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Objective: To identify the echocardiographic abnormalities in children with chronic kidney disease on maintenance hemodialysis. Study Design: Prospective longitudinal study. Place and Duration of Study: Hemodialysis unit of Department of Pediatric Nephrology, The Children's Hospital and Institute of Child Health, Lahore from Jun to Nov 2020. Methodology: A total of 75 children of chronic kidney disease on hemodialysis were included. Blood and urine tests, chest x-ray and transthoracic echo cardio-grapy were performed to assess the cardiac morphological and functional abnormalities. Results: The mean age of patients was 12.14 ± 2.18 years with 54 (72%) males and 21 (28%) females. The mean duration of hemodialysis was 22.54 ± 17.01 months with mean urea reduction ratio (URR) (%) 65.58 ± 4.31 and mean Kt/v 1.3 ± 0.1. Hypertension was noted in 70 (93.3%) patients with mean systolic and diastolic blood pressure 134.07 ± 10.64 and 89.13 ± 6.78 mmHg, respectively. The echocardiography revealed the mean ejection fraction of 58.02 ± 12.40 with mild systolic and diastolic dysfunction noted in 48 (64%) patients, pericardial effusion in 23 (30.7%) cases and left ventricular hypertrophy (LVH) in 52 (69.3%) cases. Conclusion: As the frequency of left ventricular hypertrophy (LVH) was noted to be high in our chronic kidney disease patients on hemodialysis, there is a need to implement echocardiographic screening of these patients at regular intervals to identify and rectify cardiac complications early. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency of various types of infectious complications occurring in patients undergoing hemodialysis using temporary non-cuffed hemodialysis catheters. Study Design: Cross-sectional study. Place and Duration of Study: The Children's Hospital and the Institute of Child Health, Lahore, from Oct 2016 to Sep 2017. Material and Methods: The study was conducted on 104 patients aged 5-15 years with end stage renal disease. Demographic information like age, gender, duration of end stage renal disease (ESRD), and details about etiology of ESRD, number of days catheter remained in situ, difficult catheter insertion and infectious complications related to catheter were recorded. Exit site, tunnel and blood stream infections and their causative organisms were detected using blood and catheter tip cultures. Results: The mean age of the patients was 11.1 ± 2.7 (range: 5-15) years and female to male ratio 1.48. Internal jugular, femoral and subclavian veins were used in 85.6%, 7.7% and 6.7% of the cases respectively. The frequency of catheter related exit site infection, tunnel infection, blood stream infection and infective endocarditis was found to be 16.3%, 7.7%, 52.9% and 34.6% respectively. Staphylococcus aureus, Escherichia coli and Klebsiella pneumonia were the commonest etiological pathogens in blood cultures whereas Staphylococcus aureus, Pseudomonas aeuroginosa and Escherichia coli were the commonest organisms found in the catheter tip cultures. Conclusion: Hemodialysis poses a very heavy burden of blood stream infections which should alert clinicians of their timely management to prevent life threatening complications later. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and pattern of dyslipidemia in pediatric patients with end stage renal disease presenting in a tertiary care hospital. Study Design: Cross-sectional, observational study. Place and Duration of Study: The Children's hospital and the Institute of Child Health Lahore, from Sep 2016 to Nov 2017. Material and Methods: Children aged 5-15 years, of either gender and diagnosed with end stage renal disease were selected for the study. All the patients were undergoing renal replacement therapy in the form of hemodialysis and/or continuous ambulatory peritoneal dialysis. The serum levels of total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein and very low density lipoprotein were measured. Results: There were 138 patients in the study with mean age 11.24 ± 2.37 years and male to female ratio 2.5:1. The mean ± SD values of total serum cholesterol, triglycerides, and low density lipoprotein were found to be 174.0 ± 54.1, 241.2 ± 142.4 and 95.2 ± 49.0 mg/dl respectively. The frequency of abnormally high levels of total serum cholesterol, triglycerides, and low density lipoprotein were found to be 21.7%, 84.8% and 19.6% respectively. The lipid profile of patients on peritoneal dialysis was markedly elevated as compared to that of patients on maintenance hemodialysis (p-value ≤0.05). Conclusion: Majority of pediatric patients with end stage renal disease had suffered from dyslipidemia especially raised serum triglycerides. Timely identification of abnormal lipid levels and appropriate management is expected to help reduce cardiovascular morbidity and mortality associated with dyslipidemia in these pediatric patients. Moreover, lipid profile of patients on peritoneal dialysis was more deranged than those on hemodialysis. [ABSTRACT FROM AUTHOR]