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This study aimed to compare the differences in echocardiographic and strain parameters in patients with diabetic kidney disease (DKD) and non-diabetic kidney disease (NDKD) in a cohort with pre-dialysis chronic kidney disease (CKD) and normal ejection fraction (EF). In this single-center prospective study, patients with CKD stages 3–5 and EF > 55% were included. We compared cardiac structure and function using conventional and speckle-tracking strain echocardiography among DKD and NDKD groups. Cardiovascular outcomes were assessed at the end of the study. Of the included 117 patients, 56 (47.9%) had DKD, and 61 (52.1%) had NDKD. Patients with DKD had higher ratios of early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) (11.9 ± 4.4 vs. 9.8 ± 3.5; p = 0.004), lower septal e’ velocity (7.1 ± 2.5 vs. 8.2 ± 2.8; p = 0.031), lower lateral e’ velocity (9.2 ± 2.9 vs. 10.4 ± 3.8; p = 0.045) and longer deceleration times (209.2 ± 41.5 vs. 189.1 ± 48.0; p = 0.017), compared to those with NDKD. Left ventricular mass index (LVMI), global longitudinal strain (GLS), early diastolic strain rate (SRE), and E/SRE were similar. At a median follow-up of 239 days, 3-P MACE (11.5% vs. 4.9%; p = 0.047) and 4-P MACE (28.6% vs. 11.5%; p = 0.020) were observed to be higher in the DKD group. Diastolic dysfunction was more common in patients with DKD, compared to those with NDKD, although both groups had similar LVMI and GLS. Those with DKD also had poorer cardiovascular outcomes. This highlights the importance of the assessment of diastolic function in CKD, particularly in those with diabetic CKD.

Chronic kidney disease (CKD) is extremely common all over the world and is strongly linked to cardiovascular disease (CVD). The great majority of CKD patients have hypertension, which raises the risk of cardiovascular disease (CVD), end-stage kidney disease, and mortality. Controlling hypertension in patients with CKD is critical in our clinical practice since it slows the course of the disease and lowers the risk of CVD. As a result, accurate blood pressure (BP) monitoring is crucial for CKD diagnosis and therapy. Three important guidelines on BP thresholds and targets for antihypertensive medication therapy have been published in the recent decade emphasizing the way we measure BP. For both office BP and out-of-office BP measuring techniques, their clinical importance in the management of hypertension has been well defined. Although BP measurement is widely disseminated and routinely performed in most clinical settings, it remains unstandardized, and practitioners frequently fail to follow the basic recommendations to avoid measurement errors. This may lead to misdiagnosis and wrong management of hypertension, especially in CKD patients. Here, we review presently available all BP measuring techniques and their use in clinical practice and the recommendations from various guidelines and research gaps emphasizing CKD patients.

Introduction: In hemodialysis (HD) patients, catheter-related bloodstream infections (CRBSI) cause significant morbidity and mortality. Objectives: We analyzed dialysis CRBSI incidence, associated factors, and the spectrum of the causative organisms. Patients and Methods: Patients aged ≥18 years either on maintenance HD or with acute kidney injury having CRBSI (NKF-KDOQI criteria) were included in this prospective observational study and patients with other infections were excluded. Blood, catheter tip culture, and antibiogram were analyzed. All patients were initially treated with antibiotics covering both gram-positive and gram-negative pathogens. Results: Of 921 catheters (882 patients) included, 212 (23%) had CRBSI, of which 69(32.5%) and 143 (67.5%) had culture-positive probable CRBSI and culture-negative possible CRBSI respectively. 131 (61.8%) were

BACKGROUND AND AIMS An arteriovenous (AV) fistula is preferred for long-term haemodialysis vascular access. AV fistula creation requires adequate arterial and venous anatomy to support its creation and a sufficient time interval to allow the AV fistula to mature prior to its use. Failure to mature remains a problem highlighting the importance of the perioperative evaluation of the fistula. Ultrasound and colour doppler are a rapid, non-invasive and repeatable tools that can be used for the early diagnosis of vascular complications. METHOD A prospective, observational study was conducted at a tertiary hospital in South India. All the patients with arteriovenous fistulas made in the upper limb between the time period of June 2021–August 2021 were included. A preoperative doppler mapping and assessment of the upper lime was done by the nephrology team and two DUS exams in the post-operative period. RESULTS In our study, a total of 134 patients were evaluated with a mean age of 51.89 ± 13.7 years. The total number of males in the study was 115 (85.8%). The aetiology of end-stage renal disease (ESRD) was predominantly nondiabetic in origin seen in 56.7% of the patients. Ischaemic heart disease was seen in 36 patients. There were 116 brachiocephalic,18 radiocephalic AV fistulas in our group of patients. The overall success rate of the fistula was 79.9%. The average vein diameter in patients with successful AV fistula was 3.03 ± 1.05 mm and was 2.25 ± 0.9 mm in those who had a failed fistula. The average blood flow measurement in the proximal artery supplying the fistula was 479.42 ± 113.1 mL/min in the immediate post-op period and 1055.88 ± 227.6 mL/min at 6 weeks. There was a significant difference (P CONCLUSION It is essential for a practicing nephrologist to be acquainted with the technique of doppler to assess AV fistula to assess for maturity and to see for.

BACKGROUND AND AIMS The risk of developing tuberculosis (TB) is 10–25% in chronic kidney disease (CKD) patients. TB in CKD patients may have a mortality of 16–37%. Standard treatment with four drugs (Isoniazid, Rifampin, Pyrazinamide and Ethambutol) predisposes to side effects, drug interactions and incomplete adherence in this population. We studied adverse drug reactions and potential drug–drug interactions in CKD patients with TB. METHOD Consecutive patients with CKD and TB attending tertiary care hospitals in South India were included over a period of 12 months. CKD was diagnosed based on estimated GFR using CKD EPI and TB using standard methodology. Data on demographic details and adverse drug reactions were collected from case records. Potential drug–drug interactions were checked using Micromedex Drug-Reax® (Truven Health Analytics, Greenwood Village, Colorado, USA). Statistical analysis was done using SPSS version 20. RESULTS Of 1300 TB patients, 59 had CKD. The demographic details are as per Table 1. CONCLUSION In CKD with TB, adverse drug reactions were seen in 45.5% and potential drug–drug interactions were seen mostly with rifampin (28.81% in CKD).

BACKGROUND AND AIMS The involvement of kidney in plasma cell dyscrasias is widespread, often referred to as myeloma kidney. At the time of presentation, nearly 50% of patients have renal involvement which is associated with higher mortality [1, 2]. Multiple myeloma is more common in African Americans, with male predilection and median age about 65–70 years [3]. Two major causes of renal insufficiency are light chain cast nephropathy and hyperkalcaemia [4]. Flow cytometry plays an important role in diagnosis of plasma cell dyscrasias. Myeloma cells infrequently express CD19 and variable CD45 in contrast to normal plasma cells. Approximately 70% of myeloma cells will express CD56, which is typically negative in normal plasma cells and in plasma cell leukaemia [5]. Studies addressing the relation of flow cytometry parameters with respect to prognosis and outcome in plasma cell dyscrasias are sparse in Asian population. Hence, this research was conducted to study the clinical profile and correlation of flow cytometry parameters with renal outcomes in patients with plasma cell dyscrasias. METHOD All consecutive patients, aged above 18 years and diagnosed with plasma cell dyscrasias from January 2016 to June 2021 were included. RESULTS Of 165 patients, 115 were males (69.7%), with mean age 58.2 ± 6.4 years. Pallor was seen in 126 (76.4%), bone pains in 90 (54.5%), lytic lesions in 63 (38.2%) and fractures in 37 (22.4%) patients. Severe anaemia ( Remission was attained with chemotherapy in 139 patients (64.3%), and bone marrow transplantation was done in 27 patients (16.4%). Relapse of disease was seen in 31 patients (18.8%) and worsening of renal parameters at relapse was seen in 15 (48.4%) patients. A total of 35 (21.2%) patients expired. Correlation of flow cytometry parameters with renal outcomes showed presence of CD56 with worse renal outcomes (P = .032), and presence of CD117 with favourable renal outcomes (P = .003) with statistical significance. Presence of CD56 and CD138 had increased risk of mortality with significant P value (P = .04, P = .01, respectively). CONCLUSION Flow cytometry parameters may play a role in predicting the prognosis and renal outcomes in patients of plasma cell dyscrasias. Our study showed presence of CD56 with worse renal outcome and mortality, while CD117 presence with favourable renal outcome. Table 1. Flow cytometry parameters in patients with plasma cell dyscrasias CD markers (n = 165) Present Absent CD19 21/165 (12.7%) 144/165 (87.3%) CD38 53/165 (32.1%) 112/165 (67.9%) CD45 46/165 (27.9%) 119/165 (73.9%) CD56 134/165 (81.2%) 31/165 (18.8%) CD117 86/165 (52.1%) 79/165 (48.9%) CD138 46/165 (27.9%) 119/165 (73.9%) KAPPA 93/165 (56.4%) 72/165 (44.6%) LAMBDA 71/165 (43%) 94/165 (57%)

Shankar Prasad Nagaraju,1 Mohan V Bhojaraja,1 Ganesh Paramasivam,2 Ravindra Attur Prabhu,1 Dharshan Rangaswamy,1 Indu Ramachandra Rao,1 Srinivas Vinayak Shenoy1 1Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Manipal, Karnataka, 576104, India; 2Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Manipal, Karnataka, 576104, IndiaCorrespondence: Mohan V Bhojaraja Email mohan.vb@manipal.eduIntroduction: Pulmonary hypertension (PH) is an underestimated cardiovascular consequence and a mortality predictor in patients on hemodialysis (HD). Thus, we studied its prevalence, risk factors, association with inflammation/oxidative stress, and cardiac changes in HD patients.Methods: This was a single-center cross-sectional observational study conducted at a tertiary care hospital. Patients aged > 18 years on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters (C-reactive protein and malondialdehyde with thiol assay were used as markers of inflammation and oxidative stress, respectively), and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure of > 25 mmHg at rest, and it was further divided as mild (25– 40 mmHg), moderate (40– 60 mmHg), and severe (> 60 mmHg).Results: Of 52 patients, 28 patients had PH (mild 24, moderate 4, and none had severe PH) with prevalence of 54%. No difference was found in clinical characteristics, dialysis-related factors, biochemical parameters including inflammation (C-reactive protein; p=0.76), or oxidative stress (thiol; p=0.36 and MDA; p=0.46) between the groups. When compared to individuals without PH, HD patients with PH exhibited significantly more mitral regurgitation (p=0.002).Conclusion: Hemodialysis patients have a high prevalence of PH. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Our study did not find differences in traditional risk factors, HD-related factors, and inflammation/oxidative markers between the groups with and without PH.Keywords: chronic kidney disease, hemodialysis, inflammation, oxidative stress, pulmonary hypertension

Introduction: Intradialytic hypertension (IDH) is associated with significant vascular and cardiac adverse outcomes. Objectives: This study was performed to know the prevalence and factors predicting IDH. Patients and Methods: A single-center cross-sectional observational study at a tertiary care hospital. After ethics committee approval and informed consent, all patients over 18 years on twice weekly hemodialysis were included, those on peritoneal dialysis and acute kidney injury excluded. Primary outcome was prevalence of IDH based on three definitions and secondary outcome was predictive factors. IDH was defined as ≥10 mm Hg surge in systolic blood pressure (SBP) between pre-and postdialysis in 4 of 6 successive sessions or >15 mm Hg rise in mean arterial pressure (MAP) between start and end of dialysis or symptomatic rise in blood pressure requiring intervention. SBP and MAP were measured on standardized monitors before, hourly and 30 minutes post dialysis. Results: Of 136 patients, prevalence of intra-dialytic hypertension was 78/136 (57%), 33/136 (24%), 15/136 (11%) based on systolic rise, rise in MAP and symptomatic rise in BP respectively. Among those with systolic rise, diabetes mellitus (P= 0.03), undernourishment (P=0.03), inter-dialytic weight gain >3 kg (P< 0.001) and dialysis vintage > 3 years (P< 0.001) were significantly associated with IDH. Conclusion: IDH prevalence varied from 11 to 57% with different definitions. Diabetes mellitus, under nutrition, inter-dialytic weight gain >3 kg and dialysis vintage >3 years predicted IDH.