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. 2022 Dec;32(Suppl 1):S1–S18.

ORAL PRESENTATION

PMCID: PMC9997682
Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 1: RENAL PATHOLOGIES ASSOCIATED WITH THE USE OF INDIGENOUS INDIAN MEDICATIONS

Prem Kumar Devaraju 1, Chelvamalai Muthukumaran Balasubramanian 1, Guhan Senthilkumaran 1, V S Jibia 1, Vaishanavi Devi Rajarathinam 1, Vinoj Murugesan 1, Gopalakrishnan Natarajan 1, Shankar Palaniselvam 1

BACKGROUND: Membranous nephropathy secondary to heavy metal toxicity is known to occur in patients undergoing treatment with indigenous Indian medications. Here we studied the different renal pathologies that were identified among patients with a history of intake of indigenous Indian medications.

AIM OF THE STUDY: To study the various renal pathologies associated with the use of indigenous Indian medications and their clinical profile.

METHODS: This was an ambispective observational study conducted at Madras Medical College Chennai India between May 2021 and August 2022. All patients with nephrotic syndrome or unexplained acute kidney injury who underwent a kidney biopsy for diagnostic purposes and who provided a history of recent ingestion of indigenous medications were included in the study. Histopathological examination of the biopsy tissue was performed by a single nephro-pathologist and included light microscopy and immunofluorescence. Serum and urine samples of the patient were analyzed using mass spectrometry for heavy metals. Indigenous medications when available were also analyzed using inductive coupled plasma-optical emission spectrometer.

RESULTS: A total of 18 patients were enrolled in the study; the median age was 46 years (IQR 40 to 53) with female preponderance (n = 14; 77.7%). The median duration of indigenous medication intake was 5 months. Indications for these medications were asthma (n = 6), joint pain (n = 8), diabetes (n = 1), general ill health (n = 2), and allergic symptoms (n = 1). A total of 12 patients (66.6%) had urine and 7 patients (38.8%) had serum mercury levels exceeding normal limits. Four patients were able to provide the indigenous formulations that they had been taking. All four of these samples contained high levels of mercury. The renal biopsy findings included membranous nephropathy (n = 11), minimal change disease (n = 6), and mesangial proliferative glomerulonephritis (n = 1). Tissue staining for PLA2R was negative in patients with membranous nephropathy, but two patients were positive for NELL-1 on direct immunofluorescence. The median quantum of proteinuria was 5.3 grams per day. Four patients had acute kidney injury at presentation. Acute kidney injury recovered during follow-up. Seven patients achieved complete remission with conservative management, three patients received steroids and achieved complete remission, three patients in partial remission, two patients lost follow-up, and three patients are currently in conservative management awaiting remission.

CONCLUSIONS: The most common pathology noted in patients having a history of intake of Indigenous Indian medications was membranous nephropathy (61%). Most patients recovered completely after withdrawing the drugs. Steroid-responsiveness was documented in some cases that did not remit spontaneously. Limitation: Despite the temporal association between the use of indigenous Indian medications and various renal pathologies, it is not possible to attribute causality, given the small number of patients studied.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 2: NON-INVASIVE ASSESSMENT OF RENAL ALLOGRAFT FIBROSIS BY SHEARWAVE ELASTOGRAPHY: A RADIOLOGICAL- PATHOLOGICAL CORRELATION ANALYSIS

Sandeep Singhal 1

BACKGROUND: Currently, renal allograft biopsy is the only reliable tool available to detect fibrosis in the transplanted kidney. However, it is an invasive procedure and is associated with complications. Therefore, a non-invasive tool to detect renal allograft fibrosis is needed.

AIM OF THE STUDY: To evaluate the usefulness of SWE in the quantitative measurement of renal allograft fibrosis and to correlate shear-wave elastography (SWE) measurements with histological findings resistive index serum creatinine level and eGFR obtained with the CKD-EPI.

METHODS: A cross-sectional study of 110 renal transplant patients. Patients were classified as having stable allograft and allograft dysfunction based on clinical parameters. Only patients with allograft dysfunction underwent renal allograft biopsy. SWE assessment was done by a single radiologist using the same ultrasound machine to quantify allograft fibrosis in kPa. Renal allograft biopsies were interpreted by the same pathologist according to the 2019 Banff classification. The potential correlation between SWE scores and Banff classification was performed in allograft dysfunction group. The receiver operating characteristic curves were drawn to evaluate the likelihood of differentiation.

RESULTS: Sixty-six patients had allograft dysfunction, and 44 patients had stable allograft function. Mean parenchymal stiffness showed a significant negative correlation with eGFR (r = -0.317, p = 0.001) and a positive correlation with serum creatinine level (r = 0.256; p = 0.007). There was a significant correlation between the Banff grade of IFTA and the mean SWE score, (p = 0.003). The correlation of resistive index was insignificant when compared to the mean SWE score (r = 0.058, p = 0.547). The area under the curve was higher and significant at IFTA grading ≥ 2 (AUC- 0.801, p < 0.0001) when compared it with IFTA grading 0 (AC—0.523, p = 0.831) and 1 (AUC-0.551, p = 0.431). The sensitivity was 86%, and specificity was 73% in the differentiation of stable graft from graft dysfunction with moderate-to-severe fibrosis (cut-off value, 16.15 kPa).

CONCLUSIONS: Renal allograft parenchymal stiffness quantified by SWE showed a significant correlation with allograft fibrosis graded by Banff classification. SWE can differentiate between mild fibrosis and moderate to severe fibrosis with high accuracy. The inverse correlation of parenchymal stiffness with eGFR and positive correlation with serum creatinine level showed that SWE may reflect the functional status of the renal allograft. Therefore, SWE can be used as a noninvasive tool to assess renal allograft fibrosis and is better than the resistive index.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 3: SINGLE CENTRE EXPERIENCE OF METFORMIN THERAPY IN ADPKD: AN INTERIM ANALYSIS

Aniruddha Datta 1, Arpita Raychaudhury 1, Atanu Pal 1, Koushik Bhattacharya 1, Debarata Sen 1

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common of the inherited renal cystic diseases which accounts for 2.6% cases of CKD in India. Metformin acting via the AMPK pathway has shown to impact cystogenesis and in preclinical animal models retards the progression of ADPKD.

AIM OF THE STUDY: Assessment of the efficacy of Metformin therapy in the change in the progression of Autosomal Polycystic Kidney Disease by measuring the total kidney volume (height adjusted) by MRI and eGFR loss. Assessment of the safety of long-term Metformin therapy in ADPKD patients prevalence analysis of ADPKD based on Mayo Classification in our population.

METHODS: ADPKD patients undergoing treatment from our OPD were recruited for an interim analysis. ADPKD patients diagnosed on the basis of Unified Pei-Ravine’s criteria were grouped into those only on antihypertensives and lifestyle modification (conservative arm) and those on additional Metformin therapy and followed up by annual monitoring of height adjusted total kidney volume (htTKV) and estimated GFR by creatinine measurement by CKD-EPI 2021 Equation. Data was analyzed as per intention to treat analysis. Due to variable median follow-up periods, the patients were classified in three groups based on the completed period on therapy & the groups were compared in the aspects of GFR loss and Percentage increase in htTKV with further subclassification into each Mayo Class based on height adjusted TKV, and head-to-head comparison was done.

RESULTS: The patients were classified into three groups based on completed duration on therapy, 24 months, 12 months, and 6 months. The htTKV assessment was done annually; thus, the only the group completing 24 months had available comparative htTKV value. ADPKD patients with eGFR ≥ 45 ml/ min/1.37 m2 were selected, of the 80 patients who were eligible, 59 patients could be taken up for analysis, and 21 patients were excluded. In the assessed group, Mayo Class 1C was the most prevalent (37.29%) class. Overall, 35 (59.32%) patients were on additional metformin therapy and 24 (40.68%) patients were on conservative therapy. In the group of patients with 24 months completed on therapy, in the Metformin arm mean eGFR loss over the period was 8.25 ± 7.18 ml/min/1.37 m2, compared to 11.29 ± 5.21 ml/min/1.37 m2 in the conservative arm [p: 0.807 CI:-3.99 to 5.05]. Mean percentage of increase in htTKV in Metformin arm was 6.44 ± 4.74 compared to 6.97 ± 4.06 in the conservative arm [p: 0.34 CI:-3.53 to 9.1]. In the group of patients with 12 months completed on therapy, mean eGFR loss over the period in Metformin arm was 3.4 ± 6.31 ml/min/1.37 m2 and in the conservative arm was 2.83 ± 2.32 ml/min/1.37 m2 [p:0.84 CI: -6.38 to 5.24]. In the group of patients with 6 months completed on therapy, mean eGFR loss over the period in the Metformin arm was 0.54 ± 2.91 ml/min/1.37 m2 and in conservative arm was 1.91 ± 1.97 ml/min/1.37 m2 [p: 0.19 CI:-0.77 to 3.51] In subgroup analysis of the groups according to Mayo Classification, in Class 1B of the group completing 6 months on therapy had statistically significant less reduction in the GFR with mean eGFR loss of 0.50  ± 1.0 ml/min/1.37 m2 in the Metformin arm compared to 2.25  ± 0.96 ml/min/1.37 m2 in conservative arm [p:0.045 CI:0.054 to 3.45]. In all the other subclasses of the groups no statistically significant benefit in terms of eGFR preservation or percentage increase in htTKV could be demonstrated. However, in the group on 24 months therapy, in Class 1C mean eGFR loss in Metformin arm was numerically less than the conservative group at 10.33 ± 6.5 ml/min/1.37 m2 vs. 12.67 ± 5.85 ml/min/1.37 m2 Even in Class 1D similar numerical benefit was seen but both failed to show statistical significance. There were no significant adverse effects except gastrointestinal symptom-related dose reduction of Metformin in 2 patients and withdrawal in 2 patients due to reduction in eGFR below 30 ml/min/1.37 m2

CONCLUSIONS: Although there was a slight numerical benefit in terms of loss of eGFR and percentage increase in htTKV in most of the cohorts, but it did not translate into statistical significance across all the groups. Greater numerical benefit in the rapid progressor in the group on longer duration of therapy shows need for further study with larger sample size with longer duration of follow-up. Variability in benefit within the groups shows better understanding is needed in identifying subpopulations that may get greatest benefit with the therapy and earlier initiation in those specific populations.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 4: NOVEL PREDICTION MODEL OF NON-DIABETIC KIDNEY DISEASE IN TYPE-2 DIABETES MELLITUS — DEVELOPMENT AND EXTERNAL VALIDATION

Vamsidhar Veeranki 1, Narayan Prasad 1

BACKGROUND: The renal involvement in diabetes could be either due to Diabetes Mellitus (DKD) non-diabetic kidney disease (NDKD) or both. In face of increasing prevalence of Type-2 diabetes mellitus (Type-2 DM) and changing epidemiological factors including age infections and systemic diseases and better glycemic control, there is an increase in the prevalence of NDKD among the diabetics. However, the diagnosis of NDKD requires an invasive renal biopsy which remains the gold standard. In current study, we aimed to develop and validate the prediction model of NDKD based on the clinical and laboratory parameters.

AIM OF THE STUDY: We aimed to develop and validate the prediction model of NDKD based on the clinical and laboratory parameters.

METHODS: This retrospective single-center study included data of patients with Type-2 DM who underwent renal biopsy across 17 years between August 1, 2017 and July 31, 2022. Besides the demographic data parameters including the DM-related micro- and macrovascular end organ changes degree of proteinuria microscopic hematuria complements levels syndromic presentation at the time of hospital admission physician’s indication for renal biopsy were collected. For the purpose of developing and validating the prediction model, patients were classified into developmental (2005 till 2019) and validation cohorts (2019 till 2022). Primary outcome was presence of NDKD on renal biopsy.

RESULTS: A total of 5,485 biopsies were performed in the study period, 538 patients with Type-2 DM were included in the study. Only DKD pathological was noted in 166 patients (33%), NDKD alone in 262 patients (49%) and NDKD with DKD in 110 patients (20%). Using multivariate logistic regression with backward Wald’s elimination, a predictive model was created which included the variables - duration of DM < 5 years, absence of coronary artery disease, absence of diabetic-retinopathy, oliguria at presentation, acute rise in creatinine and low C3 at presentation. When the performance of this tool was tested on a separate validation cohort using receiver-operator-characteristic, the diagnostic accuracy (determined by AUC) was 81.4%. A score of ï'35.5 was noted to have a sensitivity of 84.3% and specificity of 64.4% in predicting the NDKD.

CONCLUSIONS: The non-invasive model using the clinical and laboratory features, robustly predicted the chance of NDKD in patients with Type-2 DM on external validation. This tool with a good sensitivity of around 85% may be used as a potential pre-biopsy screening tool for prediction of NDKD in routine clinical practice.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 5: COMPARATIVE ANALYSIS OF SUPERVISED VERSUS CONVENTIONAL DIETARY INTERVENTION ON NURITIONAL STATUS FRAILTY AND QUALITY OF LIFE IN DIALYSIS PATIENTS

Preeti Chaudhary 1, Lalit Pursnani 1, Muthukumar B 1, H S Mahapatra 1

BACKGROUND: Protein energy wasting (PEW) is one of the late consequences of chronic kidney disease (CKD) and approximately 18%–75% of patients on dialysis show evidence of this alteration. PEW adversely affects the muscle mass nutritional status and physical function of dialysis patients and subsequently reduces quality of life (QOL) leading to frailty disability and increased mortality. Dietetic intervention has been associated with improvement in nutritional status and dietary intake but evidence in Indian patients on dialysis is scarce. Thereby this randomized controlled pilot study was undertaken to compare and analyze the supervised home based dietary intervention with re-enforcement and conventional dietary prescription in terms of effect on nutritional status frailty and quality of life in dialysis patients

AIM OF THE STUDY: To compare the effects of supervised home-based dietary intervention versus conventional dietary prescription on nutritional status frailty and quality of life in dialysis patients

METHODS: Seventy patients on dialysis (Hemodialysis- HD/Peritoneal dialysis-PD) with age >18 years at dialysis initiation and ï'3 3 months of dialysis duration were selected and randomized into two groups of 35 patients each by a software to either group A- undergoing routine dietary prescription or group B- undergoing supervised home-based dietary intervention and re-enforcement with help of telephone calls by a renal dietician. Pre-selected parameters of nutritional status (malnutrition inflammation score (MIS) and lean tissue mass index (LTMI) by bioimpedance analysis), frailty (simplified Fried criteria), QOL [Kidney disease quality of life- 36 (KDQOL-36)], and nutrient analysis (4 days dietary record- 4DDR DietCal 10.0 software) were measured/calculated at baseline and at 3 and 6 months in both the groups.

RESULTS: The dietary intervention group did better in improving nutritional intake, nutritional parameters, frailty, and QOL of the patients at the end of the study, though in few parameters, it couldn’t achieve the recommended values for dialysis population. At baseline, dietary analysis for nutrients (total calories, protein, fiber, sodium, potassium, calcium, phosphorus) was comparable in both the groups except for significantly increased protein intake in group A. At 3 months, it was comparable except for increased intake of sodium and calcium in group B. At 6 months, total calories, protein and calcium intake was higher in group B as compared to group A. The presence of combined moderate and severe malnutrition by MIS score was comparable in both the groups at baseline and 3 months; at 6 months it was insignificantly lower in group B, though severe malnutrition was significantly lower. Mean LTI was comparable in both the groups at baseline, but showed significant higher values in group B at 3 months and 6 months. Frailty was significantly higher in group B at baseline, reached comparable state at 3 months and significantly decreased at 6 months as compared to group A. QOL was comparable between both the groups at baseline, insignificantly increased in group B at 3 months and significantly increased in group B at 6 months.

CONCLUSIONS: Supervised dietary intervention and re-enforcement by a renal dietician is superior to conventional dietary prescription in improving nutritional status, frailty, and QOL and should be advocated in all dialysis patients

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 6: EFFICACY OF NFKB INHIBITOR IN MITIGATING CHRONIC KIDNEY DISEASE GENES IN OBSTRUCTIVE NEPHROPATHY RAT MODEL

Shruti Tomar 1, Veena Puri 2, Sanjeev Puri 3, Seemha Rai 1

BACKGROUND: The study investigated the molecular mechanisms by which inhibitor of NF-kB PDTC exerts its reno-protective effects in rat model of CKD developed through obstructive nephropathy. UUO is well-tested model broadly used to explore the pathogenesis of CKD which produces inflammation apoptosis and fibrosis. NF-kB plays a major role in immunological processes and metabolic disorders. The pathology associated with CKD is convoluted due to its multifactorial etiology although inflammation, and apoptosis has been reported to be the major risk factors in disease pathophysiology irrespective of the underlying root cause. Thus NF-kB seemed to be a significant player.

AIM OF THE STUDY: To seek the role of NF-kB inhibitor in amelioration of CKD so that it can be used as potential therapeutic target for disease prevention.

METHODS: Three topmost important genes recouped through bioinformatics approach were validated in vivo by creating a rat model of CKD by unilateral ureter obstruction method. It was performed by surgically ligating the left ureter at two points. Blood samples were collected for BUN-creatinine tests, and kidney samples were harvested for histology at 14 and 18 days of control and operated rats. Expression level analysis of top three genes was performed by real-time PCR and immunohistochemistry. 18 days of obstruction caused more significant changes as compared to 14 days of obstruction. Therefore, effect of PDTC was observed on kidneys of rats obstructed for 18 days. After confirmation of injury PDTC was given intraperitoneally from day 14 to day 18. The rats were then sacrificed to analyze kidney function restoration by biochemical estimation of serum creatinine and urea nitrogen and expression level analysis of the recouped genes.

RESULTS: Top 3 genes retrieved through bioinformatics included NF-kB, TNFÎ ±, TGFÎ2. The expression level of these top three hub genes was found to be elevated in in vivo unilateral ureter obstruction model of CKD through PCR as well as through immunohistochemistry studies. The extent of the damage was more pronounced on 18th day post-ureter obstruction as compared to day 14th. These observations are corroborated by the fact that BUN and creatinine levels remained unaltered after 14 days of ligation. The increased creatinine on day 18th does reflect changes in the kidney architecture. Chemical inhibition of NFkB by PDTC simultaneously lowered the expression levels of TNFÎ ±, TGFÎ2 mRNA as well as level of serum creatinine leading to restoration of renal function from ureter obstruction induced CKD. To further strengthen the validity of our results, immunofluorescence studies of renal tissue also showed a decline in the levels of TNFÎ ±, and TGFÎ2 proteins after treatment of PDTC.

CONCLUSIONS: The study explored the therapeutic approach of PDTC, inhibitor of NF-kB, with the potential to provide pronounced increase in renal function and showing decreased serum creatinine levels and therefore can be used as an attractive approach to improve treatment efficacy.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 7: CLINICAL PROFILE AND OUTCOMES OF PATIENTS WITH PRIMARY MEMBRANOUS NEPHROPATHY RESISTANT TO MODIFIED PONTICELLI REGIMEN

Guhan Senthilkumaran 1, Shivakumar Dakshinamoorthy 1, P Shankar 1, Vaishanavi Devi Rajarathinam 1, Jibia VS 1, Prem Kumar Devaraju 1, Vinoj Murugesan 1, Chelvamalai Muthukumaran BA 1, Natarajan Gopalakrishnan 1

BACKGROUND: Membranous nephropathy is a common cause of nephrotic syndrome. Patients who remain nephrotic typically progress to advanced kidney disease or kidney failure. Despite the use of the modified Ponticelli regimen, close to one-quarter of patients fail to attain complete remission. Data is limited with regard to the outcomes of these patients.

AIM OF THE STUDY: To study the clinical profile and outcomes of patients with primary membranous nephropathy resistant to modified Ponticelli regimen

METHODS: This was an ambispective observational study conducted in Madras Medical College Chennai India between April 2021 and August 2022. All patients with biopsy-proven membranous nephropathy resistant to modified Ponticelli regimen were included in the study. Resistance to therapy was defined as the failure to attain at least partial remission 12 months after completion of modified Ponticelli regimen. Complete remission was defined as proteinuria < 0.5 g/day combined with a stable eGFR. Partial remission was defined as reduction of proteinuria by 50% to < 3.5 g/day but >0.5 g/day. Wherever feasible MPLA2R titers were estimated by qualitative or quantitative assays.

RESULTS: A total of eleven patients were enrolled in the study. The median age was 41 years (IQR 38-50) with a male preponderance (n = 7; 60%). Serum MPLA2R titers were positive for 8 patients. All patients received modified Ponticelli regimen and had no response at 12 months. • Three patients had a trend toward normalization of serum albumin and immunological remission, and so were managed only with optimized RAS inhibition. At last follow-up they had all achieved partial remission. • Three patients were treated with a second course of modified Ponticelli regimen; of them one patient achieved partial remission and two progressed to ESRD. • Five patients were initiated on calcineurin inhibitors (CNI). There was no clinical response in any of the patients after 12 months, and all cases had persistent nephrotic-range proteinuria and CNIs were tapered. One patient was then given a second session of modified Ponticelli regimen and went on to attain complete remission. The remaining four patients were given Inj. Rituximab - two attained complete remission and two attained partial remission. Thrombotic complications were noted in two patients during the course of therapy. One developed NSTEMI, and one developed renal vein thrombosis.

CONCLUSIONS: Current clinical practice in managing patients with primary membranous nephropathy who are resistant to the modified Ponticelli regimen, is heterogenous and individualized, and patient outcomes are also variable. Furthermore, these patients are a high risk of thrombotic complications because of the prolonged nephrotic state. Limitations: 1. Clinical response from modified Ponticelli regimen is known to occur for up to 40 months. Thus, the possibility of a “legacy effect†cannot be excluded when considering clinical responses to other therapies that were initiated subsequently. 2. The number of doses of rituximab, the strength of each dose, and the CNI trough level targets were decided on a case-to-case basis.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 8: RANDOMISED CONTROL TRIAL (RCT) TO STUDY THE EFFECT OF HAND BALL EXERCISE ON AVF (ARTERIO VENOUS FISTULA) MATURATION IN END STAGE KIDNEY DISEASE PATIENTS

Vipul Gupta 1, Himansu Sekhar Mahapatra 1

BACKGROUND: Evidence on the effect of isometric hand ball exercise on AVF maturation is scarce. This RCT was planned to study the effect of hand ball exercise on AVF maturation.

AIM OF THE STUDY: To study the effect of hand ball exercise on AVF maturation.

METHODS: A total of 104 incidental CKD5 patients of age 18 to 60 years requiring immediate dialysis and opted for Hemodialysis (HD) were randomized into hand ball exercise (Group 1) and no hand ball exercise (Group 2). Bilateral central vein catheterization complete occlusion of central vein and vascular gangrene were excluded. Group 1 patients were performed a soft ball exercise and group 2 as a control. All group 1 patients did the exercise with a soft ball which was squeezed 10 times as 1 set. Three such sets of squeezes each at a 1-minute rest interval during twice in the morning and afternoon were performed by them during 2 weeks prior and post-surgery till 6 weeks period. Pre-surgery vascular mapping of the vessels followed by side to side artery-vein anastomosis was done. Follow-up of the AVF was done with clinical and ultrasound Doppler assessment in both the groups at 2, 4, 6, and 12 weeks. AVF maturation was defined radiologically as a combination of blood flow of 500 mL/min and diameter 5 mm or more and clinically as ability to use fistula with 2 needles for 3 consecutive dialysis sessions. Else it was defined as non-mature. All the data between mature and non-mature were analyzed by using student’s t-test and chi-square test.

RESULTS: Of 104 patients, group 1 comprised 51 (49%) and group 2 as 53 (51%). Males were 90 (86.5%). In group 1, 37 (72.5%) AVF matured in group 2, 42 (79.2%) of AVF matured (p = 0.424). Mean age (in years) of patients in AVF mature group was 37.85Â ± 13.25 vs. 45.19Â ± 9.01 in non-mature group (p = 0.01). Mean blood flow (ml/min) in the AVF mature group was 885.98Â ± 316.03 vs. 457.57Â ± 167.17 in the non-mature group (p = 0.01). Body of fistula diameter (cm) in AVF mature group was 0.58Â ± 0.53 vs. 0.44Â ± 0.32 in the non-mature group (p = 0.01). None of the other parameters including basic disease, comorbidities including HTN, DM, Mean BP, or biochemical parameters including hemoglobin, serum creatinine, iPTH, and phosphorous had shown any statistically significant distribution in between two groups.

CONCLUSIONS: Isometric hand ball exercise during pre- and post-vascular AVF creation has no impact on AVF maturation.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 9: CLINICAL PROFILE AND OUTCOMES OF EXERTIONAL RHABDOMYOLYSIS RELATED ACUTE KIDNEY INJURY IN A TERTIARY CARE CENTRE

Srikanth K 1, Vineet Behera 1, Prabhat Chauhan 1, R Ananthakrishnan 1

BACKGROUND: Exertional rhabdomyolysis is a potentially serious condition characterized by muscle breakdown leading to muscle pain acute kidney and liver injury and various other complications. Most data is anecdotal, and there is no major data in this regard.

AIM OF THE STUDY: Clinical Profile and Outcomes of Exertional Rhabdomyolysis related Acute Kidney Injury in a Tertiary Care Centre

METHODS: A retrospective observational study was conducted from June 2019 to June 2022 in a tertiary care hospital in Western India. All patients of exertional rhabdomyolysis reporting to the OPD/IPD and having acute kidney injury (AKI) (based on AKIN criteria) were included. The patients without any history of exertion and triggered by other causes were excluded. Details of demography mode of exertion clinical presentation course of illness laboratory abnormalities treatment received and outcomes were recorded. IEC approval and consent was obtained

RESULTS: Sixteen cases of exertional rhabdomyolysis were included of which 14 (87.55) were males with mean age of 23.4 ± 3.2 years, and 10 (62.5%) had unaccustomed exertion with prolonged running 7 (43.7%) being the most common. Muscle pain with body ache was present in all (100%) followed by dark urine in 8 (50%), fever in 7 (43.7%), swelling feet in 7 (43.7%), oliguria/anuria in 6 (37.5%) individuals. The mean maximum levels of creatinine were 5.4 ± 2.2 mg/dL, SGOT/SGPT were 810 ± 112.2 / 755.4 ± 98.2 IU/L, LDH was 1224 ± 312.2, CPK was 800 ± 92.2; hyperkalemia was present in 7 (43.7%), and urine for myoglobinuria or hemosiderinuria was present in 12 (75%) cases. Eight (50%) patients were dialysis requiring with mean dialysis required being 3.8 ± 1.9 (range 1—11). Renal biopsy was done in 5 (31.2%) showing severe ATN in all, pigment nephropathy in 3 (18.7%). No mortality was seen. AKI recovered in all, while 1 (6.25) developed CKD

CONCLUSIONS: Exertional rhabdomyolysis with AKI is a serious condition with dialysis requirement in 50% cases. An early diagnosis and aggressive treatment has good outcomes with complete recovery in 93%

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 10: ABO-INCOMPATIBLE VS COMPATIBLE KIDNEY TRANSPLANTATION AS A SECOND TRANSPLANT: A SINGLE CENTRE RETROSPECTIVE COHORT STUDY

J Meyyappan 1, A Kaul 1, M R Behera 1, DS Bhadauria 1, MR Patel 1, R S Kushwaha 1, M Yachha 1, N Prasad 1

BACKGROUND: Second renal transplantation is associated with reduced mortality rates compared to remaining on dialysis after an initial graft loss. Effective desensitization protocols have enabled us to overcome the ABO barrier in renal transplantation. However, there are no reports comparing ABO-incompatible and compatible kidney transplantation as a second transplant.

AIM OF THE STUDY: To study the patient and graft survival associated with ABO incompatible 2nd Transplant and compare it with outcomes of ABO compatible 2nd Transplant

METHODS: We conducted a retrospective cohort study of the second renal transplant procedures undertaken at our institute between 2000 and 2019. Patients were divided into two groups. ABO compatible and ABO incompatible second transplant groups. Those who have completed minimum 3-year follow-up were included for this analysis. Primary outcomes were 1- and 3-year graft survival. Secondary outcomes include 3-year patient survival BPAR rate at 1-year serious infection rate and CRAI at 1-year post-transplantation. Unpaired Student's t-test/ Mann–Whitney U-test was used for comparative analysis between two groups. Pearson’s chi-square test/ Fisher's exact test was employed to analyze categorical data as appropriate. Kaplan–Meier method was used to calculate patient survival

RESULTS: A total of 56 second transplant recipients were included (11 in ABO incompatible and 45 in ABO compatible group). Mean age at second transplant was 42.8 (ï' ± 9.7), most common native disease was chronic glomerulonephritis (58.9%), most common reason first graft loss was chronic rejection (46.4%), median duration of first graft survival was 91 months (range 0 — 312), and comparable between groups. Spouse was the most common second donor (44.6%) and HLA immunological work up was comparable between groups. However, the maintenance immunosuppression of cyclosporine, MMF, and prednisolone was used in 26.7% of ABOc group and was not used in ABOi group. One-year graft survival was 83.9% (ABOc 86.7% Vs ABOi 72.7%, p 0.259), 3-year graft survival 64.3% (ABOc 62.2% Vs ABOi 72.7%, p 0. 515), 3-year patient survival 76.8% (ABOc 77.8% vs. ABO I 72.7%, p 0.499), BPAR at 1 year 26.8% (ABOc 28.9% vs. 18.2%).

CONCLUSIONS: As an option for second living donor transplantation, ABO incompatible grafts have similar outcomes when compared with ABO compatible grafts. Our study was limited due to disproportionate sample size between groups, retrospective study design, and differential use of immunosuppression regimens. Prospective studies using similar maintenance immunosuppression protocols are needed.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 11: THE EFFECT OF HIGH FLUX DIALYSIS ON CHRONIC KIDNEY DISEASE STAGE VD PATIENTS WITH MODERATE TO SEVERE PULMONARY ARTERY HYPERTENSION

JK Jayaram 1, M Abi Abraham 1, Jithin S Kumar 1, Kartik Ganesh 1, Sunita Simon 1

BACKGROUND: Pulmonary artery hypertension occurs frequently in patients with chronic kidney disease. Prevalence of pulmonary hypertension ranges 18.8%–68.8% in hemodialysis patients. Mortality rate of hemodialysis patients with elevated pulmonary artery pressure is significantly higher than those patients with normal pulmonary artery pressures. Early intervention to reduce pulmonary artery pressure may prevent deterioration to heart failure and death.

AIM OF THE STUDY: 1. To study the effect of high flux dialysis on chronic kidney disease stage 5D patients with moderate to severe of pulmonary hypertension 2. To assess factors contributing to pulmonary hypertension in chronic kidney disease 5D (Anemia LV function PTH Calcium Phosphorus hypertension).

METHODS: Cross-sectional prospective study done in chronic kidney disease patients undergoing hemodialysis in VPS Lakeshore hospital Kochi. Two-dimensional echocardiogram will be performed initially post-HD with digital cardiac ultrasound machine by one expert cardiologist to find mean pulmonary artery pressure and to classify into mild, moderate, or severe pulmonary hypertension. Patients having moderate or severe pulmonary hypertension are randomized into two groups. One group was given thrice weekly high flux dialysis and other group thrice weekly hemodialysis without high flux dialyzer. Follow-up echocardiogram and levels of biochemical parameters will be done at the end of first and second week. Changes in mean pulmonary artery pressure biochemical parameters will be documented. Sample size 22. Study period March 2021 to August 2022

RESULTS: The median age of the study participants was 57 years, and 59% were males. Diabetic nephropathy was the most common cause of renal dysfunction (55%). The median baseline ejection fraction was 60%, and the median pulmonary arterial pressure was 50.5 mm Hg. No significant difference in baseline parameters was observed between groups. Participants who underwent high flux dialysis had significant reduction in pulmonary arterial pressure (p = 0.005) and serum parathormone (p < 0.001). Participants who underwent hemodialysis had significant increase in left ventricular ejection fraction (p = 0.048) and hemoglobin (p = 0.02). No significant difference was observed in the left ventricular ejection fraction (p = 0.3), pulmonary arterial pressure (p = 0.7), hemoglobin (p = 0.2), parathormone (p = 0.7), albumin (p = 0.3), calcium (p = 0.4), & phosphate (p = 0.2) between the groups. No significant difference in change of these parameters from baseline was observed between groups.

CONCLUSIONS: High flux dialysis is effective in reducing the pulmonary artery hypertension in chronic kidney disease patients on dialysis.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 12: CLINICAL AND LABORATORY PROFILE AND GENETIC EVALUATION OF PRIMARY DISTAL RENAL TUBULAR ACIDOSIS IN PATIENTS FROM WESTERN INDIA

Sayali B Thakare 1, Ankita Patil 1, Sreyashi Bose 1, Satarupa Deb 1, Divya Bajpai 1, Tukaram Jamale 1

BACKGROUND: Distal Renal Tubular Acidosis (DRTA) is a rare renal tubulopathy where failure of secretion of hydrogen ions from distal tubule leads to normal anion gap metabolic acidosis hypokalemia hypercalciuria nephrolithiasis growth retardation in children osteoporosis in adults decline in GFR and progression to renal failure in some. Sparse Indian or international data exists for elucidating the behavior of this disease. Research is limited to individual case experiences or few retrospective case series pooled from multiple centers. Most daily management of such cases relies on our intuitive understanding and problem solving guided by available knowledge. Not much is known about the common or unique clinical features laboratory parameters prognosis response to treatment of our Indian patients of distal RTA. This study was designed to examine disease in our population and also to couple it with genetic analysis which hasn’t been systematically performed so far in Indian patients.

AIM OF THE STUDY: 1. To study the etiology presentation and clinical features in patients of Distal RTA on regular outpatient follow-up 2. To study the disease progression and response to standard therapy 3. To study patient outcomes on long-term follow-up 4. To determine prevalence of known causative genetic mutations in the cohort 5. To study genotype-phenotype correlation in inherited disease

METHODS: This study was approved by Institutional Ethics Committee (EC/OA-28/2020). This is an ongoing observational study planned for duration of 4 years. 24 patients with distal RTA following up at the Tubulopathy Clinic of our department have been enrolled in this study at present. The study involves history taking clinical examination scrutiny of records for obtaining pre-decided clinical and laboratory parameters. Genetic analysis is to be performed in patients suspected to have a genetic cause for the disease. Estimated sample size is approximately 50 cases in total.

RESULTS: Mean age of onset of primary genetic distal RTA was 4.2 (0–25) years. Parental consanguinity was present in 7 (29.2%) of cases. Five (20.8%) patients had history of death in siblings during neonatal period or infancy. Most common presenting feature was growth failure in 14/24 (58.3%) patients. Sensorineural hearing loss was present in 6 (25%) patients, intellectual impairment in 3 (12.5%), amelogenesis imperfecta in 2 (8.3%), medullary sponge kidney in 2 (8.3%), and spherocytosis was present in 1 (4.16%) patient. Medullary nephrocalcinosis was present in 18 (75%) of patients. 15 (62.5%) had elevated urine calcium/creatinine ratio and were on hydrochlorothiazide therapy. Alkali requirement ranged from 1.2 to 3.7 meq/kg/day. Pathogenic genetic mutations were detected in 15 (62.5%) patients. SLC4A1 mutations were the commonest in our population and were found in 6 (25%) of total patients, followed by ATP6V1B1-3 (12.5%), ATP6V0A4-2 (8.3%), WDR72-3 (12.5%), and FOXI1-1 (4.16%). Sensorineural hearing loss was present in both ATP6 mutations. Amelogenesis imperfecta was observed in WDR72 mutations.

CONCLUSIONS: Distal RTA, though an uncommon disease, is one of the most common tubulopathies observed in clinical nephrology practice. High occurrence of consanguinity was observed in our cohort. Also, severe presentation in form of neonatal or infantile deaths was noted in our study. Younger age at presentation indicates the need to catch them young and start early therapy. Genetic analysis showed SLC4A1 mutations to be the commonest in our population. Also, specific genotype phenotype correlation of sensorineural hearing loss and ATP6 mutations and amelogenesis imperfecta with WDR72 mutations were observed. Continuing research on course of disease through this study will highlight further aspects of disease behavior in our cohort.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 13: ASSOCIATION OF CYTOTOXIC T CELL PROFILES AND PHOSPHOSMAD-3 SIGNALING IN INFLAMMATORY INTERSTITIAL FIBROSIS AND TUBULAR ATROPHY IN RENAL TRANSPLANT RECIPIENTS

Brijesh Yadav 1, Narayan Prasad 1, Vinita Agrawal 1, Manoj Jain 1, Vikas Agarwal 1

BACKGROUND: Inflammatory interstitial fibrosis and tubular atrophy (i-IF/TA) is a prominent histological lesion reported in late biopsy and poorly associated with graft survival. Cytotoxic T-cell secretes Granzyme-B which cleaves cytoskeleton protein activates IL-1Î2 TGF-Î2 leading to inflammation and apoptosis in target cell. The role of cytotoxic T cell (CTLc) profiles and fibrosis pathway in i-IF/TA has been not explored in depth.

AIM OF THE STUDY: To determine the circulating and intragraft CTLc profiles and phosphoSMAD-3 signaling pathway in renal transplant recipients (RTRs) with i-IFTA.

METHODS: The CTLc profiles frequency by flow cytometry; serum, and PBMCs culture supernatants Granzyme-B and proinflammatory TGF-Î2 IL-1Î2 level by the ELISA Intragraft Granzyme-B mRNA transcript expression by the RT-PCR and Granzyme-B+ pSMAD-3+ Cell was analyzed by the immunohistochemistry techniques. Independent t-test for continuous variables and Pearson correlation were applied for the different variables.

RESULTS: The circulating frequency of cytotoxic T-cell (CD3+CD8+Granzyme-B+) in SGF vs i-IF/TA was (27.96Â ± 4.86 vs 23.19Â ± 3.85%, p = 0.011), CD3+T cell was (66.08Â ± 6.8 vs 65.18Â ± 9.35%; p = 0.68), CD3+CD8+T cell was (37.29Â ± 4.11 vs 34.68Â ± 5.43%; p = 0.28). Serum Granzyme-B level was in SGF vs IF/TA was (100.82Â ± 22.41 vs 130.32Â ± 46.60, p = 0.038 pg/ml), serum TGF-Î2 level was (367.50Â ± 31.50 vs 318.81Â ± 48.39, p = 0.005), and IL-1Î2 level was (49.14Â ± 17.03 vs 63.69Â ± 23.13, p = 0.076). Intragraft Granzyme-B mRNA transcript expression in SGF vs i-IF/TA was (1.01Â ± 0.048 vs 2.10Â ± 1.02-fold, p < 0.001). Granzyme-B+ cell/mm2 count was (0.40Â ± 0.69 vs 2.20Â ± 1.27; p = 0.001). The intragraft phosphorylated SMAD-3+ cell was (3.70Â ± 1.82 vs 6.73Â ± 3.21; p = 0.008). The intragraft Granzyme-B+ cell count was positively correlated with pSMAD-3+ cell (r = 0.315, p = 0.047). The frequency of circulating CTLc was negatively correlated with urine proteinuria (r = -0.51, p < 0.001), serum creatinine (r = -0.28, P = 0.007), and eGFR (r = -0.28, p = 0.037). While urine proteinuria was positively correlated with serum Granzyme-B level (r = 0.343, p = 0.001), intragraft Granzyme-B mRNA transcript expression (r = 0.38, p < 0.001).

CONCLUSIONS: Circulating and intragraft Granzyme-B+ Cytotoxic T-cell profiles mediates phosphoSMAD-3-dependent i-IF/TA in RTRs.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 14: A SINGLE-CENTER PROSPECTIVE RANDOMIZED PARALLEL GROUP STUDY ON ROLE OF SODIUM BICARBONATE THERAPY IN RETARDING CHRONIC KIDNEY DISEASE PROGRESSION

Rajarshi Datta 1, Arpita Roychoudhury 1

BACKGROUND: Metabolic acidosis is a common complication in patients with chronic kidney disease. It may bring about a variety of sequelae such as stunted growth in children negative nitrogen balance loss of bone and muscle mass and possible acceleration of progression of CKD. The lack of long-term studies in India examining the impact of alleviation of metabolic acidosis on renal function in pre-dialysis patients and on nutritional status was the particular stimulus to perform this study.

AIM OF THE STUDY: To assess the efficacy and safety of oral sodium bicarbonate supplementation in retarding the progression of CKD and impact on nutritional status in pre-dialysis patients.

METHODS: In this single-center prospective randomized double-blinded parallel group study from April 2020 through October 2021 at IPGME&R Kolkata 100 Participants with eGFR (calculated from CKD-EPI 2009) of 15 to 59 ml/min per 1.73 m2 were randomly assigned to receive either oral sodium bicarbonate tablets 500 mg twice daily increased as necessary to achieve and maintain HCO3âˆ' level ≥23 mmol/L in the treatment group or placebo. Both groups received identical standard treatment and monitoring for their CKD. The primary end points were the rate of eGFR decline in 2 groups and proportion of patients with rapid decline of eGFR (>5 ml/min per 1.73 m2/year). The secondary end points were the proportion of patients with adverse effects (death worsening hypertension worsening edema/heart failure) and changes in nutritional status (normalized protein nitrogen appearance serum albumin and mid-arm muscle circumference).

RESULTS: Compared with placebo, decline in eGFR was slower with bicarbonate supplementation [decline of 6.74 ml/min per 1.73 m2 (95% confidence interval [CI]4.19 to 7.76 ml/min per 1.73 m2) in the placebo group compared with decline of 2.16 ml/min per 1.73 m2 (95% CI _0.39 to 4.15 ml/min per 1.73 m2) in the treatment group; P < 0.0001] Patients supplemented with bicarbonate were significantly less likely to experience rapid progression (14% and 60% of patients underwent rapid progression of their CKD (eGFR decline of >5 ml/min per 1.73 m2/year) in the bicarbonate and control groups, respectively (relative risk [RR] 0.15;95% CI 0.06 to 0.40; P < 0.0001). Sodium bicarbonate supplementation was also associated with a trend toward better nutritional status, with significant differences between change in albumin levels (4.1Â ± 0.17 g/dl to 4.2Â ± 0.87 g/dl in cases vs 4.16Â ± 0.12 to 4.06Â ± 0.18 g/dl in controls; P < 0.05), although not statistically significant with respect to lean body mass (mid arm muscle circumference) and protein catabolism (normalized protein nitrogen appearance). Incidentally, a significant decline was observed in serum potassium levels in the bicarbonate group compared with placebo. There was no difference in worsening hypertension [(18.0%) vs (20.0%) (p = 0.7987).] or worsening edema [(26.0%) vs (28.0%) (p = 0.8217)] as assessed clinically at every clinic consultation.

CONCLUSIONS: Oral bicarbonate supplementation resulted in decrease in rate of eGFR decline and increase in serum albumin level among patients with CKD. It also has a possible role in correcting hyperkalemia. There was no increase in adverse events.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 15: DOES GENETIC POLYMORPHISM & SERUM LEVELS OF TOLL-LIKE RECEPTORS (TLR-2 AND TLR-4) INFLUENCE CYTOMEGALOVIRUS (CMV) INFECTION IN RENAL TRANSPLANT RECIPIENTS (RTR)?

Arshi Rizwan 1, Sandeep Mahajan 1

BACKGROUND: CMV infection is important cause of morbidity mortality & limited graft survival in RTRs. TLR-2 & TLR-4 play important role in innate immune & antiviral response. Reduced TLR expression & polymorphisms are associated with blunted immunological response & higher infections. Identifying this population at higher risk of infections can help in individualizing immunosuppressive therapy

AIM OF THE STUDY: We looked at TLR polymorphism and serum levels of TLRs in RTR with & without CMV infection

METHODS: 85 RTRs (35 with CMV & 50 without CMV infection) & 50 healthy controls were studied. All RTRs were on tacrolimus MMF & steroids. Patients on ganciclovir rATG induction recent infection & anti-rejection therapy were excluded. Diagnosis of CMV infection was done by blood quantitative CMV DNA PCR testing (>500 copies/ml) at 45 days 3, 6, 9, & 12 months post-RT and/or as per clinical need. Allele-specific polymorphisms were studied on extracted DNA samples by using PCR-based genotyping assay, and serum levels of TLR-2 & TLR-4 were determined by using commercially available ELISA kits

RESULTS: Mean age & gender distribution were similar in three groups. CMV infection was symptomatic in 23 (60%) patients & all presented with history of fever & diarrhea. RTRs having CMV infection had lower serum TLR2 and TLR4 values as compared to other groups. While RTRs without CMV infection only had lower TLR4 levels as compared to controls. None of studied subject showed polymorphism in studied genes.

CONCLUSIONS: RTRs with CMV disease had lower serum TLR-2 & TLR-4 levels as compared to RTRs without CMV infection & healthy controls. However, we did not document any polymorphism in studied genes

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 16: SARCOIDOSIS: PATTERN OF RENAL INVOLVEMENT AND OUTCOMES

Harshita Sharma 1, Narayan Prasad 1, Anupma Kaul 1, D S Bhadauria 1, M R Patel 1, Monika Yachha 1, M R Behera 1, Ravi S Kushwaha 1

BACKGROUND: Renal manifestations of sarcoidosis are rare, and data on its long-term outcome are scarce. This study investigates the pattern of renal involvement in sarcoidosis, its clinical course, and response to treatment in the long-term.

AIM OF THE STUDY: This study investigates the pattern of renal involvement in sarcoidosis, its clinical course, and response to treatment in the long-term.

METHODS: The study was designed as an observational study of electronically captured data on hospital information system of sarcoidosis patients with renal failure between January 2015 to December 2021

RESULTS: Between January 2015 and December 2021, 40 patients with sarcoidosis were analyzed. All patients presented with renal failure. Most common symptoms were fever (73.8%), vomiting (70.9%), and weight loss (65.4%). 28 patients (70%) had granulomatous interstitial nephritis (GIN) and 19 patients (47.5%) had hypercalcemia. Six patients (15%) had concomitant glomerular disease: IgA nephropathy (5%), membranous and focal proliferative glomerulonephritis (5%) and diffuse glomerular sclerosis (5%). All patients initially received oral prednisolone 1 mg/kg/day (30%) or 0.5 mg/kg/day (70%), respectively, with subsequent tapering or suspension. 3 patients (7.5%) were started on mycophenolate mofetyl after 2 months to spare steroids and for severe extra renal manifestations. After a mean follow-up of 39 ± 7.3 months mean estimated glomerular filtration rate (eGFR) had improved from 19 ± 7 at presentation to 49 ± 16 mL/min. Out of eight patients (20%) who required dialysis, 5 patients (12.5%) became dialysis independent and 3 patients (7.5%) succumbed to the disease.

CONCLUSIONS: GIN was the most common diagnosis in sarcoidosis patients with renal failure. Hypercalcemia as an initial presentation was observed in the majority. Early steroid treatment leads to sustained renal function improvement.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 17: A STUDY OF OUTCOMES OF PARAQUAT POISONING WITH AKI - FROM A TERTIARY CARE REFERRAL HOSPITAL SOUTH INDIA

Harshavardhan Guptha 1, Manjusha Yadla 1

BACKGROUND: Paraquat a rapidly acting herbicide is commonly used pesticide in developing countries as it is cheap. It is a leading cause of fatal poisoning when ingested. Paraquat poisoning causes multi-organ failure over a period of hours to days such as acute kidney injury (AKI) metabolic acidosis acute respiratory distress syndrome and acute liver injury. Upon ingestion, paraquat is absorbed quickly although not completely and is mostly excreted in the urine without further metabolism within 12—24 hours. The mechanism whereby paraquat causes AKI is not fully understood; however, it is known that this compound can accrue within renal tubular cells leading to cycles of reduction and oxidation generating reactive oxygen species and ultimately damaging the proximal tubules. As the kidney is the main organ responsible for paraquat excretion, the resultant kidney injury may reduce the elimination of paraquat and increase its toxicity in other organs. In this study, we investigated the clinical features AKI spectrum and outcomes in patients with deliberate paraquat intoxication, and most importantly, we evaluated the predictors of AKI after paraquat intoxication and treatment outcome of different modes of RRT (peritoneal dialysis hemodialysis CRRT)

AIM OF THE STUDY: 1. To study the outcome of patients with acute kidney injury following Paraquat poisoning. 2. To assess the outcomes of treatment following different modes of RRT (peritoneal dialysis hemodialysis CRRT) in patients with AKI (Acute Kidney Injury).

METHODS: Patients and methods: Study design: retrospective observational study. Setting: Tertiary care government teaching hospital. Study period: January 2019 to august 2022. Inclusion criteria: All paraquat poison ingestion with AKI Method; all patients who consumed paraquat poison referred to department of Nephrology were included in the study. Patient was treated with a standard detoxification protocol pulse therapies with methylprednisolone and cyclophosphamide and extended treatment with dexamethasone. Patient who had AKI was treated with hemodialysis patient with multiorgan dysfunction was treated with CRRT patient who presented with in 24 h of consumption was treated with Charcoal hemoperfusion.

RESULTS: Out of 100 patients included in the study, males were 74 and females were 26. Mean age among males was 25.71 Â ± 6.45 yrs and among females was 22.56Â ± 7.1 yrs. Suicidal in 91 patients, accidental in 7 (11%) and homicidal in 1 (2%). Among clinical symptoms and signs, vomiting was seen in 52, dysphagia seen in 17, abdominal pain in 14, breathlessness in 31, and oral ulcers accounted for 32 patients. Other features seen were icterus in 20, altered sensorium in two patients, and malena in one patient. Oliguria as a presenting complaint was seen in 17 patients as the main presenting symptom. Oliguric AKI was present among 58 patients, non-oliguria in 25 patients, and anuria in 17 patients. Average duration of hospital stay was 8.25 + 5.54 days. Mean serum creatinine at admission was 7.39 Â ± 2.07 mg/dl. Out of the 100 patients, 53 required ventilator. Among the patients, 75 underwent HD, 8 patients were managed on PD, and 14 (6.67%) patients were managed with CRRT. Patients who consumed 30 ml +/- 10.2 of paraquat had higher mortality compared to patients who consumed 10 ml +/- 5.6 ml of poison latency of referral 6.32+/-1.72 days had higher mortality compared to patents who presented soon. Mean serum creatinine 7.30+/-3.2 mg/dl had higher mortality. patients who presented with oliguria had better survival compared patients who presented with anuria MODS was significant contributor of mortality factors influencing mortality ARDS Acute hepatitis Anuric patients with high creatinine levels Patients requiring ventilator support MODS Large amount of poison consumption Late presentation to the hospital

CONCLUSIONS: Paraquat poisoning accounts for 6.26% of AKI cases in our hospital. AKI Is present in 81.3% of our paraquat patients. Non-oliguria and early presentation to the hospital were associated with renal recovery. More quantity of consumption, latency in coming to hospital, development of MODS were associated with mortality.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 18: A NOVEL CLUSTER OF CVAGD (COVID-19 VACCINE-ASSOCIATED GLOMERULAR DISEASE) — SEMIURBAN STUDY

Radha Vijayaraghavan 1, PK Senthil Kumar 1, Kannan Bhaba 1, V Ramasubramnaian 1

BACKGROUND: Vaccination against COVID-19 has to a great extent contributed to the easing of COVID-19 pandemic. Immune responses to vaccination are a known trigger for new onset of glomerular disease in susceptible individuals. Although it is not possible to conclusively determine the causal relation between vaccination and glomerular diseases, the temporal sequence of events and clinico-pathologic presentation strongly support the hypothesis of vaccine induced immune response. Development of de novo glomerular diseases following COVID-19 vaccination has been reported, and the term COVID-19 Vaccine-Associated Glomerular Disease (CVAGD) has been suggested. Most studies have shown Minimal Change Disease and IgA Nephropathy to be the common glomerular diseases. In this study, we report a different set of glomerular diseases associated with COVID-19 vaccine in this suburban tertiary care center

AIM OF THE STUDY: To study the clinicopathologic profile of new onset biopsy-proven glomerular disease within two weeks of receiving COVID-19 vaccine

METHODS: This study is a cross-sectional observational analytic study during the period November 2021 to April 2022 at the department of Nephrology Tirunelveli Medical College Hospital. Patients who presented with symptoms and signs of new onset glomerular disease within two weeks of COVID vaccination were studied. After getting informed consent, detailed history taking clinical examination relevant urine and blood investigations was done. Relevant serologic tests like ANA ANCA Anti GBM antibodies were done if indicated. Patients underwent ultrasound guided renal biopsy with biopsy gun and samples sent for light microscopy and immunofluorescence. The biopsy was reported by an expert renal pathologist. Data was collected, and statistical analysis done.

RESULTS: Total number of biopsy-proven de novo glomerular diseases during the study period in this institution was 74. Five patients developed symptoms and signs of glomerular disease within two weeks of covid vaccination and underwent renal biopsy. None of these patients had known prior COVID-19 infection. Three patients had received ChAdOX1-nCOV vaccine, one BBV152, and the other patient BECOV2D vaccine. All patients were females. Two patients developed symptoms after second dose, while three patients developed symptoms after first dose. Syndromic presentation was rapidly progressive glomerulonephritis in two subjects, nephrotic syndrome in two, and nephritic syndrome in one. Three patients were diagnosed as lupus nephritis, one PLA2R negative membranous nephropathy, and one ANCA-associated vasculitis. Two of the three patients with lupus nephritis presented only with renal symptoms, while the other patient presented with predominant renal along with mucocutaneous symptoms. Two patients showed a histologic picture of crescentic glomerulonephritis. All patients have shown good response to appropriate treatment. The commonest cause of CAVGD reported in India and other countries have been IgAN and MCD. Our study population was different in that lupus nephritis was the commonest cause. Though a few cases of new onset SLE after COVID vaccination have been reported, these patients presented with predominant systemic symptoms and signs with no significant renal involvement

CONCLUSIONS: We have described a novel cluster of CVAGD in this semiurban tertiary center. Though the benefits of vaccination are undoubtable, side effects also need to be factored. Recognition of CVAGD and prompt management is rewarding.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 19: A NOVEL POINT OF CARE AND SELF-HEALTH MONITORING URINE (MICRO) ALBUMIN TESTING PLATFORM PROFLO-U®

Aseem Mishra 1, Shivam Mishra 1, Neel Ratan Guria 1, Debapriya Bandopadhyay 1

BACKGROUND: Chronic kidney disease (CKD) is a leading cause of mortality and morbidity around the world. According to the Global burden of disease study 2017 prevalence of CKD has increased 29·3% (95% UI 26·4 to 32·6) across the age since 1990. 35·8 million (95% UI 33·7 to 38·0) Disability Adjusted Life Years has been accounted for CKD in 2017 where the diabetic nephropathy accounting for almost a third of DALYs. Kidney disease has a major effect on global health both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable provided detected in the early phase. As CKD progress asymptomatically without manifestation of clinical symptoms in certain cases up till 70% damage of the kidney. Thus, early detection by regular screening will be very effective to deterrent it to reach the projected the 5th most common cause of years of life lost globally by 2040. Urine albumin is a reliable and established non-invasive biomarker for the detection and monitoring of CKD. The reference standard for measuring albumin in urine is testing sample from 24 h urine collection however more convenient method used in routine practice involve urinary dipsticks or measurement of the albumin or total protein concentration in a spot urine sample. At the point of care dipsticks have been used for more than 50 years to measure renal albumin loss. These reagent strip devices primarily detect albumin by a colorimetric reaction with the dipstick-impregnated reagent based on the albumin concentration within the sample. Using dipsticks for detecting glomerular albuminuria has two major limitations. First most reagent strips are poor at detecting low grade but clinically relevant urinary albumin loss of 30—300 mg per day. Second tests are often falsely positive in situations of concentrated or highly alkaline urine after use of iodinated contrast agents or in case of gross hematuria. The alternative reliable and sensitive test is immunological method based that require centralized lab facility cold chain logistics and expensive. To address this issue, there has been considerable effort to develop compact and field-portable sensitive diagnostics tools that can measure < 300 mg/L albumin concentration in urine samples. In the high-risk CKD group like diabetes and hypertension patients frequent and routine monitoring through urine albumin testing is recommended. However, the inconvenience of testing at centralized laboratory or avoiding exposure or inaccessibility during situation like COIVD pandemic the self-monitoring device can be very helpful. This can improve the patient compliance significantly as has been evidenced with glucometer.

AIM OF THE STUDY: To establish a novel point of care and self-health monitoring urine albumin testing platform Proflo-U® comprising of a mini-analyzer fluorescence dye based micro-albumin test cartridge and an android app as an alternative to present method of lab-based micro-albumin analysis.

METHODS: 1. Testing process of albumin on Proflo-U® platform. 170 ul sample should be added to the Testing cartridge tube 1 and mixed properly. Empty tube 1 by pouring the solution into Testing cartridge tube 2. Wait for 2 minutes for the sample to filter down into the lower chamber filling up 80% of the chamber volume or > 11 mm height from the base. Switch on the mini-analyzer from the power button and connect with the android app through Bluetooth connection. Select the program for albumin reading on the app and press the button read to get the relative fluorescence unit or concentration in mg/L. The app averages all input data points to give the reliable readout in 25 seconds. 2. Determination of range of detection of Proflo-U® platform. Human Recombinant Serum Albumin (Himedia® Cat No. CF001-1G Lot No. 0000451232) stock of 10 mg/ml has been used to prepare the solution in 1X Phosphate Buffer Saline {137 mM NaCl (Sigma Aldrich Cat No. S7653-250G Lot No. SLBV9983), 10 mM KH2PO4 (Merck Emplura® Cat No. 1.93605.5021 Lot No. DH0D701207), 1.8 mM Na2HPO4 (Merck Emprove® Essential Cat No. 1.06585.1000 Lot No. K51666285026)} pH7.4. Different concentrations of HSA working solution of volume 1 ml have been prepared in PBS. HSA concentration used in the experiment 0 ug/ml, 20 ug/ml, 40 ug/ml, 60 ug/ml, 80 ug/ml, 100 ug/ml, 150 ug/ml, 200 ug/ml, 250 ug/ml, 300 ug/ml, 400 ug/ml, 600 ug/ml, 800 ug/ml, 1000 ug/ml, and 1200 ug/ml. To generate standard curve, three test cartridges for each concentration have been used. 170 ul of the working stock of HSA has been added to the cartridge tube C1 to perform the assay as described in 2.1.2. The RFU values obtained for each concentration have been plotted and a linear equation derived using Microsoft Excel. 3. Determination of LoB LoD and LoQ of the Proflo-U® platform. 3.1. To determine limit of blank (LoB) for the platform a matrix of 3 X 5 has been created, where cartridges from three different batches of production have been taken and the other is the number of test performed using cartridges from each batch. Therefore, a total number of data points n = 15 have been used. The 1X PBS solution has been used as the sample. The readout has been taken as concentration derived on the basis of the equation obtained with the standard curve generated. The limit of blank has been calculated with the following equation: - LoB = Mean of Blank + 1.645X Standard Deviation of Blank 3.2. To determine limit of detection (LoD) for the platform, a matrix 3 X 5 has been created, where cartridges from three different batches of production have been taken and the other is the number of test performed using cartridges from each batch. Therefore, a total number of data points n = 15 have been used. The 20 ug/ml concentration HSA solution has been used as the sample. The readout has been taken as concentration derived on the basis of the equation obtained with the standard curve generated in 2.3. The limit of detection has been calculated with the following equation ref: - LoD = LoB + 1.645 X Standard Deviation of low concentration sample 3.3. To determine limit of quantification (LoQ), a matrix has been designed with three different concentrations LoD concentration 20 ug/ml more than LoD and 30 ug/ml more than LoD stocks where each concentration was replicated n = 5 times. The mean and standard deviation were calculated for each set and determined the % coefficient of variance. The lowest concentration at which %CV< 10 has been considered as the LoQ. 4. Proflo-U® platform comparison with Beckman Coulter analyzer and microalbumin test kit. The urine spiked samples were tested in Beckman Coulter autoanalyzer using compatible microalbumin test kit according to manufacturer's protocol. The same spiked urine samples were tested on the Proflo-U® platform. The results were plotted and compared with the true value for percentage recovery.

RESULTS: The range of detection of Proflo-U platform is from 4 mg/dL to 100 mg/dL in the use format where the sample is diluted 10 times. The linearity of the curve has been found between 4 mg/dL and 60 mg/dL. The LoB has been found to be 2.05 mg/dL, LoD 3.98 mg/dL, and LoQ 5.0 mg/dL. The correlation of Proflo-U platform has been found to be 98% correlation with 95% confidence.

CONCLUSIONS: Proflo-U platform can be alternative to the lab micro-albumin test at point of care and self-health monitoring setup. Adoption of this new technology can boost the initiative of early diagnosis of kidney damage to stop progression into end-stage kidney disease.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 20: CAPD CATHETER INSERTION BY SURGICAL MINILAPAROTOMY: EVALUATION OF IMPACT OF ANTERIOR RECTUS SHEATH TUNNELING ON COMPLICATIONS AND CATHETER SURVIVAL AT ONE YEAR

P Manu Dogra 1, Ranjith Nair 1, Ashok Hooda 1, Ananthram Jairam 1, Parikshit Chauhan 1, Amit Katyal 1, Vivek Sood 1, Vishal Singh 1

BACKGROUND: Catheter migration is an oft-occurring mechanical complication in CAPD and impacts catheter survival. Incidence is much lower in surgical minilaparotomy but inevitable. We investigated the impact of subfascial tunnel (beneath anterior rectus sheath) creation on preventing catheter migration shortening of break-in period and catheter survival.

AIM OF THE STUDY: To evaluate the impact of anterior rectus sheath tunneling during CAPD catheter insertion by surgical minilaparotomy on complications and catheter survival at one year.

METHODS: This bicentric retrospective analysis compared mechanical complications and catheter survival among surgically inserted peritoneal dialysis catheters (PDC) with either subfascial tunnel creation (‘T’ group) or without it (‘NoT’ group) at two government tertiary care referral hospitals in India.

RESULTS: A total of 364 surgically inserted PDCs were analyzed into two groups: 226 PDCs, ‘T’ group vs. 138 PDCs, ‘NoT’ group. Patients with abdominal surgery scars and previously failed percutaneous insertion were included in both groups. Baseline variables were comparable. ‘T’ group had shorter break-in period (P < 0.0001). T’ group had lesser catheter migration (P = 0.005), pericatheter leak (P = 0.03), and hemorrhagic outflow (0.002). There was no bowel or vessel injury in either group. The overall catheter survival (P = 0.0002), death censored catheter survival (P = 0.003), PDC survival duration (P = 0.002) were better in ‘T’ group. Risk of poor outcome was higher in hemodialysis subgroup of ‘NoT’ cohort (RR = 1.64, P = 0.001), whereas it was non-significant in previous abdominal surgery (P = 0.56) or previously failed percutaneous insertion subgroups (P = 0.62). Peritonitis rates and refractory peritonitis were comparable.

CONCLUSIONS: We conclude that sub-fascial tunneling significantly reduced PDC migration, pericatheter leak, and hemorrhagic outflow and eventually improved the technical and patient survival among surgically inserted CAPD catheters. This technique also prevented further requirement of intervention for PDC repositioning/correction. This simple modification ensured longevity of PDC and better survivals.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 21: A SINGLE CENTER NON-CROSSOVER RANDOMISED TRIAL TO COMPARE RESPONSE TO THREE MODALITIES OF IRON REPLACEMENT FOR IRON DEFICIENCY ANAEMIA IN CHRONIC KIDNEY DISEASE STAGE G3-4

B Viswanadh 1, P Manu Dogra 1, Vivek Sood 1, B Viswanadh 1, Vishal Singh 1

BACKGROUND: Although anemia in CKD is multi-factorial in origin, 60–73% of patients with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 are iron deficient. Clinical practice guidelines recommend that patients with CKD and anemia are treated with oral iron firstly to increase hemoglobin level if transferrin saturation (TSAT) is <30% and serum ferritin level is <500 ng/ml.

AIM OF THE STUDY: A Single-Center, Non-Crossover, Randomized Trial to Compare Response to Three Modalities of Iron Replacement for Iron Deficiency Anemia in Chronic Kidney Disease stage G3-4.

METHODS: This is single-center randomization study to compare change in hemoglobin serum iron serum ferritin and percentage transferrin saturation levels at 12 weeks with alternate day oral iron supplementation and parenteral iron therapy in CKD stage G 3-4. Patients who satisfied inclusion and exclusion criteria and given informed consent for participation in this study were enrolled for the study. At enrollment, patients have entered 2 weeks run-in period to ensure compliance. Thereafter at baseline visit, patients were randomized {allocation ratio 1:1:1} to receive oral iron supplementation with ferrous ascorbate (tablet containing 100 mg elemental iron per tablet) either once daily (100 mg elemental iron OD) — group 1 or alternate day (100 mg of elemental iron twice a day on alternate day) — group 2 or single dose of Inj Ferric carboxy maltose (15 mg/kg body weight) — group 3 for correction of iron deficiency. All subjects received 1.25 mg folic acid daily.

RESULTS: A total of 340 CKD stage G 3-4 patients were evaluated, and 90 patients were enrolled into 3 arms of 30 patients each with 1:1:1 randomization. 4 patients were lost to follow-up. At the end of 12 weeks, group 1 had 27 patients, group 2 had 29 patients, and group 3 had 30 patients for analysis. Prevalence of iron deficiency anemia in patients with stage G 3-4 chronic kidney disease was 26.4%. There was a significant increase in Hb in all groups at 8 weeks (p = 0.049) and at 12 weeks (p = 0.004) from baseline; however, group 2 recorded maximum increase in Hb. Serum iron increased from baseline in all groups, with maximum increase recorded in group 2. Significant increase in iron values was seen at 8 weeks (p = 0.025) and 12 weeks (p = 0.001) from baseline. Serum ferritin increased from baseline in all groups, with maximum increase recorded in group 3. A significant increase in ferritin value was seen at 12 weeks (p = 0.018) as compared to baseline. TSAT increased from baseline in all groups, with maximum increase seen in group 2. However, this increase was not statistically significant (p = 0.308) at 12 weeks as compared to baseline.

CONCLUSIONS: Our study results showed that hemoglobin, iron, and ferritin response were seen positively in all groups. Twice a day on alternate days, iron replacement showed the best increase in hemoglobin and serum iron, whereas ferric carboxymaltose group showed the best response of ferritin levels. Hence, we conclude that oral iron supplementation with ferrous ascorbate given twice a day on alternate days is best for CKD stage G 3-4 with anemia. Alternatively, Inj Ferric carboxymaltose may be used for the same.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 22: HUMORAL IMMUNE RESPONSE TO BBV152 (COVAXIN) SARS-COV2 VACCINE IN PATIENTS ON HAEMODIALYSIS

Radha Vijayaraghavan 1, PK SenthilKumar 1, Kannan Bhaba 1, V Ramasubramanian 1

BACKGROUND: Chronic Kidney Disease (CKD) Stage V patients on hemodialysis are a vulnerable group who have reported high rates of morbidity and mortality with Covid-19 infection. Covid-19 vaccination has been reported to be immunoprotective, and these patients are prioritized for Covid-19 vaccination. It is reported that dialysis patients develop lower seroconversion to vaccines. Indeed, this lower postvaccine response led to the adaptation of hepatitis B and influenza immunization schedules. Data are lacking on the humoral immune response to indigenously manufactured BBV152 (inactive) vaccine. In this study, we estimate the serologic response to BBV152 vaccine in hemodialysis patients in our Nephrology unit

AIM OF THE STUDY: 1. To estimate the humoral immune response (conversion from seronegative to seropositive state) to inactivated SARS CoV2 vaccine administered as per The Government of India protocol in CKD stage V patients on maintenance HD 2. To correlate demographic clinical and biochemical/hematologic parameters with the humoral response

METHODS: This study was a cross-sectional observational study conducted between September 2021 and March 2022 at the Department of Nephrology Tirunelveli Medical College Hospital. Ethics Committee approval was obtained. All CKD V patients on maintenance HD for at least three months who were willing to take BBV152 vaccine were enrolled in the study. Patients suffering from intercurrent illness those who had a prior PCR confirmed diagnosis of Covid-19, and patients who had positive baseline antibody titers were excluded from the study. Sample size was calculated according to the standard sample size calculator for observational study with a qualitative variable which computed a minimum sample size of 82. Detailed history taking clinical examination hematological and biochemical investigations assessment of nutritional status was performed as per structured questionnaire. For each patient, the following parameters were noted: Age, gender, BMI, native kidney disease comorbidities whether on immunosuppressant drugs, Hb absolute lymphocyte count, ESR serum albumin, and adequacy of dialysis by calculating spKt/V. Patients were then administered two doses of COVAXIN. Antibody titers were measured at baseline and four weeks after the first and second dose. Anti-SARS-CoV-2 IgG antibodies were measured using Access 2 Immunoassay System — Beckman Coulter by Chemiluminescence Microparticle Immunoassay which detects neutralizing antibodies against Receptor-Binding Domain of spike protein with a high sensitivity and specificity. The result of antibody titer was reported as nonreactive or reactive based on S/CO (Signal/Cut-Off ratio). S/CO ≤ 0.8 was nonreactive and S/CO ≥ 1 was reactive. Data was collected in MS-Excel, and IBM SPSSv26.0 was used for statistical analysis.

RESULTS: A total of 119 patients were enrolled out of which 107 patients completed the study. 75.7% (81 out of 107) patients achieved seroconversion after two doses of BBV152 which is lesser than seen in healthy controls. The rate of seroconversion was 66.4% after the first dose. Analysis of factors associated with poor seroconversion in this study showed increasing age, presence of diabetes, atherosclerotic cardiovascular disease, severe anemia, higher ESR, and severe hypoalbuminemia (Serum albumin < 2.5 g/dl) to be statistically significant. Patients who had lower BMI and spKt/V >1.2 showed a better seropositivity response in this study. HD vintage and absolute lymphocyte counts were not significantly associated with serologic response. Poor seroconversion is generally associated with immunosuppressant therapy, but this was not seen in our study which could be due to the small number (4 patients) in the study. Unique association of diabetes and severe anaemia with poor seroconversion was noted in this study

CONCLUSIONS: 75.7% patients on maintenance hemodialysis achieved seroconversion after two doses of inactivated SARS CoV2 BBV152 vaccine. Increasing age, presence of diabetes, atherosclerotic cardiovascular disease, anaemia, inadequate hemodialysis, and hypoalbuminemia were associated with a lesser antibody response to the vaccine in this study. Revising future vaccine strategies with an aim at improving immunologic response in patients on hemodialysis with high-risk factors like diabetes mellitus brought out in our study could prove worthwhile.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 23: A PROSPECTIVE STUDY ON SPECTRUM OF RENAL DISEASE IN MALIGNANCY

Gladwin Jeemon 1, G Kartik 1, Jithin S Kumar 1, M Abi Abraham 1

BACKGROUND: Renal disease in patients with cancer constitutes a major source of morbidity and mortality. A variety of renal diseases may be associated with various malignancies. These may be seen in various capacities of cancer care such obstructive uropathies tumor lysis syndrome hypercalcemia complications of sepsis chemotherapeutic agents or radiation. Most common malignancy associated with nephropathy is solid tumors (adenocarcinoma of lung colon stomach rectum). There is lack of published data regarding overall causes and outcomes of kidney disease in malignancy. With the advent of newer therapeutic agents and increased therapeutic options in patients with malignancy, it is important to understand various causes of renal disease in malignancy.

AIM OF THE STUDY: 1. To identify incidence of renal disease in malignancy. 2. To Identify the causes of renal failure and draw comparison between different etiological groups. 3. To estimate mortality rate and hospital stay among different etiological groups

METHODS: Study Design: Cross-Sectional Prospective study Study setting: Oncology ward and ICU in VPS Lakeshore Hospital Kochi. Inclusion criteria: All renal disease associated with malignancy above 18 years of age. Exclusion criteria: Age less than 18 years. Study population: Patient group presented with proven malignancy in oncology department. Study Period: May 1, 2021 to April 30, 2022. Sample size: The minimum sample size required for the present study will be 41.

RESULTS: The mean age of study participants was 62.9 (1.2) years. Among the study participants, 42.9% (n = 30) were females and 57.1% (n = 40) were males. Among the study participants, AKI was observed in 92.9% (n = 65). Only one participant had history of chronic kidney disease. The most prevalent malignancies were breast carcinoma [12.8% (n = 11)], prostatic carcinoma [10% (n = 7)], multiple myeloma [10% (n = 7)], and cholangiocarcinoma [7.1% (n = 5)]. Sepsis [48.6% (n = 34) and obstructive uropathy [27.1% (n = 19)] were the most common cause of AKI in the study participants. The miscellaneous causes for AKI were leptospirosis [1.4% (n = 1)] and osmotic tubulopathy [1.4% (n = 1)]. The peak serum creatinine was observed on the first day in 38.6% (n = 27) and on the 5th day in 14.3% (n = 10) participants. Among participants, 41.4% (n = 29) required dialysis. Significant association was observed between dialysis requirement and sepsis (p = 0.047) as a cause of AKI. Significantly longer duration of ICU stay was observed among participants with Hodgkin’s lymphoma (p = 0.03) and significantly longer duration of hospital stay was observed in participants with lung carcinoma. Among participants those who had renal failure 52.9% completely recovered, 28.6% of participants expired, 5.7% participants become dialysis dependent, 12.8% of participants renal function was not came back to normal but stabilized at slighter higher value.

CONCLUSIONS: Renal failure is seen commonly in malignancy. Most common cause of renal failure in our study was sepsis. A lower requirement of dialysis in participants without sepsis was observed. As sepsis remains a significant contributor of AKI, reduction in sepsis would reduce the need for dialysis requirement. Renal failure in malignancy has reasonable good outcome, depending upon the staging of the disease, the comorbidities, the stage of chemotherapy.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 24: CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: A SINGLE CENTRE EXPERIENCE

Vinoj Murugesan 1, Shivakumar Dakshinamoorthy 1, R Padmaraj 1, Guhan Senthilkumaran 1, Vaishanavi Devi Rajarathinam 1, BA Chelvamalai Muthukumaran 1, Premkumar Devaraju 1, VS Jibia 1, Natarajan Gopalakrishnan 1, Venkatesh Arumugam 1

BACKGROUND: Continuous ambulatory peritoneal dialysis is currently used as a modality of renal replacement therapy by approximately 11% of the global dialysis population. In developing countries, CAPD has several advantages over hemodialysis it being a simple home-based procedure requires less trained medical staff and requires minimal technical support yet the penetrance rate of CAPD is dismally low. Hence, we intend to study the feasibility advantages and hurdles faced in implementation of the CAPD program in our population.

AIM OF THE STUDY: To Study the Clinical Characteristics and Outcomes of patients on Continuous Ambulatory Peritoneal Dialysis at our center.

METHODS: This was an ambispective study conducted at the Institute of Nephrology Madras Medical College. Patients who were on continuous ambulatory peritoneal dialysis follow-up between January 2018 and August 2022 were included. Their clinical characteristics procedural details laboratory parameters and peritonitis data were collected and analyzed.

RESULTS: Eighty-nine patients were included in the study. The median age was 43 years (IQR- 21 years), and the median PD vintage was 6.2 months (IQR - 7.4 months). Sixty-two percent of them were male. PD exchanges were performed independently by 24.2% of patients, while the rest required caregiver support (spouse was the most common caregiver 44%). Thirty-seven percent had diabetes, 62.6% had hypertension, and 18% had mild-to-moderate degree of left ventricular systolic dysfunction. CAPD was initiated as the primary mode of renal replacement therapy in 44 (39.6%) patients, while the remaining 60% switched from hemodialysis [median HD vintage: 14.9 months (IQR- 24 months)]. Multiple access failure was the major reason for transfer from hemodialysis. Percutaneous CAPD catheter insertion was performed by a trained nephrologist in 69 (76%) patients while 20 (24%) patients underwent catheter insertion by a surgeon via laparoscopy / laparotomy. The major surgical complication that occurred with the percutaneous approach was pre-peritoneal catheter placement in 9 (13.5%) patients. An urgent-start PD was warranted in 15% of patients, with the most common indication being absence of an alternative dialysis access. Peritoneal membrane transporter status was assessed in 46 patients, 15 (32.6%) of them were high transporters, 14 (30.4%) of them were low transporters. The incidence of PD peritonitis was 0.24 per patient year. Median time to first episode of peritonitis was 9 months (IQR-9.5 months). Gram-negative bacilli were detected in 33% of episodes of peritonitis, in whom Pseudomonas was the major causative organism of peritonitis in 16%. Fungal peritonitis due to Candida accounted for 16%. Twenty-four percentage of patients had culture negative peritonitis. Recurrent PD peritonitis was observed in 3 of them. Breach in technique was the predominant cause of Peritonitis followed by a recent episode of gastroenteritis. Out of the 21 episodes of PD peritonitis, medical cure was attained in 11 (53%), peritonitis-related catheter removal was warranted in 10 (47%) [mainly due to fungal peritonitis in 4]. During the follow-up period, 1 patient underwent kidney transplantation, 10 (11%) switched to hemodialysis (mainly due to PD peritonitis), 5 (5.7%) succumbed. Among the CAPD patients transferred to hemodialysis, the first 3-month mortality rate was 40% (4).

CONCLUSIONS: CAPD was initiated as the primary mode of RRT in 44 (39%) of patients. Percutaneous placement of PD catheter was done by a trained Nephrologist in 67% patients, with the most common adverse event encountered being pre-peritoneal placement in nine patients. Gram-negative bacilli were the leading cause of peritonitis in 33%, among which Pseudomonas predominated. This study has shown that implementation of the “CAPD FIRST†initiative is feasible in the Indian scenario.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 25: EXAMINING THE LINKAGE BETWEEN HEAT EXPOSURE AND CHRONIC KIDNEY DISEASE OF UNKNOWN ETIOLOGY (CKDU) IN UDDANAM ANDHRA PRADESH

Vidhya Venugopal 1, Balaji Gummidi 1, Rekha Shanmugam 1, Oommen John 1, P K Latha 1, R Balakrishnan 1, Vivekanand Jha 1

BACKGROUND: Chronic Kidney Disease of Unknown Origin (CKDU) or Uddanam Nephropathy affects the rural population in the coastal Andhra Pradesh. How occupational heat stress heavy exertion and recurring dehydration influence kidney function is yet to be examined in this population.

AIM OF THE STUDY: To explore the association between heat stress and manual labor and the risk of kidney injury among Uddanam workers

METHODS: We randomly chose 676 workers from 16-indoor and outdoor occupations in 67-villages of Srikakulam district. Wet Bulb Globe Temperature (WBGT°C) analyzed environmental heat exposures and categorized workers as exposed or unexposed based on heat exposures and job category. A validated questionnaire elicited self-reported heat-related illnesses (HRIs). We quantified pre- and post-shift Heat Strain Indicators (HSI) and calculated the estimated Glomerular Filtration Rate (eGFR) using the creatinine-based CKD-EPI formula. We repeated measurements in a subset of workers to evaluate cross-seasonal HSI and renal function fluctuations.

RESULTS: Summer WBGT was 31.7 ± 2.3°C and winter, 25.5 ± 2.5°C. 100% of workers exceeded Threshold Limit Values (TLVs) in summer and 16% in winter. Season predicts 5.8, 6.9, and 2.5-times greater HRIs (96%), dehydration (33.5%), and urogenital issues (82.3%) among heat-exposed workers. Higher cross-shift HSI increases (OR:2.3; 95%CI:1.6—3.4) were found among heat-exposed workers. 71% of the 269 workers whose blood samples were collected had an eGFR of less than 90 mL/min/1.73 m2, with the risk doubling in heat-exposed workers (95%CI:1.2—3.7), and 17% had a reduced kidney function (eGFR <60 mL/min/1.73 m2).

CONCLUSIONS: High occupational heat stress, frequent HSI, dehydration, and reduced eGFR warrant more investigation to fully understand heat stress's influence on renal health among workers in Uddanam.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 26: ANCA NEGATIVE PAUCI-IMMUNE CRESCENTIC GLOMERULONEPHRITIS; A SINGLE CENTRE EXPERIENCE IN A TERTIARY CARE CENTRE IN EASTERN INDIA

Sourav Sadhukhan 1, Taniya Bhuniya 1, Arpita Raychaudhury 1, Koushik Bhattacharjee 1, Atanu Pal 1, Debabrata Sen 1

BACKGROUND: Pauci-immune crescentic glomerulonephritis (CrGN) is the most common cause of rapidly progressive glomerulonephritis (RPGN). Although majority of cases have the anti-neutrophil cytoplasmic antibodies (ANCAs) positivity, a subgroup of patients is ANCA negative. There are only few studies regarding this subgroup of patients.

AIM OF THE STUDY: To compare the prevalence clinical manifestations histopathology and outcomes of ANCA-negative pauci-immune crescentic glomerulonephritis with those of ANCA-positive disease.

METHODS: Total 27 patients who were diagnosed with pauci-immune crescentic glomerulonephritis between January 2020 and July 2021 were enrolled in this study with a minimum follow-up of 1 year. This was a retrospective ? study data captured using preformed pro forma after taking consent tabulated using MS Excel. Differences of quantitative parameters between groups were assessed using the t-test (for data that were normally distributed) or nonparametric test (for data that were not normally distributed). Differences of qualitative results were compared using χ2 test. Kaplan–Meier curves were used to analyze patient and renal survival. P < 0.05 was considered significant.

RESULTS: In our study, out of 27 patients, 74.07% were females. MPO positive were 37.03%, PR3 positive were 33.3%. ANCA negative patients were 29.6%. ANCA negative patients were similar in age distribution with ANCA positive CrGN (35.75 Â ± 16 vs 38.4Â ± 18.32, p = 0.72). ANCA negative patients had significantly more baseline proteinuria than ANCA positive patients (2.26Â ± 1.2 gm vs 1.38Â ± 0.84, p = 0.03). Nephrotic presentation also was significantly higher in ANCA negative patients (p < 0.05). Baseline s.cr was higher in ANCA negative patients (5.43Â ± 1.37 vs 4.7Â ± 2.9, p = 0.42) but not statistically significant, similarly dialysis requirement at presentation (62.5% vs 47.3%, p = 0.47). ANCA positive patients had more extrarenal manifestation including pulmonary involvement (68.42%vs25%, p = 0.038). In renal histopathology, ANCA negative patients significantly had lower no of normal glomeruli (7.2%Â ± 10.8 vs 17.3%Â ± 18.8, p = 0.05), more no of cellular crescents (56.4%Â ± 21.8 vs 41.7%Â ± 13.9, p = 0.04), have more IFTA burden (IFTA > 25%- 50% vs 15.7%, p = 0.06). ANCA negative patients had significantly poorer renal survival at 1 year (12.5% vs 52.6%, p = 0.05), but no significant difference in patient survival at 1 year (p = 0.57).

CONCLUSIONS: Findings from our study suggests that ANCA-negative pauci-immune CrGN remains a distinct clinical entity with higher proteinuria, less extrarenal involvement and poor renal outcome. Studies with longer duration and follow-up with more no patients are required for further analysis, identification of novel antigens in pathogenesis, and potential therapeutic interventions.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 27: A CASE SERIES ON GLOMERULAR DISEASE MANIFESTING FOR THE FIRST TIME AFTER COVID 19 VACCINATION

Shuvam Roy 1, Manas Ranjan Behera 1, Anupama Kaul 1, Narayan Prasad 1, Manas Ranjan Patel 1, Ravi Shankar Kushwaha 1

BACKGROUND: Different vaccines have been developed against SARS nCoV 19 and deployed in mass immunization campaigns across the world. In India, Covishield (ChAdOx1 nCoV-19) manufactured by Serum Institute of India) and Covaxin (BBV152) manufactured by Bharat Biotech are two such vaccines that have been made available. The former is a replication-deficient adenovirus vaccine while the latter is an inactivated whole virion vaccine. There has been many case reports of new onset or relapse of glomerular disease occurring after Covid-19 vaccination. This is attributed to heighten off target effect of immune response of the vaccine.

AIM OF THE STUDY: We present a case series of four patients where glomerular disease manifested for the first time after Covid-19 vaccination in our center.

METHODS: We have included in our case series those patients whose clinical features manifested for the first time within 1 month of Covid-19 vaccination and whose renal biopsy showed glomerular pathology.

RESULTS: Case 1: A 12-year-old male presented to us with abrupt onset of edema leading to anasarca on 30/4/2022. He had received first dose of Covid-19 vaccine (Covaxin) on 26/4/2022. His labs showed urine protein of 3+ and nil RBC, serum creatinine 0.7 mg/dl, serum albumin 1.9 mg/dl, and dyslipidemia (total cholesterol 378 mg/dl, triglycerides 191 mg/dl). He underwent renal biopsy in view of nephrotic syndrome. It was suggestive of minimal change disease. He was started on prednisolone at 2 mg/kg/day. Case 2: A 39-year-old female presented to us with abrupt onset of maculopapular rash, fever, and bilateral lower limb swelling on 25/1/2022. She had received second dose of Covid-19 vaccine (Covishield) on the same day in the morning. She was found to have hypertension with BP of 160/100 mm Hg. Her labs showed urine protein of 2+ and 18-20 RBC/high power field, serum creatinine 1.9 mg/dl, serum albumin 3.7 mg/dl, negative ANA and ANCA, and normal complement levels. She underwent renal biopsy in view of renal failure with active urinary sediments. It was suggestive of focal and segmental glomerulosclerosis (FSGS). Case 3: A 37-year-old male patient with history of hypertension (on irregular treatment) presented to us with history of gross hematuria without passage of clots in May 2022 about three days after receiving booster dose of Covishield vaccine. He did not have edema, rash, joint pain, or decreased urine output. His labs showed urine protein of 2+ and 5-6 RBC/high power field, serum creatinine 2.0 mg/dl, serum albumin 4.0 mg/dl, negative ANA and ANCA, and normal complement levels. He underwent renal biopsy in view of renal failure with active urinary sediments. It was suggestive of IgA nephropathy (M1E0S1T1C0). Case 4: An 18-year-old female with family history of nail patella syndrome presented to us with history of abrupt onset of edema of both lower limbs on 21/11/2021. She also had rash at the time of presentation. She had received first dose of Covid-19 vaccine (Covaxin) on 20/11/2021. Her labs showed urine protein of 2+ and numerous RBC/high power field, serum creatinine 1.4 mg/dl, serum albumin 2.98 mg/dl, negative ANA, and dsDNA and low complement levels (C3 14.1 mg/dl, C4 10.1 mg/dl: both being low). She underwent renal biopsy in view of renal failure with active urinary sediments. It was suggestive of membranoproliferative glomerulonephritis (MPGN). She was started on prednisolone at 1 mg/kg/day.

CONCLUSIONS: Different vaccines have different mechanisms of action, but their target remains the spike protein of the SARS Cov2 virus. Glomerular disease has mostly been reported with mRNA-based vaccines. Here we have reported glomerular disease occurring in close temporal relation to Covishield and Covaxin which have different mechanism of action. There have been reports of IgA nephropathy, minimal change disease and FSGS which manifested soon after vaccination. MPGN after Covid-19 vaccination is rarely seen. Thus, this case series shows that post-Covid vaccination glomerular disease can have varied pathologies.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 28: ASSOCIATION BETWEEN REDUCED MIDTERM RENAL HYPERFILTRATION AND ADVERSE GESTATIONAL OUTCOMES- A PROSPECTIVE STUDY FROM A TERTIARY CARE CENTRE

KP Deepa 1, Ashish George 1, S Gomathy 1

BACKGROUND: Midterm renal hyperfiltration (MRH) is a unique physiological phenomenon of hemodynamic adaptation that develops early in gestation and persists until parturition. An increase of 30%—50% in the estimated glomerular filtration rate (eGFR) or an absolute eGFR value >120 ml/min per 1.73 m2 at 20 weeks of gestation is considered normal MRH.

AIM OF THE STUDY: This study evaluated the relationship between midterm eGFR its change from baseline and adverse pregnancy outcomes.

METHODS: In this prospective study, 210 pregnant women without any prior underlying renal dysfunction and chronic diseases affecting gestation were included. Serum creatinine and eGFR were recorded at baseline 20 weeks, and patients were closely monitored till delivery.

RESULTS: The mean age was 26.55Â ± 0.297 years with a baseline creatinine and eGFR of 0.813Â ± 0.07 and 100.56Â ± 0.693 respectively. Mean midterm eGFR was 131.06Â ± 0.637 with a MRH incidence of 64%. Patients without MRH were found to have significantly higher age and parity. The incidence of adverse pregnancy outcomes (preeclampsia, preterm, and low birth weight) was significantly higher in patients without MRH. The relative risk for developing complications at delivery in the non-MRH group compared to MRH group was 4.937 (p = 0.0001). Patients with midterm eGFR <120 were found to have higher risk of complications compared to GFR >120.

CONCLUSIONS: Increase in age and multiparity were the risk factors for lower MRH which in turn was associated with individual and composite adverse gestational outcomes. Comparing the midterm eGFR categories, higher categories experienced lesser pregnancy complications.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 29: A QUALITY ASSURANCE DASHBOARD TO MONITOR HEMODIALYSIS METRICS AND PATIENT OUTCOMES

Viswanath Billa 1, V Billa 1, U Deepa 1, S Bagarao 1, M Gowda 1, R Singhal 1, J Desai 1, S Kothari 1, J Kothari 1, R Kumar 1, S Bichu 1

BACKGROUND: CKD patients on maintenance dialysis continue to suffer from poor health outcomes and represent a suitable target for quality improvement. The conventional practices to evaluate quality of care practices fail to address this when dealing with large patient volumes across multiple geographies. It is important to digitize these processes as well create an Electronic Dialysis Dashboard to facilitate quality measurement and target improvement in order to achieve better patient outcomes.

AIM OF THE STUDY: To design & operate a digital system to monitor large numbers of dialysis patients at multiple centers across the country

METHODS: A digital application was developed to capture clinical and dialysis data of every patient undergoing dialysis across the Apex Kidney Care ecosystem. The responsibility of capturing data was assigned hierarchically to the center technicians, nurses, administrators, and physicians. The data gathered provided a live feed to a Quality Assurance Dashboard. This dashboard was then monitored by QA executives supervised by the QA Review board periodically

RESULTS: The Axis Dialysis Dashboard summarizes and highlights key performance indices across dialysis centers into an easily manageable visual display. Patient data points including active patient number, dropouts, exits including deaths, hospitalizations, and mortality show up on the dashboard. The quality of dialysis metrics including dialysis frequency, adequacy, dry weight deviations, vascular access information, viral status, and vaccination status is easily visible on the dashboard. A comprehensive view of the monthly bloodwork, dialysis events, and water quality reports are also featured on the same page. Using this, the QA executives are able to deep dive into specific sections and identify which patient or which machine is deviating from the prescribed standards of care. This Dialysis dashboard is in use for the past 2 years and has improved the focus of all the QA efforts by targeted approach to trouble spots.

CONCLUSIONS: Managing patients on hemodialysis to achieve desired outcomes is a hugely laborious and intensive process. There are multiple data points which need to be monitored at multiple levels of authorization. Digitizing this data, visualizing it on a focused dashboard and addressing treatment delivery shortcomings based upon the level of priority, is the only effective way to ensure that our patients don’t fall between the cracks.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 30: CLINICAL AND MICROBIOLOGICAL PROFILE OF CARBAPENEM RESISTANT URINARY TRACT INFECTION AT A TERTIARY CARE HOSPITAL IN SOUTH INDIA

Gangula Rahul Sai 1

BACKGROUND: Carbapenem-resistant urinary tract infection (CR-UTI) is a major and an ongoing global health threat. Many factors contribute to increasing incidence of CR-UTI. Carbapenem-resistant (CR) strains of most common pathogens further complicate treatment approaches due to limited pharmacological armamentarium available.

AIM OF THE STUDY: Our aim is to determine incidence clinical spectrum risk factors and microbiological profile of Carbapenem-resistant urinary tract infection (UTI) in our hospital.

METHODS: This is an observational study conducted at M S Ramaiah Medical College Hospital Bengaluru India. All the patients who had Culture-Proven Urinary Tract Infection between January 2017 and December 2021 at our hospital were considered for the study. All patients (in-patients and out-patients) who had culture-positive Carbapenem-resistant UTI were included.

RESULTS: A total of 3268 patients with urinary tract infection were considered for the study. Out of which 728 patients had Carbapenem-resistant urinary tract infection. Most common causative agents were Escherichia coli and Klebsiella pneumonia. Multi-drug resistant and Carbapenem resistance was higher in patients with Klebsiella pneumonia, followed by Enterobacter and Escherichia coli. Most common risk factors noted were prolonged Foleys catheterization, prior use of empirical broad-spectrum antibiotics within 2 weeks of hospitalization, uncontrolled diabetes, prior instrumentation. Around 30 percent patients had UTI with Bacteremia, among which 20 percent had hemodynamic instability during the course of hospital stay (ionotropic support). High incidence of mortality was noted in Carbapenem-resistant UTI patients who had septic shock at admission or within 1 week of admission to hospital. Large proportion of patients with CR infections, among those who were alive at the time of discharge, were readmitted with the same pathogen (35.6%), nearly double the proportion of those with CS infections (18.5%).

CONCLUSIONS: Our analysis clearly demonstrates the increased morbidity and mortality associated with the presence of CR pathogens in patients with UTIs, particularly those with infections complicated by bacteremia, in terms of the risk of overall as well as infection-associated LOS (length of stay) and ICU LOS, readmissions, and in patients with bacteremia higher risk of mortality.

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 31: THE EPIDEMIOLOGY ETIOLOGY AND OUTCOME OF AKI IN A TERTIARY CARE CENTER IN SOUTH INDIA

Shimna Kunhiraman 1, Sugan Gandhi Thangaraju 1, Shanmugasundaram Angusamy 1, Dhanapriya Jeyachandran 1, Ramudu Venkatraman 1, T Balasubramanian 1

BACKGROUND: The etiology and outcome of acute kidney injury vary among different medical centers.

AIM OF THE STUDY: The objective of our study was to study the epidemiology etiology and outcome of AKI in a tertiary care center in South India

METHODS: We did a prospective observational study from September 2021 to March 2022. The patients of age ≥ 12 years of age and AKI as per KDIGO (Kidney Disease Improving Global Outcomes) 2012 definition were included in the study. Patients with known chronic kidney disease and those with contracted kidneys on imaging were excluded from the study. We analyzed the clinicodemographic data renal replacement therapy (RRT) and 30-day outcome in the form of mortality and dialysis dependency. Statistical analysis was performed using SPSS 22.0 version software.

RESULTS: A total of 83 patients were included in our study. The AKI incidence was higher in males (73.49%) and in patients aged 51–60 years (24.09%). 48.19% had stage 1 AKI, 22.89% had stage 2 AKI, and 34.93% had stage 3 AKI. Renal replacement therapy (RRT) was required in 33 (39.7%) patients with hemodialysis (87.87%) being the most common modality. The indications for dialysis were refractory volume overload (36.36%), encephalopathy (27.27%), oliguria (24.24%), and refractory acidosis (12.12%). The common etiological factors were ADD, tropical fever, CA bladder, CA cervix, and sepsis. Acute diarrheal disease (50.6%) was the predominant etiology followed by sepsis (29%). The most common comorbidities were diabetes mellitus (18.07%) and hypertension (12.04%). Out of the 39.7% of AKI patients requiring RRT, 6.06% patients were dialysis dependent. Obstructive uropathy secondary to pelvic solid organ malignancies was the most common etiology among dialysis dependent patients. The 30-day mortality was 7.2%. The most common etiology of AKI causing death was sepsis (66.66%), and the most common comorbidity was diabetes mellites (50%).

CONCLUSIONS: Acute diarrheal disease (50.6%) was the predominant etiology of acute kidney injury followed by sepsis (29%). The most common comorbidities were diabetes mellitus (18.07%) and hypertension (12.04%). Obstructive uropathy secondary to pelvic solid organ malignancies was the most common etiology among dialysis-dependent patients. The most common etiology of AKI causing death was sepsis (66.66%), and the most common comorbidity was diabetes mellites (50%).

Indian J Nephrol. 2022 Dec;32(Suppl 1):S1–S18.

ABSTRACT NO. 32: CLINICAL OUTCOMESÂ OF PEDIATRIC RENAL TRANSPLANTATION

Ajay George Kurian 1

BACKGROUND: The exact burden of End-Stage Renal Disease (ESRD) among children in our country is not known due to absence of a national register. Renal transplantation is the best treatment option for these children.

AIM OF THE STUDY: Study the clinical profile of pediatric renal transplantation and to study the incidence of graft rejection patient and graft survival

METHODS: The study was conducted in children with ESRD (below 18 years of age) who underwent renal transplantation at Aster Medicity. Those with multi-organ transplantation and those who were lost to follow-up were excluded from the study. Data from charts and medical records of all patients below 18 years of age  who received a kidney transplant from January 2016 to June  2022 were collected. This included information on patients’ demographics anthropometry pre- and post-transplant requirement of anti-hypertensive medications  etiology of ESRD dialysis modality and donor details  the incidence of acute or chronic rejection patient and graft survival.Â

RESULTS: Thirty-six children were included in the study, of which 64% were males. There were 13 children below 10 years of age, and 23 between 11 and 18 years. The mean follow-up period was 40 months (range 1–78 months). Four children weighed less than 10 kg at the time of surgery and 7 children weighed between 11 and 20 kg. Congenital anomaly of kidney and urinary tract (50%) and chronic glomerulonephritis (33%) were the common native kidney diseases that led to ESRD. Majority were undergoing hemodialysis prior to transplantation; one-third were on peritoneal dialysis. Robot-assisted renal transplantation done in 36%. Mother was the donor in 66% cases, others being fathers, grandparents, brothers. All children received triple immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone. Induction with Basiliximab was given for 22 children, and ATG was given for one child. Patient survival was 100% at 5 years. Four children had graft loss during the follow-up period and back on dialysis: one graft loss occurred within one year and other three between three and five years after surgery: of these, two adolescent children lost the graft due to non-compliance to medicines and other two had chronic antibody mediated rejection

CONCLUSIONS: CAKUT and glomerulonephritis are the most common cause for ESRD in children. The outcomes of renal transplantation in children are very good and hence are the preferred mode of renal replacement therapy in children.

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