaluations should be performed regularly in ADPKD patients.
Early versus Late Ureteral Stent Removal in Kidney Transplantation: A Systematic Review and Meta- Analysis of Urological Outcomes
Background: The optimal timing for ureteral stent removal following kidney transplantation remains controversial. This meta-analysis aimed to compare outcomes between early and late stent removal. Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, and Scopus databases up to July 2024 to identify studies comparing early (within 3 weeks) versus late removal of ureteral stents in kidney transplant recipients. The primary outcomes assessed were the incidence of urinary tract infections (UTIs) and ureteric leakage. Data synthesis and meta-analysis were performed using RevMan Software version 5.4. Results: Fourteen studies comprising 3096 patients were included. Early stent removal was associated with a significantly lower incidence of UTIs compared to late removal (Odds ratio (OR) 0.46, 95% confidence interval 1 0.32-0.66, P<0.0001). This benefit was observed across different early removal time intervals. However, very early removal (within the first week) was associated with a higher risk of ureteric leakage (OR 4.71, 95% CI 1.65-13.44, P=0.004). No significant differences were found between groups for other urological complications. Conclusion: Early ureteral stent removal, particularly within 1-3 weeks post-transplant, significantly reduces UTI risk without increasing other urological complications. However, removal within the first week posttransplant may increase the risk of ureteric leakage. These findings suggest that adopting protocols for stent removal between 1-3 weeks posttransplant could be beneficial for suitable patients, balancing the reduced risk of UTIs against the potential for early urological complications. Future prospective studies with longer follow-up are needed to further optimize stent management in kidney transplantation.
Dynamics of Erythropoietin Deficiency During the Progression of Chronic Kidney Disease: An Analysis from Stages I to V in Cameroonian Adults
Background: Erythropoietin deficiency significantly contributes to the development of severe anemia, which in turn leads to therapeutic complications and significantly worsens the prognosis of patients with chronic kidney disease (CKD). Among Cameroonian adults, data on variations in erythropoietin concentrations in CKD patients are scarce. The aim of this study was to explore the dynamics of erythropoietin deficiency during the progression of chronic kidney disease from stages I to V in Cameroonian adults. Methods: We conducted an analytical cross-sectional study in the nephrology department of the Douala General Hospital over a sixmonth period. A total of 262 patients with CKD at various stages were included. Glomerular filtration rate (GFR), creatinine, and erythropoietin concentrations were measured. One-way analysis of variance (ANOVA) and the Kruskal-Wallis rank sum test were used to compare mean erythropoietin concentrations across CKD stages. Results: The mean age of the patients was 49 ± 14 years, ranging from 17 to 78 years. The majority were male (60%, n = 157), married (63%, n = 148), and worked in the informal sector (48%, n = 103). Mean erythropoietin levels decreased progressively and significantly across CKD stages: stage I (4.62 ± 2.19 mIU/mL), stage II (3.36 ± 2.06 mIU/mL), stage III (1.86 ± 1.50 mIU/mL), stage IV (0.99 ± 0.58 mIU/mL), and stage V (0.63 ± 0.29 mIU/mL) (P < 0.001). Conclusion: Our study shows that among Cameroonian adults with CKD, erythropoietin deficiency begins early and progresses from stage II onward, leading to an approximate 86% reduction in serum erythropoietin levels between stages I and V.
Fouda Menye Epouse Ebana Hermine Danielle
Bizarre Anca Vasculitis in a Young Woman: Aggressive Treatment is Justified
ANCA vasculitis is a multisystem autoimmune disease characterized by inflammation involving medium and small sized blood vessels. The inflammation is typically caused by self-reacting auto antibodies that bind to neutrophil and make them overly activated. There are 3 subtypes of ANCA mediated vasculitis namely granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis. In PR3- ANCA positive vasculitis, the most affected sites are upper respiratory tract, lungs and kidney. A 34-year-old woman presented with cough and dyspnea, and features of AKI among many other symptoms. RT-PCR was negative and pulmonary CT scan showed peripheral ground glass opacities. Kidney Biopsy showed crescentic glomerulonephritis after which COVID-19 infection and SLE were ruled out. PR3-ANCA was positive, and she was diagnosed with granulomatosis with polyangiitis. Her renal and lung function improved eventually after aggressive administration of methylprednisolone followed by cyclophosphamide. Here we present a case of ANCA vasculitis with multisystem involvement, initially COVID-19 confusing the radiological diagnosis.
Renal hydatidosis is a rare manifestation of echinococcal disease, accounting for only 2-3% of all hydatid infections. We present the case of a 21-year-old female with no typical risk factors who presented with a large renal hydatid cyst. The patient reported a four-month history of progressive abdominal distension in the right hypochondrium extending to the right flank, accompanied by oppressive pain, nausea, vomiting, fatigue, anorexia, and weight loss. Imaging studies confirmed a large renal hydatid cyst in the upper pole of the right kidney. The patient underwent preoperative treatment with albendazole followed by successful surgical management with partial nephrectomy and cyst enucleation. This case highlights the importance of considering hydatid disease in the differential diagnosis of cystic renal masses, even in patients without typical epidemiological risk factors, and demonstrates the efficacy of a combined medical and surgical approach.
Gender Dependency of Microvascular Complications in Patients of Diabetes Mellitus at a Tertiary Level Hospital in Bangladesh
Background: Diabetes and chronic kidney disease (CKD) are major public health burden in a developing country like Bangladesh. Chronic hyperglycemia in diabetes mellitus (DM) leads to serious microvascular complications. Aim: To assess gender-based differences in the prevalence and severity of microvascular complications and chronic kidney disease (CKD) among diabetic patients at a tertiary-level hospital in Bangladesh. Method: This cross-sectional study was conducted at the outpatient department of a tertiary-level hospital in Bangladesh between July 2022 to December 2022 and included 282 diabetic patients (182 males and 100 females). Data were collected using structured questionnaires from medical records, and laboratory test results. Demographic details, clinical characteristics, biochemical parameters, and microvascular complications were assessed. CKD stages were determined using estimated glomerular filtration rate (eGFR). Results: Out of 282 diabetic patients (182 males, 100 females) with most aged between 40–60 years, the highest age group among males was 50–60 years (38%) and among females that was 40–50 years (36%). Females were more likely to be from urban areas (68% versus 52%, p= 0.024) and showed non-significant trends toward higher rates of hypertension (34.3% versus 26.5%) and family history of diabetes (52% versus 40.9%). Biochemical parameters- including renal status, lipid levels, and glycemic markers were compared between sexes. However, females had significantly lower mean eGFR (22.88 ml/minute/1.73m² versus 27.8 ml/minute/1.73m², p= 0.006), with 46.1% in CKD Stage IV compared to 35.4% of males. Among males, advanced CKD stages were significantly associated with proliferative diabetic retinopathy (p<0.001) and neuropathy (p= 0.008). Conclusion: These results are clear indication that there is considerable difference in prevalence of different microvascular diabetic complications related to chronic kidney disease between male and female. There are social, economic, and perhaps metabolic reasons for these differences.
A clinicopathological study of C1q nephropathy: A single center experience
Background: C1q nephropathy also known as seronegative lupus nephritis, is a relatively rare form of glomerulonephritis which is less understood till now. With the advancement of immunofluorescence and electron microscopic histopathological examination more and more new cases are being diagnosed now a days. Previously it was considered as a diseases of children and young adults but in practical point of view a large number of adult patients are affected by these diseases. The aim of this study is to review the incidence, clinical features, histolopathological morphology of C1q nephropathy in adult Bangladeshi population in BSMMU. Methods and Material: This is a retrospective study done in nephrology department of BSMMU. Out of 180 biopsy reports which were done in between 2020 to 2025, 10 reports of C1q nephropathy were retrieved. Results: This study shows the incidence of C1q Nephropathy is 5.5%, mostly females are affected (80%). Mean age at presentation was 35.5 year. Most common presentation was hematuria with sub nephrotic range proteinuria(50%), Nephrotic range proteinurea was present in 20% cases, 2 patients presentd with isolated proteinuria(20%). 1 patient (10%) presented with renal impairments. Regarding histopathological findings all patients had mesangeal proliferation, 70% patients had dominant and 30 % patients had co-dominant deposition of C1q in the mesangium. Conclusion: This study gives an idea regarding the clinicopathological findings of C1q nephropathy in Bangladeshi population.
Sleep Disorders in Chronic Kidney Disease Patients
Background: Chronic kidney disease (CKD) is associated with a variety of comorbidities, including sleep disorders, which significantly impact patients' quality of life. Sleep disturbances in CKD patients are underreported and poorly managed, despite their potential to exacerbate CKD-related complications. Aim of the study: This study aims to assess the prevalence and types of sleep disorders among CKD patients and explore their clinical characteristics. Methods: A cross-sectional study was conducted on 50 CKD patients at conducted at the Department of Nephrology, Medical College for Women& Hospital, Dhaka Bangladesh. During 1 year from January 2024 to December 2024. Sleep disorders were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Clinical and demographic data were also collected. Result: The study revealed that 40% of participants experienced insomnia, 30% had obstructive sleep apnea (OSA), 20% suffered from restless legs syndrome (RLS), and 10% reported excessive daytime sleepiness. A total of 80% of the participants exhibited poor sleep quality based on the PSQI score, and 30% showed excessive daytime sleepiness according to the ESS. The majority of patients were in advanced stages of CKD (stage 5D), with a high prevalence of comorbidities such as hypertension and diabetes mellitus. Conclusion: In our study, sleep disorders were highly prevalent in CKD patients, significantly affecting their quality of life. The findings underscore the need for routine screening and management of sleep disturbances in this population. Further research is needed to explore the mechanisms linking CKD and sleep disorders, as well as the efficacy of targeted interventions to improve sleep quality in these patients.
Efficacy of Ferric Citrate as Phosphate Binder Among End-Stage Renal Disease Patients on Maintenance Hemodialysis: A Randomized Controlled Trial
Background: End-stage renal disease (ESRD) patients primarily use phosphate binders to manage hyperphosphatemia. Recently, ferric citrate has shown promise as a safer and more acceptable alternative. Objective: The study aimed to evaluate the efficacy of ferric citrate in patients with ESRD undergoing maintenance hemodialysis in Bangladesh. Methods: This open-label randomized controlled trial (RCT) was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) from August 2022 to March 2023. A total of 45 patients on maintenance hemodialysis with CKD stage 5D were randomized into three groups: Group A (ferric citrate), Group B (sevelamer carbonate), and Group C (calcium acetate) and were treated for three months. Intact parathyroid hormone (iPTH), inorganic phosphate, and corrected calcium levels were measured at baseline and after three months. Results: Baseline demographics and comorbidities were similar across groups. After three months, all groups showed significant reductions in serum phosphate: Group A (ferric citrate) [median (range): 4.5 (4.0-7.0) to 4.2 (3.2-6.9) (mg/dl)], Group B (sevelamer carbonate) [median (range): 5.9 (4.37-7.80) to 5.4 (3.2-7.00) (mg/dl)], and Group C (calcium acetate) [median (range): 5.6 (4.2-7.0) to 5.0 (3.8-6.8) (mg/dl)]. iPTH levels also decreased significantly in all groups. Corrected calcium increased significantly only in Group C [median (range): 8.8 (8.2-9.9) to 10.0 (9.4-10.9) (mg/dl)], with no significant changes in Groups A and B. Conclusion: Ferric citrate is an effective and safe option to use as a first-line treatment for hyperphosphatemia in ESRD patients undergoing maintenance dialysis.
Association of Plasma PCSK9 with Hypercholesterolemia in Patients with Nephrotic Syndrome
Background: Hypercholesterolemia poses a significant cardiovascular risk in patients with nephrotic syndrome. Elevated proprotein convertase subtilisin/kexin type 9 (PCSK9) levels in these patients may exacerbate lipid dysregulation, contributing to heightened cardiovascular events. Objective: To investigate the association between PCSK9 and hypercholesterolemia in patients with nephrotic syndrome. Methods: This study was conducted at the Department of Nephrology, National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh. A total of 80 patients were enrolled; of them 40 patients were nephrotic syndrome (Group A) and 40 were apparently healthy subjects (Group B). Their detailed clinical history with demographic profile were recorded. Fasting blood samples were taken for lipid profile, serum albumin, serum creatinine, plasma PCSK9 and 24 hours urine sample for protein creatinine ratio. After collection of all required data, analysis was done accordingly. Results: Mean age of group A patients was 35.40±7.66 years and that was 31.02±9.27 years in group B. Nephrotic syndrome patients have a slightly higher mean BMI than healthy controls (24.84±3.26 kg/m2 versus 23.53±2.97 kg/m2, p= 0.067). Majority (25%) of the nephrotic syndrome patients had minimal change disease (MCD) followed by focal segmental glomerulosclerosis. (FSGS), membranous nephropathy (MN). lupus nephritis (LN) and IgA nephropathy (IgAN). Individuals with nephrotic syndrome had markedly elevated levels of TC, LDL cholesterol and TG compared to healthy controls (p<0.001). Mean PCSK9 level was significantly higher (p<0.001) in nephrotic syndrome group (274.87±139.73 ng/mL) compared to healthy controls (82.91±37.41 ng/ mL). In individuals with nephrotic syndrome, PCSK9 levels have a significant positive correlation with LDL cholesterol (r= 0.646, p<0.001), total cholesterol (TC) (r= 0.341, p= 0.031) and triglycerides (TG) (r= 0.488, p= 0.001); indicating higher PCSK9 levels correspond to elevated lipid levels, while no significant correlation was found with highdensity lipoprotein (HDL) cholesterol (r=0.288, p=0.072). Conclusion: The plasma PCSK9 level is significantly higher in patients with nephrotic syndrome. High PCSK9 level associated with high total cholesterol, LDL cholesterol and TG levels in nephrotic syndrome
Cardiovascular Complications in Patients with Chronic Kidney Disease at the Departmental Teaching Hospital of Borgou/Alibori (Benin)
Background: Background In patients with advanced chronic kidney disease, cardiovascular disease is known to be the leading cause of death. Objective: To study cardiovascular complications in patients with chronic kidney disease (CKD) at CHUD B/A in 2023. Methods: This was a descriptive, analytical, cross-sectional study with prospective data collection involving non-dialysis CKD patients seen in the nephrology, cardiology and internal medicine departments of CHUD B/A from 1 January 2023 to 31 August 2023. The dependent variable was the existence of at least one cardiovascular complication. Data were collected and analysed using R Studio 4.2.2 software. For comparisons, a p-value < 5% was considered statistically significant. Results: 64 patients were included. The mean age of the patients was 58.3 ± 14.1 years, [extremes of 29 and 92 years]. The patients were predominantly male ( 60.9%) with a sex ratio of 1.6. Of the 64 patients with CKD, 51 (79.7%) had at least one cardiovascular complication. The most prevalent cardiovascular complication was LVH in 48 patients (75.0%), followed by heart failure (42.2%), uraemic pericarditis (28.2%) and hypertension (17.2%). In univariate analysis, the stage of CKD, hyperuraemia, anaemia, hypocalcaemia, hyperphosphaemia, positive CRP and lack of compliance with treatment were the factors statistically associated with cardiovascular complications in CKD patients (p<0.05). After adjustment, hyperuraemia was the potential factor associated with the presence of at least one cardiovascular complication (ORa= 62.92; IC95% = [3.12-1271.05]; p= 0.007). Conclusion: Cardiovascular complications are common in patients with advanced chronic kidney disease, and many factors are associated with them.
Benign Nephroangiosclerosis at the Zinder National Hospital: Clinical Presentation and Paraclinical Aspects
Introduction: The aim of our study was to examine the clinical and paraclinical characteristics of benign nephroangiosclerosis (BNA) in the Nephrology department of the National Hospital of Zinder. Patients and method: This is a cross-sectional study with a descriptive aim that involved 152 patient files who had undergone a kidney biopsy (KB) over a period of 4 years from November 1, 2019 to November 1, 2023 at the Nephrology department of the Zinder National Hospital. The processing and analysis of the data collected were carried out using Excel and Epi Info software version 7.2.5.0. Results: During the study period, 152 patients underwent kidney biopsy, 31% of whom (n=47) were hypertensive. The hospital prevalence of NAS represented 9% (n=13) of all kidney biopsies. The mean age was 44.69 ± 10.66 years with extremes of 28 and 63 years. The sex ratio was 5.5 in favor of men. Two out of three patients had 24-hour proteinuria between 1 and 3g. In total, 61% (n= 8) of the patients in our sample were in the last stage of kidney failure. The main indication for kidney biopsy, unexplained kidney failure, was therefore the most frequent indication representing 53.85% (n= 7). Conclusion: This work demonstrates that benign NAS is a reality at the Zinder National Hospital. This disease is more common in young people with cardiovascular risk factors, whose diagnosis is most often made at the last stage of kidney failure. Its progression is insidious and potentially fatal, which is why detecting and controlling high blood pressure at the initial stage will reduce the morbidity and mortality of NAS in our context of limited resources.
Epidemiological Trends and Risk Factors Associated with Renal Cell Carcinoma
Background: Renal cell carcinoma (RCC) is most prevalent form of kidney cancer and represents a large global health burden. There are many demographic, environmental, and lifestyle factors to its incidence. Understanding the trends is necessary in order to prevent and manage effectively. The objective of this study was to evaluate the epidemiological trends and risk factors of RCC in a tertiary care hospital in Bangladesh. Methods: A retrospective study was conducted at Department of Urology, Reliance General and Renal Hospital, Dhaka, from April 2023 to March 2024. Total 40 patients diagnosed with renal cell carcinoma are included in this study following the inclusion and exclusion criteria. Data on demographic characteristics, tumor stages, histological subtypes, and risk factors were collected from medical records and analyzed using SPSS (version 25.0). Results: Among the 40 patients, mostly were male (72.5%). Stage II tumors were most common (40.0%), and clear cell carcinoma was the predominant subtype (62.5%). Significant risk factors included smoking (72.5%), obesity (30.0%), hypertension (67.5%), and urban residence (60.0%). Family history of RCC was noted in 17.5% of cases. Conclusion: RCC in this cohort reflects global trends, with a predominance of modifiable risk factors. Targeted interventions addressing smoking, obesity, and hypertension, along with early detection strategies, is crucial for reducing the RCC burden in resource-limited settings.
Association of Adiponectin with Renal Involvement in Sedentary Obese Individuals.
Background: The global prevalence of chronic kidney disease (CKD) among obese individuals is on the rise, accompanied by a growing economic burden associated with its treatment. Therefore, early detection of renal dysfunction is crucial to prevent CKD progression. Sedentary obesity is a significant risk factor for early renal impairment, often marked by microalbuminuria. Adiponectin, an anti-inflammatory adipokine, serves a protective role in mitigating metabolic and renal disorders. Adiponectin is typically reduced in obese individuals. The study was aimed to evaluate the association of serum adiponectin and renal involvement in sedentary obese individuals without diabetes, hypertension & hypothyroidism. Methods: This observational cross-sectional study was carried out in the Department of Nephrology at BSMMU, Dhaka. The study period ranged from February 2023 to August 2024. The study included 67 sedentary obese individuals, selected according to specific inclusion and exclusion criteria. A purposive sampling approach was employed, and data were gathered using a pre-tested questionnaire, which incorporated patient history and clinical examination. Serum adiponectin levels were measured using the DRG Adiponectin ELISA Kit, which operates on the sandwich principle. Renal involvement was evaluated by determining the urinary albuminto- creatinine ratio (uACR) and estimating the glomerular filtration rate (eGFR) using the MDRD equation. Correlation and ROC curve analyses were conducted to investigate the association between adiponectin levels and microalbuminuria. Results: The study included participants with an average age of 35.88 ± 8.34 years, predominantly male (55.2%), with a significant portion being students (34.3%). Most participants exhibited obesity, with a mean BMI of 34.84 ± 3.47 kg/m², and more than 95% had central obesity. Laboratory results indicated normal glycemic control, with a mean fasting blood sugar of 4.93 ± 0.31 mmol/L and HbA1c of 5.06 ± 0.27%. However, 86.6% of participants had low HDL levels, and a significant number had elevated triglycerides and LDL levels. At enrollment, 8 participants (11.9%) had elevated urinary ACR. After excluding cases of transient microalbuminuria, 7 participants (10.4%) were confirmed to have microalbuminuria, resulting in an overall renal involvement rate of 10.4%. Participants with microalbuminuria had significantly lower serum adiponectin levels (0.93 ± 0.35 μg/ml, p<0.001). A weak inverse correlation was found between BMI and serum adiponectin (r = -0.295, p = 0.013). Adiponectin was found to be a strong predictor of microalbuminuria with a cut-off value of ≤1.0 μg/ ml, exhibiting good sensitivity and specificity. Conclusion: Reduced adiponectin levels were significantly associated with microalbuminuria, underscoring its potential as a biomarker for early renal involvement in sedentary obese individuals
Etiological Association of Pruritus in End Stage Renal Disease Patients on Maintenance Hemodialysis
Background: Chronic kidney disease–associated pruritus (CKD-aP) is a common, troubling and, in some cases, debilitating problem for patients with CKD and end-stage renal disease (ESRD). Despite a prevalence rate of approximately 20% in CKD and 40% in ESRD and a clear association with poorer psychosocial and medical outcomes, this condition is often underreported by patients and overlooked by healthcare providers. This is likely due to uncertainty regarding its pathogenesis and treatment. Most commonly, CKD-aP is attributed to toxin build-up, peripheral neuropathy, immune system dysregulation, or opioid dysregulation. The exact pathogenesis remains largely elusive, which hampers the definite treatment protocol. Studies have shown changes in the immunochemical milieu of the skin in patients with CKD-aP, with several inciting stimuli identified. However, other unrecognized factors are likely to be involved. Aim of the study: To find out the etiological association of pruritus in ESRD patients on maintenance hemodialysis. Methods: This prospective observational study was carried out in the Department of Nephrology BSMMU and ShSMCH, Dhaka, Bangladesh. A total of 60 patients with CKD Stage 5 on MHD were included in this study. CKD stage 5 on MHD with pruritus and without pruritus were considered group I and group II. Patients aged above 18 years and undergoing hemodialysis for at least 3 months were enrolled in this study. Result: This study showed mean age was 47.24±15.63 years (range: 18-69) in Group I and 43.14±15.07 years (range: 18-73) in Group II, with the majority (76.5%) of the population being female in Group I. Glomerulonephritis (GN) was the predominant aetiology and hypertension (HTN) was a prominent comorbidity in both groups. Mild pruritus was most prevalent (47.1%) in a pruritic group of patients. Among pruritic patients, more than half (52.9%) patients had generalized pruritus. Almost three-fourths (70.6%) of patients rarely experienced sleep disturbance. The IL-31 exhibited a marked difference, with Group I showing a significantly higher mean of 128.23±77.34 xiii compared to Group II's mean of 60.52±36.25 (P0.05) with the severity of pruritus. Twice weekly treated patients (Mean±SD was 107.9±68.9) were more prone to develop pruritus than those getting thrice weekly with no significant difference in terms of IL-31, with the frequency of HD per week. Laboratory parameters had no significant differences between the two groups in terms of Hb, WBC, Circulatory eosinophil count, IgE, S. Ca, S. P04, Ca *P04 product and iPTH. Receiver-operator characteristic (ROC) was constructed by using IL-31, which cut value 87.7, with 70.6% sensitivity and 81.4% specificity. Conclusion: In this study, there was a significant difference in the IL-31 level between pruritic and nonpruritic patients. IL-31 levels didn't directly correlate with the severity of pruritus in ESRD patients on maintenance hemodialysis. Twice-weekly hemodialysis patients were more prone to develop pruritus than thrice-weekly treated patients. Besides, there was no significant difference in terms of IL-31 level with the frequency of HD.
Urine KIM-1 as Predictor of Renal Histopathology and Treatment Response in Lupus Nephritis Patients
Introduction: Lupus nephritis is one of the most severe complications of systemic lupus erythematosus (SLE) and typically develops within five years of an SLE diagnosis in 50%-60% of patients. Lupus nephritis is a major predictor of prognosis and a significant contributor to morbidity and mortality in SLE. Renal biopsy is the gold standard for diagnosing lupus nephritis patients. However, its invasive nature and associated risks limit its use, highlighting the need for non-invasive biomarker like Kidney Injury Molecule-1 (KIM-1). Present study aimed to assess urine KIM- 1 as predictors of renal histopathology and treatment response in lupus nephritis patients. Materials & Methods: This prospective observational study was conducted in the Nephrology department at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from March 2023 to August 2024, involving adult patients (age ≥ 18 years) diagnosed with SLE and lupus nephritis. Using convenience sampling, 52 respondents were enrolled. Ethical approval was obtained from the Institutional Review Board (IRB) of BSMMU. Renal biopsies and urine samples were collected for analysis, and patients were followed up at six months. Results: The study population had a mean age of 28.1 years. The female predominance was 92.3%. The mean BMI was 24.2 kg/m². Hypertension was present in 46.2% of respondents, anemia in 30.8%, edema in 59.6%, and proteinuria in 48.1% (++), and 34.6% (+++). Histologically, 57.7% were classified as Class IV lupus nephritis, and 17.3% as Class III. Hydroxychloroquine was administered to 100% of respondents, cyclophosphamide with corticosteroids to 61.5%, MMF with corticosteroids to 23.1%, and corticosteroids alone to 15.4%. Complete response was achieved by 67.3%, partial response by 28.8%, and no response by 3.8%. At baseline, Class IV lupus nephritis patients had the highest mean urine KIM-1 levels (672.7 ± 504.0 ng/mL), which decreased after six months but remained highest (231.6 ± 191.4 ng/mL). The proliferative group had significantly higher mean urine KIM-1 levels than the non-proliferative group at both baseline and six months. Mean Urine KIM-1 level was significantly (p < 0.05) lower in respondents with a complete response compared to those with partial or no response, both at baseline and after six months. Statistically significant differences in mean serum creatinine, serum albumin, and urinary PCR levels were observed between response groups. Conclusion: Urine KIM-1 levels significantly correlate with disease severity and renal function markers, highlighting its clinical utility. Future research should validate urine KIM-1 as a biomarker and explore its potential in guiding treatment decisions.
Role of Ferric Citrate in Correcting Anemia Among Chronic Kidney Disease Patients on Maintenance Hemodialysis
Background: In chronic kidney disease (CKD), anemia and hyperphosphatemia are significant complications. Anemia due to erythropoietin and iron deficiencies, often requires supplementation. Phosphate binders including ferric citrate, sevelamer carbonate, and calcium acetate are crucial for managing hyperphosphatemia, as they prevent the absorption of dietary phosphate. Objective: Present study was aimed to assess the role of ferric citrate in correcting anemia among CKD patients on maintenance hemodialysis (MHD). Methods: This randomized control trial was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, that enrolled 45 adult CKD patients on hemodialysis. Study population were divided into equal three groups to compare the effects of ferric citrate, sevelamer carbonate, and calcium acetate. Of these groups, ferric citrate was the intervention group, whereas sevelamer carbonate and calcium acetate were the active control group. Data were collected through interviews and medical evaluations, including serum hemoglobin level and iron status. The focus was on the role of ferric citrate in correcting anemia and iron status among maintenance hemodialysis (MHD) patients. Results: In this study with CKD patients undergoing hemodialysis, the majority of participants were male across all groups. Initially, no significant differences were observed in serum hemoglobin, iron, and transferrin saturation (TSAT) level among the groups. However, after three months of treatment, significant (p<0.05) improvements were noted in the intervention group, with increases in hemoglobin level from 9.39 ± 1.08 g/dl to 10.6 ± 0.89 g/dl and in serum iron level from 50.8 ± 17.0 μg/dl to 118.2 ± 35.5 μg/dl. Transferrin saturation was also raised significantly from 23.5% to 45%. In contrast, the control groups did not show significant changes in these parameters. Ferric citrate significantly (p<0.05) increases serum ferritin level from 344 ng/ml to 568 ng/ml. No significant changes were noted in total iron binding capacity (TIBC) level across all phosphate binders. Conclusion: The study indicates that ferric citrate is better at correcting hemoglobin level and iron status in CKD patients on MHD than sevelamer carbonate and calcium acetate. Therefore, ferric citrate can be used as a primary treatment for the correction of anemia in MHD patients
Copyright (c) 2024 Archives of Nephrology and Urology
Clinico-Pathological Evaluation of Carcinoma Thyroid
Background: Thyroid cancer varies from well-differentiated lesions with a favorable prognosis to nearly always fatal anaplastic carcinoma. Accounting for 1% of human cancers, its global annual incidence is estimated at 0.5 to 10 per 100,000 people. This study aimed to assess the clinicopathological features of thyroid carcinoma. Methods: This prospective study at the Department of Surgery, Bangabandhu Sheikh Mujib Medical University, analyzed 50 consecutive thyroid malignancy cases over 12 months, all confirmed post-surgery by histopathological examination. Results: The age of the patient ranged from 15 years to 75 years (mean age 36.54years) with a maximum incidence in 4th decade. Only 2 patients (2 females) aged below 21 years. Out of 50 patients, 30 patients (60%) were female and 20 patients (40%) were male with a female to male ratio 1.5:1. Presenting symptoms were neck swelling (painless or painful), pressure symptoms, (Dysphasia or dyspnea), voice change, cervical lymphadenopathy, cough and bone pain. Neck swelling (painful or painless) is the most common presentation (100%). All 50 patients were undergone total thyroidectomy and histopathological proved thyroid malignancy. Regarding the types of malignancy in this study, papillary carcinoma was the most common variety (66%) followed by follicular carcinoma (20%), medullary carcinoma (12%), and anaplastic carcinoma (2%). FNAC proved malignancy in 50 patients (100%). Conclusion: The risk of thyroid malignancy is seen in middle age. Females are more sufferer than male. The most common clinical presentation of thyroid malignancy is neck swelling. Also most common pattern of thyroid carcinoma was papillary carcinoma.
Successful Percutaneous Gastrostomy Tube Insertion in Adult Prevalent Peritoneal Dialysis Patients: Case-Series and Literature Review
Protein-energy malnutrition (PEM) is a prevalent condition in peritoneal dialysis (PD) patients, contributing to increased morbidity and mortality. Feeding difficulties can exacerbate PEM, making adequate nutrition challenging. Percutaneous endoscopic gastrostomy (PEG) tubes offer a potential solution for patients unable to maintain oral intake. This case series presents adult prevalent six PD patients with PEM who underwent PEG tube placement by an interventional radiologist. Clinical outcomes, including complications, survival rates, and nutritional status, were evaluated. PEG tube insertion was successfully performed in all six patients without major complications. Nutritional status improved, and patients tolerated feeding well. Despite successful PEG placement, mortality rates remained high due to underlying comorbidities and complications unrelated to the PEG tube. Percutaneous endoscopic gastrostomy tubes can be a safe and effective option for PD patients with PEM and feeding difficulties. Further research is needed to establish definitive guidelines and evaluate long-term outcomes in this population.
Disseminated Tuberculosis Following Renal Transplant: A Case Report
Tuberculosis is a great challenge for post-transplant patients. The burden is more complicated in developing countries like Bangladesh. It can cause allograft rejection and graft loss due to delayed diagnosis or loss of efficacy of immunosuppressant drugs following anti-tubercular therapy. The present study documents a case where a patient developed disseminated tuberculosis after receiving a kidney transplant. This article presents the case of a 58-year-old woman who had a renal transplant 10 years back and presented with fever for 2 months. Detailed history and examination shows there is nodular swelling in the left post auricular area along with multiple swelling in the scalp. There was tenderness in the right hypochondriac area. Thorough investigations including a CT scan of the abdomen were done which showed a collection of pus in the subphrenic area. Ultrasound guided aspiration of the pus was done and was sent for microbiological evaluation. FNAC was done from the left post auricular swelling and was sent for microbiological evaluation. Both of the samples were positive for tubercular bacilli. Urine GeneXpert was also positive for AFB. The patient was diagnosed as a case of disseminated tuberculosis and an antitubercular regimen was started. After the treatment patient was clinically improved. The index of suspicion should be high when a posttransplant patient presents with PUO. Early diagnosis may save the graft function
Bendamustine, Prednisone and Bortezomib (BPV) Induction Therapy Prior Autologous Stem Cell Transplantation (ASCT) in 135 Newly Diagnosed Multiple Myeloma Patients: Comparison Between Patients with Normal and Impaired Renal Function
Introduction: Autologous stem cell transplantation (ASCT) is the standard first line treatment for younger patients with multiple myeloma (MM). Bortezomib and bendamustine have both been identified as rapidly acting and well-tolerated drugs for patients with MM-induced renal failure. In this retrospective study we analyzed the efficacy of induction therapy with a combination bendamustine, prednisone and bortezomib (BPV) prior to ASCT in newly diagnosed MM-patients (NDMM) depending on severity of renal impairment. Methods: 135 patients with NDMM were treated with BPV-induction. Results: The majority of patients (n=117; 87%) responded after BPV-induction with 9 sCR, 3 CR, 51 VGPR, and 54 PR. After first ASCT ORR increased to 99% with 33 sCR, 10 CR, 73 VGPR and 17 PR. Median PFS was 47 months and OS at 60 months was 67%. Patients were divided into four groups depending on severity of renal impairment: A (n=13) with eGFR<15mL/min, B (n=15) 15–29mL/min, C (n=19) 30-59mL/min and D (n=88) ≥60mL/min. We observed no significant difference in PFS between patients with normal/mild, moderate, severe renal dysfunction and renal failure/dialysis (50 vs 47 vs 34 vs 24 months, p=0.05) and in 60 months OS (69 vs 72 vs 58 vs 70%, p=0.23). The renal response rate improved from 68% after BPV to 74% following ASCT. Conclusion: These results indicate that BPV-induction followed by ASCT is feasible, effective and well tolerated in patients with MM-induced renal failure. Furthermore, we showed that pretreatment with short-term bendamustine had no negative impact on stem cell mobilization.
Hypovitaminosis D and Poor Nutritional Status are Independent Risk Factors of Insulin Resistance in Patients on Maintenance Hemodialysis
Background: Insulin resistance is one of the essential components of metabolic syndrome, is recognized in patients on maintenance hemodialysis, and is directly associated with increased cardiovascular mortality. Vitamin D deficiency is a risk factor for glucose intolerance, and 1,25 dihydroxy cholecalciferol regulates insulin secretion. Malnutrition is also a risk factor for insulin resistance and is associated with increased morbidity and mortality. Aims: To assess hypovitaminosis D, poor nutritional status, and independent risk factors of insulin resistance in patients on maintenance hemodialysis. Methods: This cross-sectional study was conducted in the Department of Nephrology, Dhaka Medical College, Dhaka, from May 2021 to October 2022. This study included one hundred twenty patients on maintenance hemodialysis according to inclusion and exclusion criteria. Statistical analyses of the results were obtained using window-based computer software devised with statistical packages for social sciences (SPSS-26). Results: It was observed that almost one-third (32.6%) of subjects belonging to age 41-50 years were insulin resistant, and 14(41.2%) were non-insulin resistant. The mean age was 50.36±12.03 years and 48.24±10.17 years in insulin and non-insulin resistance, respectively. More than half (53.5%) of subjects were male in insulin resistance, and 20(58.8%) in non-insulin resistance. According to the TST Z-score, 29(33.7%) and 2(5.9%) were malnourished in insulin-resistant presence and absence. According to the MAC Z-score malnourished was found 46(53.5%) insulin resistant were present, and 3(8.8%) were absent. According to the MAMC, Z-score malnourished was found in 37(43.0%) insulin-resistant patients and 3(8.8%) insulin-resistant patients. The difference between the two groups was statistically significant (p<0.05). Study subjects according to malnutrition score based on SGA, it was observed that more than two-thirds (67.4%) of subjects were mild to moderately malnourished in insulin resistant and 4(11.8%) in non-insulin resistant. The difference was statistically (p<0.05) significant between the two groups. About 78(90.7%) subjects had found Vitamin D deficiency (<20) levels in insulin resistant and 9 (26.47%) in non-insulin resistant subjects. Vitamin D deficiency had a 12.4 times risk of developing insulin resistance (OR=12.34; 95% CI=4.2-38.1). Eighteen (20.9%) of subjects had lower (<35g/l) serum albumin in insulin resistance and 2(5.9%) in non-insulin resistance. Low albumin had a 4.24 times risk of developing insulin resistance (OR=4.2;95% CI=0.9-28.2). The difference was statistically (p<0.05) significant between the two groups. Based on subjective global assessment, a significant positive correlation exists between insulin resistance and TST, MAC, MAMC, and malnutrition scores. There is a negative significant correlation between insulin resistance and vitamin D. Conclusion: Most of the patients on maintenance hemodialysis are Vitamin D deficient. Low Vitamin D levels and muscle mass will likely cause more insulin resistance in patients on maintenance hemodialysis.
Association of High HbA1c with Interdialytic Weight Gain in Diabetic Patients on Maintenance Hemodialysis
Background: Chronic kidney disease (CKD) is a progressive loss of kidney function over months or years. The majority of CKD patients ultimately reach ESRD and need RRT. Hemodialysis is one of the treatment options for end-stage renal disease (ESRD). Excessive fluid gain between hemodialysis sessions is one crucial factor associated with hypertension and shortened survival for patients. In addition, excessive weight gain between hemodialysis predisposes to an increase in the risk of intradialytic hypotension or morbidity due to corresponding increased ultrafiltration rates when the duration of dialysis sessions cannot be extended. Many studies have shown that increased IDWG is associated with increased glycosylated hemoglobin. The glycosylated hemoglobin (HbA1c) test has been the most widely accepted, reliable biomarker for evaluating long-term glycemic control in patients with diabetes mellitus. Diabetic patients on MHD have increased thirst, and a recent multi-center study showed that they were more likely to have more significant interdialytic weight gain than nondiabetic patients. Aim of the study: To determine the association between interdialytic weight gain and glycosylated hemoglobin in diabetic patients on maintenance hemodialysis. Methods: This hospital-based prospective analytical study was conducted at the Department of Nephrology, Dhaka Medical College. A total of 109 diabetic patients with MHD were included in this study according to selection criteria. HbA1c was determined for each patient. IDWG was calculated from two weights measured between two dialysis sessions. A pretested questionnaire was used for the interview. Informed written consent was obtained. Seventeen patients were dropped out, so, finally, data were analyzed for 92 patients. ANOVA, Student's t-test, and Chi-squared test were carried out. Following the completion of data collection, data were analyzed using SPSS version 26. Result: The mean age of the patients was 45.86±14.10 years, ranging from 23-78 years. Males (65.2%) were predominant than females (34.8%). Male to female ratio was 1.88:1. HbA1c level was significantly elevated as age increased (p=0.037). Sixty-one (66.3%) patients had interdialytic weight gain. Mean weight gain was 2.88±1.04 kg, ranging from 0.6 kg to 4.67 kg. Among the study subjects, 15.2%, 30.4%, and 54.3% had HbA1c ≤6%, 6.1-7.9%, and ≥8%, respectively. A significant (p=0.023) association was observed. HbA1c was elevated as the increment of IDWG. There was a significant positive correlation between HbA1c and IDWG (r=0.365; p<0.001). Interdialytic weight gain decreased as per increment of the duration of dialysis. There was a significant negative correlation between interdialytic weight gain and the duration of dialysis (r= -0.382; p<0.001). Conclusion: The results of this study demonstrated that interdialytic weight gain (IDWG) is positively correlated with high HbA1c and inversely related to the duration of dialysis.