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Introduction: Chronic kidney disease patients on hemodialysis (CKD-5D) are among the worst hit by the coronavirus disease 2019 (COVID-19) pandemic. Need to travel for dialysis, comorbidities, and immunosuppressive state put them at risk of severe disease and poor outcomes. We report our experience of COVID-19 in a cohort of CKD-5D from a public sector tertiary-care center from western India. Material and Methods: We retrospectively analyzed the records of 58 CKD-5D patients with confirmed COVID-19 admitted to our COVID-19 hospital. Suspected COVID-19, acute kidney injury (AKI), or AKI on CKD were excluded. We studied the clinical, demographic, radiological, and laboratory profiles; treatment; and outcomes of the patients. We assessed the potential clinical and laboratory parameters to predict mortality. Results: The mean age of the patients was 48.7 ± 16.9 years, with 55% males. Comorbidities included hypertension (65%), diabetes (19%), and cardiovascular disease (15.5%). The presenting features included fever (69%), respiratory distress (50%), upper respiratory symptoms (36%), and diarrhea (13%). Five (8.6%) were asymptomatic. Bilateral infiltrates on chest imaging were the commonest radiological pattern. The patients were managed with oxygenation, hydroxychloroquine, steroids, anticoagulation, remdesivir, and favipiravir. Twenty-two (37.9%) patients died, predominantly due to respiratory failure. Disease severity and C-reactive protein (CRP) above 175 mg/L at admission were the only parameters predictive of mortality. Conclusion: CKD-5D patients with COVID-19 were less likely to present with the classical syndrome of fever and respiratory distress compared with reports from the general population and had higher mortality. Only disease severity and high CRP (>175 mg/L) were predictive of mortality in our cohort. [ABSTRACT FROM AUTHOR]

Introduction: Tunneled cuffed catheters (TCC) provides a short and intermediate-term access solution for dialysis patients who fail to get an arteriovenous fistula (AVF). They are associated with high morbidity and mortality along with high rates of infectious complications. Methods: We present a single-center prospective cohort of 159 TCCs inserted over one year. Patients were dialyzed in-hospital and in various peripheral dialysis units attached to the institute. The primary endpoint was catheter drop-out. Results: The mean age of patients was 41.8 ± 16.9 years. The right internal jugular vein was the commonest site of TCC insertion (66%). The absence of suitable veins was the predominant reason for TCC insertion. The mean time to catheter drop-out was 134.4 ± 83.3 days (5-399 days). Death with a working catheter was the most common cause of catheter drop-out (22.6%). About 25% of catheters were lost to catheter-related bloodstream infections (CRBSI), either alone or as overlap with poor flow. CRBSI rates were 3.74 episodes per 1000 catheter-days. No difference in survival between the staggered tip and split-tip catheters was found. Conclusions: With the advent of the "hub and spoke" model for dialysis in the public sector healthcare, TCCs are suboptimal with regards to patient and catheter survival, with high infection rates. It must be regarded as a temporary solution and AVF creation should be prioritized. [ABSTRACT FROM AUTHOR]

Aims of the study: This cross-sectional study aimed to investigate the prevalence of hyperhomocysteinemia, the determinants of plasma total homocysteine concentrations, and the relationship of total homocysteine with parameters of nutrition and inflammation. We also studied correlation between homocysteine level and carotid intimal medial thickness (CIIVlT), which is a surrogate marker of atherosclerosis in a sample of patients with CKD and not yet on dialysis. Materials and Methods: The study was done in outpatient from the Nephrology Division of our institute. Thirty-eight patients with CKD (29 males/9 females; age 50±14 years) with moderate to severe renal impairment (CRCl.=26.9±13.7 mL/min, clinically stable, and older than 18 years were included. Fasting blood samples were collected to determine plasma total homocysteine, folate, vitamin B-12, serum albumin, C-reactive protein and creatinine. SPSS software was used for statistical analysis. Results: The main results showed that the concentration of total homocysteine in the patients was significantly increased (26.8±13 mmol/L). Plasma folate and plasma vitamin B-12 were in the normal range. A high prevalence of hyperhomocysteinemia (> 15 mmol/L) was found in the patients (82%). Plasma total homocysteine inversely correlated with CrCl. (r² = -0.121), folate (r² = -0.251) and Vitamin B12 (r² = -0.341). There was positive association between homocysteine and albumin (r² = 0.152). Significant positive correlation was also found with CIMT (r² =0.273). Homocysteine level was lower in CRP negative group. According to the multiple regression analysis, the determinants of total homocysteine were only plasma folate, plasma vitamin B-12, and albumin. Conclusion: A high prevalence of hyperhomocysteinemia was found in our sample of nondialyzed patients with CKD. The determinants of total homocysteine levels were plasma folate, plasma vitamin B-12, and albumin. There was strong association between homocysteine and atherosclerosis. [ABSTRACT FROM AUTHOR]