Reprocessing and reuse of dialyzers: A technological solution for balancing cost and quality in lower and middle-income countries.

Hemodialysis is the commonest kidney replacement therapy (KRT) globally and rapidly growing in developing countries, while in developed countries it is reaching a plateau. The penetration of hemodialysis (HD) varies widely among countries and is largely influenced by socioeconomics, healthcare financing, particularly by government, local infrastructure, healthcare workforce, health system characteristics, and affordability of the population. Biomedical equipment, consumables, disposables, and labor are major cost drivers of KRT.

Chronic Kidney Disease of Unknown Etiology: Case Definition for India - A Perspective.

Chronic kidney disease of unknown etiology (CKDu) is a form of chronic kidney disease (CKD) that is prevalent in certain rural populations around the world. It is distinct by its clinicopathologic characteristics and has multifactorial etiology, being mostly linked to several environmental toxins. Although the presentation is similar in various regions across the globe, it also differs in subtle ways from region to region.

A Comparison of Practice Pattern and Outcome of Twice-weekly and Thrice-weekly Hemodialysis Patients.

Renal replacement therapy (RRT) options and practice varies in countries worldwide and is influenced by patients' choice, nephrologists' practice patterns, health system, payer practice, public policy, and socioeconomic factors. In India, hemodialysis (HD) remains the dominant RRT modality, and the practice is largely influenced by socioeconomics of the region of practice since third party payer is limited. Resource stretch to maximize outcome benefit is essential and HD session twice weekly is an improvized and cost-effective clinical practice.

Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy.

Mortality is highest in the first months of maintenance hemodialysis (HD) therapy. In many Western countries, patients who transition to kidney replacement therapy usually begin thrice-weekly HD regardless of their level of residual kidney function (RKF). RKF is a major predictor of survival.

Outcomes and characteristics of intermittent hemodialysis for acute kidney injury in an intensive care unit.

Renal replacement therapy in intensive care units (ICUs) varies globally and is dependent on medical and non-medical factors. We performed a retrospective analysis of patients initiated on dialysis in an ICU. Patient and clinical characteristics, cause of kidney injury, laboratory parameters, hemodialysis characteristics, and survival were reviewed.

The metabolic syndrome and associated risk factors in an urban industrial male population in South India.

Background: The metabolic syndrome is characterized by clustering of risk factors, which predisposes subjects to increased risk of diabetes and cardiovascular disease. Objectives of this study were to estimate prevalence of the metabolic syndrome and determine the association of risk factors with the metabolic syndrome in an urban industrial male population in Chennai, India.

Methods: We conducted a cross-sectional survey for male employees working in an industrial unit.

A comparison of anthropometric indices for predicting hypertension and type 2 diabetes in a male industrial population of Chennai, South India.

Objectives: To assess the association of four obesity-related indices--body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR)--with hypertension and type 2 diabetes among a male industrial population in south India.

Design, Setting, And Participants: A cross sectional study of 2148 men aged 18-69 years in two purposely selected industrial units in Chennai, India, in 2003-2005.

Main Outcome Measures: The examination included blood pressure and anthropometric measurements (height, weight, hip circumference, and WC) to calculate BMI, WHR, and WSR.

Prevalence and distribution of cardiovascular risk factors in an urban industrial population in south India: a cross-sectional study.

Background: Cardiovascular diseases (CVD) are leading cause of death in developing countries including India. The huge burden of CVD in Indian subcontinent is the consequence of the large population and high prevalence of cardiovascular risk factors. This study was done to determine the prevalence of cardiovascular risk factors in two industrial units in Chennai, India.

Chronic peritoneal dialysis in South Asia - challenges and future.

Chronic peritoneal dialysis (PD), especially continuous ambulatory PD (CAPD), is being increasingly utilized in South Asian countries (population of 1.4 billion). There are divergent geopolitical and socioeconomic factors that influence the growth and expansion of CAPD in this region.

Are three exchanges suitable for Asian patients on peritoneal dialysis?

Phenomenal growth in continuous ambulatory peritoneal dialysis (CAPD) has occurred in the developing countries of Asia. In many regions in Asia, neither governments nor insurance companies fully cover treatment expenses for dialysis. Hence, patients in developing countries such as India, Bangladesh, Pakistan, and Nepal use just three 2-L exchanges daily.

Challenges and limitations of maintenance hemodialysis in urban South India.

Maintenance hemodialysis is a treatment modality available to few patients reaching end-stage renal disease in India. However, the morbidity and outcome of such treatment remains largely unknown. A retrospective cohort of patients commencing hemodialysis in a secondary care institution in India between January 1, 2002 and December 31, 2004 was studied.

Tacrolimus-associated hypomagnesemia in renal transplant recipients.

Background: Since hypomagnesemia occurs frequently in tacrolimus treated patients, we studied the correlation between renal magnesium wasting and tacrolimus blood levels in renal transplant patients.

Methods: Serum magnesium, fractional excretion of magnesium (FEMg), and 24-hour urinary excretion of magnesium were measured in 41 transplant patients and 10 healthy volunteers for correlation with tacrolimus level.

Results: Of tacrolimus-treated patients, 43% displayed hypomagnesemia.

Parathyroid hormone and biochemical profile in chronic kidney disease patients in South India.

Renal osteodystrophy is an important complication of chronic kidney disease characterized by abnormal bone turnover with varied bone histologic changes. Etiology is multifactorial including abnormalities of serum calcium, phosphorus, and 1,25(OH)(2)-vitamin D deficiency; secondary hyperparathyroidism; age; cause of kidney disease; diet; renal replacement therapy; and drug therapy. In addition, there is evidence that there may be ethnic differences.

Identification of a novel form of renal glucosuria with overexcretion of arginine, carnosine, and taurine.

Glucosuria occurs in diabetes mellitus, generalized proximal tubular dysfunction of Fanconi's syndrome, glucose-galactose malabsorption syndrome, and primary renal glucosuria. Patients with primary renal glucosuria have normal blood glucose levels, normal oral glucose tolerance test results, and persistent glucosuria that may approach the filtered load of glucose in the most severe cases. The primary defect is proposed to be in the sodium-glucose cotransporter type-2 (SGLT2) located in the apical membrane of S1 segment proximal renal tubule cells.

An analysis of the increased demands placed on dialysis health care team members by functionally dependent hemodialysis patients.

A team of health care providers is integral to the care of chronic hemodialysis patients and includes nephrologists, social workers, dietitians, and nurses. Increasingly, the chronic hemodialysis population is composed of older patients with multiple comorbid conditions and reduced functional independence. The demands placed on social workers, nurses, and dietitians caring for the increasingly fragile chronic hemodialysis population have not been examined.

Cryofibrinogenemia: an addition to the differential diagnosis of calciphylaxis in end-stage renal disease.

Cryofibrinogenemia is a disorder characterized by cryoprecipitation with variable clinical presentation that was first described by Korst and Kratochvil in 1955. Cryofibrinogen is a cold insoluble complex of fibrin, fibrinogen, and fibrin split products with albumin, cold insoluble globulin, factor VIII, and plasma proteins. Cryofibrinogenemia is associated with metastatic malignancies, collagen vascular diseases, and thromboembolic disorders and may be clinically asymptomatic or present with thromboembolic phenomena of skin and viscera.