Health Science Reports

BackgroundCatheter-related bloodstream infection (CRBSI) is a major cause of morbidity and mortality among patients undergoing hemodialysis (HD), particularly in low- and middle-income settings where non-tunneled hemodialysis catheters (NTHC) are widely used. Local epidemiological data are essential to guide preventive and therapeutic strategies. ObjectivesTo determine the prevalence, microbiological profile, antimicrobial resistance patterns, and clinical outcomes of CRBSI in patients undergoing HD via internal jugular NTHC at a tertiary care center in South India. MethodsThis retrospective observational study included adults initiated on HD using internal jugular NTHC between January 2017 and December 2023. Patients with pre-existing infections or catheters inserted elsewhere were excluded. CRBSI was defined using KDOQI criteria. Demographic, clinical, laboratory, microbiological, and outcome data were analyzed. Logistic regression identified risk factors, and receiver operating characteristic (ROC) analysis evaluated predictors of adverse outcomes. ResultsAmong 396 patients (mean age 56.3 {+/-} 14 years; 70.4% male), 65 (16.4%) developed CRBSI, with an incidence of 4.7 per 1000 catheter days. Emergency HD initiation (OR 14.86, p < 0.001) and access failure (OR 2.71, p = 0.004) significantly increased CRBSI risk, while planned initiation for uremic symptoms was protective. Patients with CRBSI had lower serum albumin and higher leukocyte counts. Gram-negative organisms predominated (53.8%), with Klebsiella pneumoniae being the most common isolate. High resistance was observed to {beta}-lactam/{beta}-lactamase inhibitor combinations and carbapenems. Gram-negative CRBSI was associated with significantly higher odds of hospitalization, ICU admission, inotropic support, and mortality. ROC analysis showed good predictive ability for adverse outcomes (AUC 0.73-0.77). ConclusionsCRBSI remains a significant complication of NTHC-based HD. Predominant Gram-negative infections with high antimicrobial resistance are associated with worse clinical outcomes, underscoring the need for early permanent access creation, strict catheter care, and robust antibiotic stewardship.

BackgroundUrinary tract infections (UTIs) are common among hospitalized stroke patients, leading to increased hospital stays and patient discomfort. While its known that post-stroke infections generally worsen outcomes, specific factors contributing to UTIs after stroke remain unclear. MethodsThis study aimed to investigate the incidence of post-stroke UTI (PSUTI) in patients admitted to the Hospitals from September 2020 to June 2021. The study included patients with a suspected diagnosis of stroke at the time of initial visit by a specialist. The final diagnosis was approved by an experienced neurologist and radiologist according to their brain CT scan. Data was collected from patients files, including demographics, comorbidities, drug history, smoking history, admission unit, clinical manifestations, systolic and diastolic blood pressure, type of stroke, etiology, laboratory findings, admission unit, in-hospital stay duration, therapies, use of NG tubes, urinary catheters, CV lines, brain drain, intratracheal tube, chest tube, dialysis catheter, and their durations. ResultsA study involving 612 patients found that PSUTI-positive patients had worse conditions at admission, with ischemic stroke being more common. They had longer stays in the ward or ICU, and were more likely to have a death outcome. The most common pathogen was Escherichia coli, followed by Staphylococcus epidermidis, Enterococcus spp, and Pseudomonas aeruginosa. In-hospital complications were more prevalent in PSUTI-positive patients, except for hydrocephalus and pulmonary embolism. Positive history of diabetes, falling symptoms, urinary catheter, and intubation were independent risk factors for post-stroke UTI. ConclusionThe study highlights the impact of urinary tract infections (UTIs) on stroke outcomes, revealing severe clinical profiles, comorbidities, longer hospital stays, and increased invasive interventions. Key risk factors like diabetes and urinary catheter use highlight the need for vigilant monitoring and tailored management strategies.

IntroductionBK Polyomavirus infection has a high incidence in the post-renal transplant phase and is considered a significant cause of premature graft failure after transplantation. Pediatric renal patients undergo relatively more potent immunosuppression; however, despite the large number of studies conducted in adult renal recipients, there is limited information on BKPyV infection in the pediatric population. ObjectiveTo estimate the incidence of BK Polyomavirus infection after kidney transplantation in pediatric patients undergoing immunosuppressive therapy at a referral center. MethodologyObservational descriptive study, with data collection based on medical records of children undergoing kidney transplantation at Hospital Ana Nery, Salvador-BA, from 2009 to 2017. ResultsForty-one children were evaluated, of which 21 (51.2%) were female. The mean age of the sample was 11 {+/-} 3, with a higher frequency of patients in the age range of 13-17 years (43.9%). Regarding the presence of BKPyV infection, most patients were not infected (56.1%). Regarding the type of antiproliferative and calcineurin inhibitor, Mycophenolate Mofetil was used in 37 (90.2%) patients and Tacrolimus in 40 (97.6%). When comparing the groups with the presence or absence of BKPyV infection, there was no statistically significant difference between the variables: sex (p = 0.890), age (p = 0.829) and type of antiproliferative used (p = 0.187). In the analysis of renal function, an increase in creatinine was observed in 38.9% of infected patients, while among the uninfected patients, only 13% presented an increase in the period of one year. The difference between these two groups (p = 0.05) therefore demonstrated an association between worsening renal function and the presence of BKPyV infection. ConclusionThe incidence of BK Polyomavirus infection in pediatric patients undergoing kidney transplantation, in the period of one year after the surgical procedure, is almost 50%. No differences could be demonstrated between the groups with and without BKPyV infection and established risk factors, such as sex, age and immunosuppressive therapy used. Furthermore, a worsening of renal function was evidenced among infected patients, when compared to the uninfected group, in this period of one year.

The novel coronavirus (COVID-19) is known to be the fifth pandemic causing massive deaths worldwide. This virus has not only been deeply associated with acute respiratory distress, but also acute kidney injury (AKI). This study describes the baseline characteristics and various outcomes of AKI based on the KDIGO 2012 Clinical Practice Guidelines in patients hospitalized with COVID-19 at a Philippine tertiary hospital. A total of 195 patient records were retrospectively reviewed for the study. Of the 195 patients, 81(42%) patients developed AKI. Significant baseline characteristics included older age (56.28 + 14.12), presence of hypertension (p=0.004), diabetes mellitus (p=0.002), and cardiovascular disease (p=0.003). Also, the use of diuretics, inotropes and antibiotics were more prevalent in patients who developed AKI. Most of the patients who had AKI were categorized as stage 1 (49.38%). Mechanical ventilation was significantly (p<0.001) more prevalent in patients with AKI (20.99%) compared to patients without AKI (5.26%). There was significantly higher rates (p<0.001) of renal replacement therapy in patients with AKI (30.86%). Lastly, higher mortality rates were observed in patients with AKI (50.62%) versus patients without AKI (12.28%). Our study demonstrated that patients with COVID-19 can develop AKI and tend to have a poorer prognosis.

IntroductionTuberculosis (TB) remains as an important concern of public health worldwide because the high prevalence and severe sequelae. Tuberculous meningitis (TBM) is the most lethal and disabling form. AimTo describe the clinical, laboratory, and neuroimaging characteristics of TBM on admission at neurological center in Mexico City. MethodsRetrospective cohort study at the third level neurological center from 2010 to 2016. Clinical follow-up was evaluated at hospital discharge, three months, and one-year either due to lack of follow-up or mortality, during the follow-up the adverse events were registered. ResultsOne-hundred and six patients were included, 74 (69.8%) males and 32 (30.2%) females. From these 31 (29.2%) were HIV-positive. The median age was 35.5 (IQR:28-51). Pulmonary TB was found in 25% of the population. Alcoholism was observed in a half of the patients while diabetes in 15%, the latter being significant (p=0.04). Abnormalities in neuroimaging were significant among our population (p=0.003). Only one-third of the population had a positive Lowenstein-Jensen culture. There were no differences in clinical outcomes between HIV positive and non-HIV patients. ConclusionOur study shows data to those described in the literature. The initiation of empirical treatment in all patients with a high clinical suspicion of tuberculosis mandatory to try to avoid severe neurological sequels.

BackgroundIn the Philippines, stroke is the second most common cause of mortality and is among the five leading causes of disability. Mannitol, a hyperosmolar agent, is a mainstay for the treatment of brain edema caused by elevated intracranial pressure in acute stroke patients. It is a potent diuretic that may trigger intravascular volume depletion, electrolyte imbalance, and renal tubular damage, which may lead to acute kidney injury in acute stroke. ObjectiveThis study aims to describe the incidence, identify the risk factors, and determine the clinical outcomes of mannitol-induced acute kidney injury among acute stroke patients admitted to East Avenue Medical Center from January 1, 2019, to December 31, 2021. MethodsThis is a retrospective study conducted at the East Avenue Medical Center, a tertiary training hospital in Quezon City, Philippines. A three-year chart review of acute stroke patients who developed mannitol-induced acute kidney injury (MI-AKI) was conducted. ResultA total of 348 eligible acute stroke patients were included in the study. Of these, 60 patients (17%) developed MI-AKI during confinement. There was a higher predominance among males than females with more than half of patients (65%) belonging to the 40 to 59 years age group. The risk factors identified were high National Institutes of Health Stroke Scale (NIHSS) score, chronic kidney disease, possibly cardiovascular disease, such as heart failure, intraparenchymal type hemorrhagic stroke, and high mannitol infusion dose >0.40g/kg in more than 48 hours. A high mortality rate was observed among MI-AKI patients in the study as compared with those without AKI (61.67% vs 27.43%, P<0.001) whereas spontaneous resolution of AKI was seen in 25 patients (41.67%, P<0.001). Only 4 patients (6.67%, P=0.001) who had renal replacement therapy had worsening renal function compared to the 27 patients (45%, P<0.001) who did not receive renal replacement therapy. ConclusionRisk factors for MI-AKI include moderate to severe NIHSS score, chronic kidney disease 3 and above, cardiovascular disease, and high-dose mannitol infusion. Early nephrology referral among patients with mannitol infusion for stroke is a must among patients who have co-morbidities including chronic kidney disease stage 3 and above, and cardiovascular disease such as heart failure. Serial monitoring of renal function should be performed especially for those patients with moderate to severe NIHSS scores and high-dose mannitol infusion for appropriate dosing to prevent MI-AKI.

IntroductionNeurocognitive impairment (NCI) remains common among people living with HIV (PWH), particularly in low- and middle-income countries where accurate diagnostic tools are limited. In Peru, the lack of locally validated neuropsychological (NP) normative data in Spanish poses a major barrier to diagnosing HIV-associated NCI, especially among PWH who develop NCI at younger ages. This study aimed to develop regression-based NP norms for young and middle-aged Spanish-speaking adults in Lima, Peru and validate the norms in demographically similar PWH to improve diagnostic precision of HIV-associated NCI. MethodsA total of 164 healthy adults without HIV from Lima completed a comprehensive NP battery assessing memory, attention, executive function, and language, which are commonly affected in HIV-associated NCI. Multiple regression models were used to consider the influence of age, years of education, and sex on raw scores, yielding standardized demographically-adjusted norms for the population. The resulting norms were then applied to 310 PWH from Lima and then compared with previously published norms for Spanish speaking adults to evaluate performance differences. ResultsAge and education were the strongest predictors of performance across tests, while sex had minimal influence. Compared to people without HIV, PWH had significantly lower educational attainment (mean 12.6 vs. 13.7 years) and exhibited significantly worse performance on normed scores of Benson Figure Copy, Benson Figure Delayed Recall, Color Trails 1 and 2, Hopkins Verbal Learning Test - Revised, and WAIS-III Digit Symbol Coding, Digit Span, and Symbol Search. There were statistically significant differences between T-scores on nearly all tests between our population-specific norms and previously published norms in both directions, indicating potential over- and under-detection errors when applying norms from non-local samples. DiscussionOur findings highlight the utility of locally derived norms in detecting subtle cognitive changes among young and middle-aged PWH compared with previously published norms for Spanish-speakers. Application of these norms reveals significant between-group differences that may go undetected using non-local normative data or raw scores. Future efforts should focus on rural norm development and inclusion of individuals with lower educational backgrounds in Peru and other Latin American countries.

BackgroundThe research has long reported that depression and stress are highly prevalent among patients with end-stage kidney disease requiring dialysis. Growing studies suggest that the inflammatory gene IL-6, in particular, contributes to the etiology of depression & stress by affecting the function of serotonin; one of the other explanations is by causing hypercortisolemia with overstimulation of the HPA axis. This study aimed to assess the inflammatory gene IL-6 in adolescent & adult patients with end-stage kidney disease receiving hemodialysis. Furthermore, to assess the coping skills of those patients upon the emergence of depressive symptoms & stress levels. MethodOne hundred and twenty-one patients receiving hemodialysis were recruited in a cross-sectional study from King Fahd Unit at Kasr Al-Ainy Hospital, Cairo University, Egypt. They were assessed for depression using Becks II depression inventory, stress by the stress perceived scale, coping by the short COPE questionnaire & they had inflammatory gene IL-6 level measured. ResultsSeventy-six patients showed depressive symptoms; adults were more depressed than adolescent patients, yet adolescents were subjected to more stress. The mean level of Interleukin-6 was 148.0{+/-}50.5pg/ml, which is higher than average. Perceived Stress Scale mean scores showed a statistically significant difference between depressed adults and adolescents (p=0.050). ConclusionsInflammatory gene IL-6 shows a higher level in depressed adolescent and adult patients receiving hemodialysis. Adult patients are more depressed than adolescent patients with end-stage kidney disease yet coping strategies are far better in depressed adolescents than adults.

IntroductionChronic Kidney Disease (CKD) is being recognized as a global public health problem. CKD is a major non-communicable disease with the global prevalence varying between 10.5% and 13.1%. Diabetes and hypertension appear to be the leading causes of CKD and End Stage Renal Disease worldwide. The aim of this study is to determine the prevalence of CKD and its associated factors among patients admitted to medical ward in a tertiary hospital, Northern Ethiopia. MethodologyAn institution based cross-sectional study was undertaken using systematic random sampling technique to select study participants. Sample sizes of 450 patients were included in the study. Data was collected using a pre-tested semi-structured questionnaire designed to meet the study objective. The data collection period was from October 20, 2017 to March 20, 2018 G.C. Data was analyzed using SPSS version 21.The odds ratio with their 95% confidence interval and P value were calculated. Statistical significance was declared if P value < 0.05. ResultOf the 450 patients, 260(57.8%) were males. More than half (54.2%) were between ages of 25 to 40 years. The overall prevalence of CKD among patients admitted to medical ward was 17.3% (95% CI 13 - 29.9) and 14.4% (95 % CI 6.2 - 12.3) by Cockcroft Gault and MDRD equations respectively. Prevalence of stage 5 CKD was 61.5% by Cockcroft Gault equation. Hypertension AOR 3(95%CI 1.28, 4.1), history of recurrent urinary tract infection AOR 3.5 (95% CI 1.1, 7.3) and history of using nephrotoxic drugs AOR 3.4 (95% CI 2, 9.3) were significantly associated with CKD. ConclusionThe prevalence of CKD among adult patients admitted to medical ward in tertiary hospital, Northern Ethiopia was high and majority of patients with CKD were stage 5. Hypertension, use of nephrotoxic agents and recurrent urinary tract infections were significantly associated with CKD.

PurposeDepressive disorder is common among hemodialysis (HD) patients and is associated with higher mortality rate. However, depression screening and treatment in dialysis population remains insufficient. The aim of the study was to show the prevalence of depression in patients on maintenance HD and to discuss the proper diagnostic approach, including dementia screening. Patients and methodsWe conducted a cross-sectional study that included 103 HD patients from one Dialysis Centre in Gda[n]sk (Poland). Cognitive functions were evaluated using Mini-Mental State Examination (MMSE). The screening for depression was assessed using Beck Depression Inventory (BDI-II). The diagnosis of depressive disorder was confirmed and its severity evaluated by psychiatrists based upon clinical assessment and scales. Sociodemographic, laboratory and dialysis data were also collected. ResultsAccording to BDI-II depressive symptoms were present in 43% of patients while the diagnosis of clinical Major Depressive Disorder (MDD) was confirmed by the psychiatrists in 13% of all subjects. In the depressive disorder group there was a prevalence of female and patients suffering from diabetes mellitus, levels of calcium phosphate index (CaxPi) were higher and Kt/V was lower. The optimal cut- off score for diagnosing major depressive disorder using BDI-II was [&ge;] 20 points. Cognitive impairment on the level of major neurocognitive disorder (dementia) was found in 18 % of the study group. ConclusionsThe prevalence of depression assessed using self- or clinician-administered questionnaires was higher than reported by clinical interview performed by the psychiatrist. Higher scores of CaxPi and lower Kt/V in depressive patients may suggest worse compliance in this group. The psychiatrists examination as a part of care at the Dialysis Centre could improve diagnosis of depression and its treatment with the goal to improve quality of life and lower the mortality rate in this population.

Chronic Kidney Disease (CKD) is a major complication of diabetes with a high burden in low-resource settings including Ethiopia due to lack of dialysis, early screening and failure to identify the risk factors for the disease. In Ethiopia, there is a shortage of comprehensive evidence on CKD among diabetic patients. Therefore, this study focused on the gap to addresses CKD in diabetic patients and associated factors in Harari region, eastern Ethiopia. Hospital-based cross-sectional retrospective study was conducted among 315 diabetic patients. Five years data (from January 1, 2019, to December 31, 2024) was collected. Data was collected using Kobo software through chart reviews and checklists in February, 2025, and analyze by SPSS version 25. Descriptive statistics were used to describe frequency, percentage, and tabulation. Bivariable and multivariable logistic regression analyses were conducted to identify associated factors with the outcome variable. Adjusted odds ratio (AOR) with 95% confidence intervals were reported to quantify the strength of associations, and statistical significance was declared at a p-value < 0.05.The study revealed that the prevalence of CKD was (33.2%, 95% CI: 28.5-38.3) among diabetic patients. Alcohol consumption (AOR, 3.89; 95% CI: 1.88-8.03), duration of diabetic (AOR, 3.13; 95% CI: 1.62, 3.77), LDL (AOR, 2.13; 95% CI: 1.21-2.32), prior renal disease (AOR, 4.51; 95% CI: 4.36-5.45), and history of cardiovascular disease (AOR, 2.28; 95% CI: 1.17-4.43) were significantly associated with CKD. However, oral antidiabetic medications has protective effect of CKD (AOR, 0.025; 95% CI: 0.007-0.094). In the study, more than one-third of diabetic patients has developed CKD. Alcohol consumption, LDL, duration of diabetic, prior renal disease, history of cardiovascular disease, and oral therapy were found significantly associated with CKD. A tailored interventions like screening, and awareness creation should be given to diabetic patients to reduce the burden of CKD among diabetic patients.

IntroductionSerum neutrophil gelatinase-associated lipocalin (sNGAL), a renal tubular marker, and Neutrophil-to-Lymphocyte Ratio (NLR), a haematological inflammatory marker are two biomarkers that have recently received attention, because of their association with kidney disease. This study examined the diagnostic value sNGAL and NLR in type 2 diabetes mellitus (T2DM) patients with reduced eGFR. Materials and methodsIn this hospital-based case-control research, 97 T2DM participants and 70 healthy subjects were included. Participants information was documented using a structured questionnaire and patient case records. Venous blood was drawn from each participant to evaluate absolute neutrophil and lymphocyte count ratio, glycosylated haemoglobin (HBA1c), creatinine, sNGAL, and fasting blood glucose. ResultssNGAL and NLR were higher in diabetes patients with reduced eGFR than those with normal eGFR and control (p < 0.05). sNGAL level was negative correlated with eGFR among both good (r= -0.317, p= 0.036) and poor (r= -0.544, p< 0.001) glycaemic-controlled T2DM subjects with reduced eGFR. A negative correlation was observed between NLR and eGFR among poor glycaemic-controlled T2DM subjects with reduced eGFR (r= -0.329, p= 0.016). At a cut off of 8.87 {micro}g/L and 2.34 respectively, sNGAL and NLR were found to be good predictors of nephropathy among T2DM patients (AUC=100.0, p< 0.0001 and AUC=76.0, p< 0.0001 respectively) with sNGAL being the superior marker. ConclusionssNGAL and NLR have important diagnostic value for diabetic with reduced eGFR. Whiles sNGAL showed superiority and is recommended, NLR can serve as a less expensive and readily measurable alternative biomarker for diabetic patients with reduced eGFR, particularly in poorly controlled diabetes. These two markers can be added to the available array of tests used to indicate nephropathy in type 2 diabetics to help clinicians in better management of the disease.

Backgroud and ObjectiveAcute kidney injury (AKI) is a significant complication of COVID-19 infection, with varied incidence rates globally. COVID-19 has exacerbated AKI cases, with a significant portion of patients experiencing kidney damage. This study investigates the prevalence and risk factors associated with AKI among COVID-19 patients in Semarang, Central Java, Indonesia. MethodsData from 364 hospitalized COVID-19 patients in a hospital in Semarang between March 2020 and September 2021 were analyzed. Statistical analysis using chi-square and logistic regression examined the relationship between AKI and its determinants, with p[&le;]0.05 considered significant. ResultsThe majority of patients were male, most had no prior medical conditions. Analysis indicated links between AKI and various factors like several physical and supportive examination results. Few comorbidities were found to increase the risk of AKI, followed also by abnormal vital signs except blood pressure, several elevated level of laboratory results, and radiologic pneumonia finding. ConclusionCOVID-19 may harm the kidneys causing AKI. This study highlights the importance of history taking, examination, and laboratory monitoring to detect AKI in COVID-19 patients.

BackgroundSnakebite is a neglected tropical disease with a high burden in South Asia, particularly India. Acute kidney injury (AKI) is one of the most serious complications of snake envenomation, which has significant morbidity, mortality and risk of chronic kidney disease (CKD). The present study aimed to evaluate the incidence, predictors, and outcomes of snakebite-associated AKI (SBE-AKI) in a tertiary care centre. MethodsWe retrospectively analysed 325 patients with snakebite envenomation, admitted to our institution. Demographic, clinical, laboratory, and treatment variables were compared between patients with and without AKI. AKI was staged according to KDIGO criteria. Renal biopsy was performed in selected patients. Outcomes assessed included recovery, Progression to CKD, and mortality. ResultsOf the 325 patients, 79 (32.1%) developed AKI. Patients with AKI were significantly younger (mean age 34 vs. 45 years, p = 0.001). Delay in anti-snake venom (ASV) administration (18 vs. 6 hrs, p = 0.001), need for inotropes (41.8% vs. 14.2%, p = 0.001), and mechanical ventilation (36.7% vs. 6.9%, p = 0.001) were strong predictors. Proteinuria was more frequent in AKI (80% vs. 32.5%). Among AKI patients, 57% had stage 3 AKI; 39.2% required dialysis. Biopsy (n=8) showed acute tubular necrosis in 37.5% and cortical necrosis in 25%. Outcomes included 77.2% recovery, 6.3% progression to CKD, and 16.5% mortality. ConclusionSBE-AKI is a common and serious complication of snakebite. Delay in ASV administration, hemodynamic instability, proteinuria, advanced AKI stage and cortical necrosis predict poor outcomes. Early ASV, timely dialysis, and long-term nephrology follow-up are essential to improve survival and reduce CKD progression.

IntroductionNirmatrelvir/Ritonavir was approved for use in high risk outpatients with coronavirus disease (COVID-19). However, patients with severe chronic kidney disease, including patients on dialysis, were excluded from the phase 3 trial, and currently the drug is not recommended below a glomerular filtration rate of 30 ml/min/1.73m2. Based on available pharmacological data and principles, we developed a modified dose which was lower, and administered at longer intervals.We administered nirmatrelvir/ritonavir as 300/100 mg on day one, followed by 150/100 mg daily from day two to day five. In this case series, we report the initial experience with this modified dose regimen. MethodsThis is a retrospective chart review, conducted after obtaining institutional board approval. Demographic and outcome data was abstracted from the electronic medical record for dialysis patients who developed COVID-19 during the period of study and received nirmatrelvir/ritonavir. The principal outcomes we describe are symptom resolution, and safety data with the modified dose regimen in the dialysis patients. Results19 patients developed COVID-19 during the period of study of whom 15 received nirmatrelvir/ritonavir. 47% of them were female and 67% had diabetes. Most patients had received three doses of the vaccine (80%) while 13% were unvaccinated. Potential drug interactions concerns were common (median 2 drugs per patient) with amlodipine and atorvastatin being the commonest drugs requiring dose modification. Nirmatrelvir/ritonavir use was associated with symptom resolution in all patients, and was well tolerated. One patient had a rebound of symptoms, which improved in 2 more days. There were no COVID-19 related hospitalizations or deaths in any of the patients. ConclusionIn this case series of 15 hemodialysis patients with COVID-19, a modified dose of nirmatrelvir/ritonavir use, with pharmacist support for drug interaction management, was associated with symptom resolution, and was well tolerated with no serious adverse effects.

IntroductionGlomerular filtration rate (GFR) is invasive to measure. Therefore, in clinical care, estimated GFR is derived from serum levels of endogenous filtration markers such as creatinine and cystatin C. Multiple studies from high income countries showed differences between estimated glomerular filtration rate based on cystatin C (eGFRcys) and creatinine (eGFRcr). This study aimed to assess the agreement between eGFRcys and eGFRcr in Ethiopian children and identify factors influencing higher eGFRcys and eGFRcr. MethodWe studied 350 Ethiopian children who were part of the iABC birth cohort study. At the recent follow-up (average age 10 years), serum cystatin C and creatinine were measured. Formulas by Berg (2015) and Hoste (2014) were used to estimate eGFRcys and eGFRcr, respectively, and Bland-Altman plots assessed their agreement. The difference in eGFR (eGFRdiff) was calculated and categorized as less than-15 mL/min/1.73 m{superscript 2} (higher eGFRcr), between-15 and <15 mL/min/1.73 m{superscript 2} (concordant), and greater than or equal to 15 mL/min/1.73 m{superscript 2} (higher eGFRcys). Multinomial logistic regression was used to identify factors associated with higher eGFRcr and higher eGFRcys. ResultEstimated glomerular filtration rate (eGFR) showed significant variation based on the estimation formula used. When using formulas by Berg (2015) and Hoste (2014), the median (IQR) eGFRcys and eGFRcr were 99.4 (90.0; 114.1), and 123.2 (110.3; 143.8) mL/min/1.73 m2, respectively. Overall, we observed a poor agreement between eGFRcys and eGFRcr, with only 94 (27.6%) children having concordant results compared to 220 (64.7%) with higher eGFRcr and 26 (7.6%) with higher eGFRcys. If the eGFRcys results are considered reliable, 27.5% of the children had eGFR below 90 mL/min/1.73 m{superscript 2}. ConclusionThere was very marked variation in the distributions of estimated eGFRs depending on which formulas for children were used. Agreement between eGFR estimated using cystatin C and creatinine was poor among Ethiopian children. Relative to eGFRcys, kidney function may be overestimated by creatinine-based equation as up to 30ml/min in Ethiopia. Ideally, a validation study with GFR measured by gold standard methods (Inlulin clearance) among children is required. However, because of its invasive nature and financial concerns, Iohexol clearance studies are recommended.

BackgroundChronic Kidney Disease (CKD) affects 10-15% of the population worldwide. The number of dialysis patients is steadily rising in Ethiopia. Chronic hemodialysis patients experience high rates of mortality; however, data is lacking in Ethiopia. We explored the mortality and its driving factors in selected dialysis center in Addis Ababa Methodwe retrospectively followed a group of End-Stage Renal Disease patients on hemodialysis from 2016 to2020 in St. Paul Millennium Medical College (SPMMC), Zewditu Memorial Hospital (ZMH), and Menellik II Hospital. We fitted Kaplan Meier analysis to estimate the one and five years survival probability of these patients and Cox Proportional regression analysis to model the predictors of mortality at p value [&le;]0.05. ResultWe analyzed a data of (139) patients under follow up. The mean age ({+/-} SD) of the patients was 36.8 ({+/-}11.95) years. Twenty-four (17%) of the patients died at the end of follow-up. The median survival time was 46.2 months (95% CI: 41.8, 50.5). The one and five-years survival probability of these patients was 64.8% and 18.7%, respectively. Our analysis showed that patients with hypertension (AHR = 4.33; 95% CI: 1.02, 34.56), cardiac complication (AHR = 4.69; 95% CI: 1.32, 16.8), and infection during dialysis (AHR = 3.89; 95% CI: 1.96, 13.8) were more likely to die. ConclusionThe survival status of hemodialysis patients in three was low. Preventing and treating comorbidities and complication during dialysis would reduce mortality of CKD patients.

BackgroundSince December 2019, Coronavirus Disease 2019(COVID-19) occurred in wuhan, China, and outbreaked rapidly into a global pandemic. This current poses great challenges to hemodialysis (HD) patients. ObjectiveTo make a comprehensive evaluation and comparison between HD patients confirmed with COVID-19 and the general HD patients. MethodsHD patients confirmed with COVID-19 in Wuhan No.5 Hospital were admitted as confirmed group from Jan 10 to Mar 15, 2020. And HD patients not infected in our dialysis center were chosen as control group. General characteristics, laboratory indicators were retrospectively collected, analyzed and compared. ResultsA total of 142 cases were admitted, including 43 cases in confirmed group and 99 in control group. Body mass index (BMI) was slightly lower in confirmed group than that in control group (P=0.011). The proportion of one or less underlying disease in confirmed group(51.16%) was higher than that in control group(14.14%)(P< 0.001), and the proportion of three or more underlying diseases in confirmed group(11.63%) was lower than that in control group(52.53%)(P< 0.001). Patients in confirmed group exhibited significantly lower hemoglobin, lymphocyte count, and lymphocyte percentage, but higher neutrophil percentage, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein, aspartate transaminase, and alkaline phosphatase. There was no significant difference in age, gender, dialysis age, primary disease, the using of ACEI/ARB, platelet-to-lymphocyte ratio (PLR), and other indicators between the two groups. ConclusionsFaced with Severe Acute Respiratory Syndrome-CoV-2 (SARS-CoV-2), HD patients with lower BMI and hemoglobin were more susceptible to be infected, which might be related to malnutrition. Once confirmed with COVID-19, HD patients expressed obviously dis-regulated of inflammation and immune.

IntroductionChronic kidney disease (CKD) is often complicated by disorders in multiple body systems, associated with higher mortality and morbidity. Young people living with HIV (YPLHIV) have an increased risk of multisystem chronic comorbidities. However, there are few data describing comorbidities associated with CKD among YPLHIV. MethodsWe conducted a case-control study in seven ART clinics in Kampala, Uganda. Cases were YPLHIV (aged 10-24 years) diagnosed with CKD and controls were those without CKD. We collected data on demographic and clinical factors: blood pressure, fasting glucose levels, anaemia, electrolytes, parathyroid hormone, and cognitive impairment. We summarized the demographic and clinical factors and used logistic regression to estimate odds ratios (OR) and 95% confidence intervals for associations between CKD comorbidities, adjusted for age, sex and viral suppression. ResultsA total of 292 participants (96 cases and 196 controls) were recruited. Cases were mostly male (59.4% vs 36.5%), and younger (88.5% vs 46.4% aged <17 years) compared to controls. CKD was associated with having a detectable HIV viral load (OR=3.73; 95% CI 1.53-9.12) and proteinuria (aOR=4.19; 95% CI 2.28-7.72). CKD was also associated with low haematocrit, hypochloraemia, hyperphosphatemia, and high mean corpuscular volume. There was no evidence of an association of CKD with hypertension, anaemia, or stunting. ConclusionThe pattern of comorbidities among YPLHIV with CKD is uncertain and difficulties may relate to difficulty determining true kidney function and normal ranges in this population. Further studies are needed to discern the pattern of CKD complications to improve management efforts and clinical outcomes.

The incidence of acute kidney injury (AKI) in hospitalized patients with coronavirus disease 2019 (COVID-19) is variable, being associated with worse outcomes. The objectives of the study were to evaluate the incidence, risk factors and impact of AKI in subjects hospitalized for COVID-19 in two third- level hospitals in Cordoba, Argentina. A retrospective cohort study was conducted. 448 adults who were consecutively hospitalized for COVID-19 between March and the end of October 2020 at Hospital Privado Universitario de Cordoba and Hospital Raul Angel Ferreyra were included. The incidence of AKI was 19% (n = 85). 50.6% presented AKI stage 1 (n=43), 20% stage 2 (n=17) and 29.4% stage 3 (n=25, of which 18 required renal replacement therapy). In the multivariate analysis, the variables that were independently associated with AKI were: age (adjusted Odd ratio -aOR- =1.30, 95%CI=1.04-1.63, p=0.022), history of chronic kidney disease (aOR=9.92, 95%CI=4.52-21.77, p<0.001), blood neutrophil count at admission (aOR=1.09, 95%CI=1.01-1.18, p=0.037) and requirement for mechanical ventilation (MV) (aOR=6.69, 95%CI=2.24-19.9, p=0.001). AKI was associated with longer hospitalization, greater admission and length of stay in the intensive care unit, a positive association with bacterial superinfection, sepsis, respiratory distress syndrome, MV requirement and mortality (mortality with AKI=47.1% vs without AKI=12.4%, p<0.001). AKI was independently associated with higher mortality (aOR=3.32, 95%CI=1.6-6.9, p=0.001). In conclusion, the incidence of AKI in adults hospitalized for COVID-19 was 19% and had a clear impact on morbidity and mortality. Local predisposing factors for AKI were identified.