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Kanna G, Patodia S, Annigeri RA, Ramakrishnan N, Venkataraman R. Prevalence of Augmented Renal Clearance (ARC), Utility of Augmented Renal Clearance Scoring System (ARC score) and Augmented Renal Clearance in Trauma Intensive Care Scoring System (ARCTIC score) in Predicting ARC in the Intensive Care Unit: Proactive Study. Indian J Crit Care Med 2023; 27:433-443. [PMID: 37378369 PMCID: PMC10291663 DOI: 10.5005/jp-journals-10071-24479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023] Open
Abstract
Objectives We aimed to study the prevalence of augmented renal clearance (ARC) and validate the utility of ARC and ARCTIC scores. We also aimed to assess the correlation and agreement between estimated GFR (eGFR-EPI) and 8-hour measured creatinine clearance (8 hr-mCLcr). Study design and methodology This was a prospective, observational study done in the mixed medical-surgical intensive care unit (ICU) and 90 patients were recruited. 8 hr-mCLcr, ARC, and ARCTIC scores and eGFR-EPI were calculated for all patients. ARC was said to be present if 8 hr-mCLcr was ≥ 130 mL/min. Results Four patients were excluded from the analysis. The prevalence of ARC was 31.4%. The sensitivity, specificity, and positive and negative predictive values of ARC and ARCTIC scores were found to be 55.6, 84.7, 62.5, 80.6, and 85.2, 67.8, 54.8, and 90.9 respectively. AUROC for ARC and ARCTIC scores were 0.802 and 0.765 respectively. A strong positive correlation and poor agreement were observed between eGFR-EPI and 8 hr-mCLcr. Conclusion The prevalence of ARC was significant and the ARCTIC score showed good potential as a screening tool to predict ARC. Lowering the cut-off of ARC score to ≥5 improved its utility in predicting ARC. Despite its poor agreement with 8 hr-mCLcr, eGFR-EPI with a cut-off ≥114 mL/min showed utility in predicting ARC. How to cite this article Kanna G, Patodia S, Annigeri RA, Ramakrishnan N, Venkataraman R. Prevalence of Augmented Renal Clearance (ARC), Utility of Augmented Renal Clearance Scoring System (ARC score) and Augmented Renal Clearance in Trauma Intensive Care Scoring System (ARCTIC score) in Predicting ARC in the Intensive Care Unit: Proactive Study. Indian J Crit Care Med 2023;27(6):433-443.
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Affiliation(s)
- Girish Kanna
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Sristi Patodia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Rajeev A Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Ramesh Venkataraman
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
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Kumar RK, Annigeri RA, Gopalakrishnan R, Kaveripattu SS, Jain N. Bilateral renal mucormycosis following COVID-19 infection: A therapeutic challenge. Clin Nephrol Case Stud 2022; 10:76-81. [PMID: 36458102 PMCID: PMC9707366 DOI: 10.5414/cncs110874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/27/2022] [Indexed: 08/23/2023] Open
Abstract
India witnessed an epidemic of mucormycosis during the second wave of the COVID-19 pandemic. Renal mucormycosis has been reported rarely, mostly from India, but only 2 cases have been reported following COVID-19 infection to date. We report a case of mucormycosis predominantly affecting kidneys in a young and previously healthy male following COVID-19 pneumonia, for which he had received corticosteroid, remdesivir, and tocilizumab. He presented with hematuria, progressive oliguria, and severe acute kidney injury (AKI) requiring dialysis. The diagnosis was made on kidney biopsy and contrast-enhanced CT (CECT) showed segmental and subsegmental renal artery pseudoaneurysms with distal occlusion of both kidneys. He underwent bilateral nephrectomy and received high-dose amphotericin (AMB) and posaconazole. He developed cardiac arrhythmia and pulmonary edema attributed to AMB-related cardiotoxicity after a cumulative ABM dose of 2,450 mg. This is the first case report describing the survival of a patient with bilateral renal mucormycosis following COVID-19 infection. Our case report highlights the importance of considering mucormycosis in a patient with post-COVID-19 AKI to make an early diagnosis and aggressive management comprising of surgical debridement and high-dose AMB to improve survival.
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Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, Govil D, Savio RD, Subbarayan B, Arora N, Chatterjee R, Chacko J, Khasne RW, Chakravarthi RM, George N, Ahmed A, Javeri Y, Chhallani AK, Khanikar RG, Margabandhu S, Lopa AJ, Chaudhry D, Samavedam S, Kar A, Dixit SB, Gopal P. ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022; 26:S13-S42. [PMID: 36896356 PMCID: PMC9989875 DOI: 10.5005/jp-journals-10071-24109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022] Open
Abstract
Acute kidney injury (AKI) is a complex syndrome with a high incidence and considerable morbidity in critically ill patients. Renal replacement therapy (RRT) remains the mainstay of treatment for AKI. There are at present multiple disparities in uniform definition, diagnosis, and prevention of AKI and timing of initiation, mode, optimal dose, and discontinuation of RRT that need to be addressed. The Indian Society of Critical Care Medicine (ISCCM) AKI and RRT guidelines aim to address the clinical issues pertaining to AKI and practices to be followed for RRT, which will aid the clinicians in their day-to-day management of ICU patients with AKI. How to cite this article Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, et al. ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022;26(S2):S13-S42.
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Affiliation(s)
- Rajesh C Mishra
- EPIC Hospital, Sanjivani Super Speciality Hospital, Ahmedabad, Gujarat, India
| | | | | | - Niraj Tyagi
- Institute of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Rajeev A Annigeri
- Department of Nephrology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Deepak Govil
- Institute of Critical Care and Anaesthesiology, Medanta, Gurugram, Haryana, India
| | - Raymond D Savio
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | | | - Nitin Arora
- Department of Intensive Care, University Hospitals Birmingham, Birmingham, West Midlands, United Kingdom
| | - Ranajit Chatterjee
- Department of Anaesthesiology and Critical Care, Swami Dayanand Hospital, New Delhi, India
| | - Jose Chacko
- Narayana Health City, Bengaluru, Karnataka, India
| | - Ruchira W Khasne
- Department of Critical Care Medicine, SMBT Institute of Medical Sciences and Research Centre, Nashik, Maharashtra, India
| | | | - Nita George
- VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Ahsan Ahmed
- KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Super Speciality Hospital, Lucknow, Uttar Pradesh, India
| | | | - Reshu G Khanikar
- Department of Critical Care Medicine, Health City Hospital, Guwahati, Assam, India
| | | | - Ahsina J Lopa
- Intensive Care Unit, MH Samorita Hospital and Medical College, Tejgaon, Dhaka, Bangladesh
| | | | - Srinivas Samavedam
- Department of Critical Care, Vrinchi Hospital, Hyderabad, Telangana, India
| | - Arindam Kar
- Reliance Hospital, Mumbai, Maharashtra, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Palepu Gopal
- Department of Critical Care Medicine, Continental Hospitals, Hyderabad, Telangana, India
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Mishra RC, Sinha S, Govil D, Chatterjee R, Gupta V, Singhal V, Lobo VA, Annigeri RA, Karanth S, Lopa AJ, Ahmed A, Kishen R, Pande R, Javeri Y, Chaudhry D, Kar A. Renal Replacement Therapy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendation. Indian J Crit Care Med 2022; 26:S3-S6. [PMID: 36896362 PMCID: PMC9989876 DOI: 10.5005/jp-journals-10071-24278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/11/2022] [Indexed: 11/07/2022] Open
Abstract
Acute kidney injury (AKI) contributes significantly to morbidity and mortality in ICU patients. The cause of AKI may be multifactorial and the management strategies focus primarily on the prevention of AKI along with optimization of hemodynamics. However, those who do not respond to medical management may require renal replacement therapy (RRT). The various options include intermittent and continuous therapies. Continuous therapy is preferred in hemodynamically unstable patients requiring moderate to high dose vasoactive drugs. A multidisciplinary approach is advocated in the management of critically ill patients with multi-organ dysfunction in ICU. However, an intensivist is a primary physician involved in life-saving interventions and key decisions. This RRT practice recommendation has been made after appropriate discussion with intensivists and nephrologists representing diversified critical care practices in Indian ICUs. The basic aim of this document is to optimize renal replacement practices (initiation and management) with the help of trained intensivists in the management of AKI patients effectively and promptly. The recommendations represent opinions and practice patterns and are not based solely on evidence or a systematic literature review. However, various existing guidelines and literature have been reviewed to support the recommendations. A trained intensivist must be involved in the management of AKI patients in ICU at all levels of care, including identifying a patient requiring RRT, writing a prescription and its modification as per the patient's metabolic need, and discontinuation of therapy on renal recovery. Nevertheless, the involvement of the nephrology team in AKI management is paramount. Appropriate documentation is strongly recommended not only to ensure quality assurance but also to help future research as well. How to cite this article Mishra RC, Sinha S, Govil D, Chatterjee R, Gupta V, Singhal V, et al. Renal Replacement Therapy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendation. Indian J Crit Care Med 2022;26(S2):S3-S6.
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Affiliation(s)
- Rajesh C Mishra
- Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
| | - Sharmili Sinha
- Department of Critical Care Medicine, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Deepak Govil
- Department of Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurugram, India
| | | | - Vivek Gupta
- Department of Cardiac Anesthesia and Intensive Care, Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - Vinay Singhal
- Department of Critical Care Medicine, Fortis Hospital, Ludhiana, Punjab, India
| | | | - Rajeev A Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Sunil Karanth
- Department of Critical Care Medicine, Manipal Hospital, Bengaluru, Karnataka, India
| | - Ahsina Jahan Lopa
- Department of Intensive Care Unit, MH Samorita Hospital and Medical College, Tejgaon, Dhaka, Bangladesh
| | - Ahsan Ahmed
- Department of Critical care, KPC Medical College, Kolkata, West Bengal, India
| | - Roop Kishen
- Department of Intensive Care and Anesthesia, Salford Royal NHS Foundation Trust, Salford, Manchester, United Kingdom
| | - Rajesh Pande
- Department of Critical Care, BLK Superspeciality Hospital, Delhi, India
| | - Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India
| | - Dhruva Chaudhry
- Department of Pulmonology and Critical Care, PGIMS, Haryana, Rohtak, India
| | - Arindam Kar
- Calcutta Medical Research Institute, Kolkata, West Bengal, India
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Babu SS, Senthilnathan G, Shah SN, Annigeri RA. Double Anti-neutrophil Cytoplasmic Antibody and Anti-glomerular Basement Membrane Antibody-positive Crescentic Glomerulonephritis, Following SARS-CoV-2 Infection. Indian J Nephrol 2022; 32:491-494. [PMID: 36568610 PMCID: PMC9775608 DOI: 10.4103/ijn.ijn_344_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 12/27/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects kidneys mainly in the form of acute kidney injury but rarely can cause glomerular disease. On a very rare occasion, SARS-CoV-2 infection can be associated with anti-neutrophil cytoplasmic antigen (ANCA)-associated vasculitis and anti-glomerular basement membrane glomerulonephritis (anti-GBM GN). We report a case of a 59-year-old man who presented with progressive renal failure 8 weeks after contracting the viral infection, which progressed slowly to severe renal dysfunction. Renal biopsy showed crescentic glomerulonephritis (CrGN) accompanied by interrupted linear IgG deposits along the glomerular basement membrane (GBM) on immunofluorescence (IF) staining with associated mild acute tubular injury. The serology for anti-myeloperoxidase (MPO), as well as anti-GBM antibodies, was positive. He was treated with steroid and pulse intravenous cyclophosphamide, following which there was a significant improvement in the renal function and serological resolution of both the antibodies 6 months post-treatment. To the best of our knowledge, this is the first reported case of "double-antibody" positive CrGN following SARS-CoV-2 infection.
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Affiliation(s)
- Selvaraj Sridhar Babu
- Departments of Nephrology and Histopathology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Gopalan Senthilnathan
- Departments of Nephrology and Histopathology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Saloni N. Shah
- Departments of Nephrology and Histopathology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Rajeev A. Annigeri
- Departments of Nephrology and Histopathology, Apollo Hospitals, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Rajeev A. Annigeri, Department of Nephrology, 21, Gream's Lane, Chennai - 600 006, Tamil Nadu, India. E-mail:
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Shah S, Jacob SS, Mani R, Parameswaran A, Kumar S, Annigeri RA, Mahesh R, Uppuluri R. Renal Microsporidiosis in Pediatric Bone Marrow Transplant Recipients: A Case Series. Turk Patoloji Derg 2020; 36:68-72. [PMID: 29630083 PMCID: PMC10512666 DOI: 10.5146/tjpath.2017.01416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
Microsporidiosis is a rare, but emerging opportunistic infection in solid organ transplant and stem cell transplant recipients. Renal involvement in microsporidiosis is very rarely seen in these recipients. We describe two cases of pediatric renal microsporidiosis, diagnosed on renal biopsies, following bone marrow transplantation presenting as severe acute kidney injury. The first patient died, whereas the second survived due to early diagnosis based on high index of suspicion and prompt treatment with Albendazole. We believe these are the first such reported cases of renal microsporidiosis in pediatric bone marrow transplant recipients.
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Affiliation(s)
- Saloni Shah
- Department of Histopathology, Apollo Hospitals, CHENNAI, TAMIL NADU, INDIA
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7
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Doshi M, Annigeri RA, Kowdle PC, Subba Rao B, Varman M. Membranous nephropathy due to chronic mercury poisoning from traditional Indian medicines: report of five cases. Clin Kidney J 2019; 12:239-244. [PMID: 30976402 PMCID: PMC6452196 DOI: 10.1093/ckj/sfy031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Indexed: 11/13/2022] Open
Abstract
Mercury contained in traditional medicines can cause chronic poisoning, which can cause membranous nephropathy (MN). We report five cases of nephrotic syndrome caused by MN with evidence of chronic mercury poisoning due to consumption of traditional Indian medicines such as Siddha and Ayurveda, which to our knowledge are the first such reports. All patients were seronegative for antibodies against phospholipase A2 receptor (PLA2R). Two patients, who had severe nephrotic syndrome, had received Siddha medicine for prolonged period and oral chelation with dimercaptopropane-1-sulfonic acid was successful in eliminating mercury, resulting in an improvement in nephrotic state in these patients. We suggest that mercury poisoning should be entertained in patients with anti-PLA2R antibody-negative MN, with history of consumption of traditional Indian medicines.
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Affiliation(s)
- Manan Doshi
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Rajeev A Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Prakash C Kowdle
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Budithi Subba Rao
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Mahendran Varman
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
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Annigeri RA, Ostermann M, Tolwani A, Vazquez-Rangel A, Ponce D, Bagga A, Chakravarthi R, Mehta RL. Renal Support for Acute Kidney Injury in the Developing World. Kidney Int Rep 2017. [PMCID: PMC5678608 DOI: 10.1016/j.ekir.2017.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Rajeev A. Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, India
- Correspondence: Dr. Rajeev A. Annigeri, Apollo Hospitals, Department of Nephrology, 21, Greams Lane, Off Greams Road, Chennai, Tamil Nadu 600006, India.Apollo Hospitals, Department of Nephrology21, Greams Lane, Off Greams RoadChennaiTamil Nadu 600006India
| | - Marlies Ostermann
- Department of Nephrology & Critical Care, Guy’s & St Thomas’ Hospital, London, UK
| | - Ashita Tolwani
- Division of Nephrology, University of Alabama, Birmingham, Alabama, USA
| | | | - Daniela Ponce
- Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ravindra L. Mehta
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California, USA
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Nayak NM, Madhumitha S, Annigeri RA, Venkataraman R, Balasubramaian S, Seshadri R, Vadamalai V, Rao BS, Kowdle PC, Ramakrishnan N, Mani MK. Clinical utility of urine neutrophil gelatinase-associated lipocalin measured at admission to predict outcomes in heterogeneous population of critically ill patients. Indian J Nephrol 2016; 26:119-24. [PMID: 27051136 PMCID: PMC4795427 DOI: 10.4103/0971-4065.157800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a reliable early biomarker of acute kidney injury (AKI) in a homogeneous patient population. However, its utility in a heterogeneous population of critically ill, in whom the time of onset of renal insult is often unclear, is not clearly established. We evaluated the ability of a single measurement of uNGAL in a heterogeneous adult population, on admission to intensive care unit (ICU), to predict the occurrence of AKI and hospital mortality. One hundred and two consecutive adult patients had uNGAL measured within 8 h of admission to ICU. The demographic and laboratory data were collected at admission. The diagnosis of AKI was based on AKI Network (AKIN) criteria. The primary outcome was the development of AKI, and the secondary outcome was hospital mortality. The mean age was 54 ± 16.4 years and 65% were males. Urine NGAL (ng/ml) was 69 ± 42 in patients with AKI (n = 42) and 30.4 ± 41.7 in those without AKI (P < 0.001). The area under the receiver operating characteristic (ROC) curve for prediction of AKI was 0.79 and for serum creatinine (SCr) was 0.88. The sensitivity and specificity for a cut-off value of uNGAL of 75 ng/ml to predict AKI were 0.5 and 0.85 respectively. uNGAL > 75 ng/ml was a strong (odd ratio = 5.17, 95% confidence interval: 1.39–19.3) and independent predictor of hospital mortality. A single measurement of uNGAL at admission to ICU exhibited good predictive ability for AKI though the sensitivity was low. The predictive ability of uNGAL was inferior to simultaneously measured SCr at admission, hence limited its clinical utility to predict AKI. However, admission uNGAL was a strong, independent predictor of hospital mortality.
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Affiliation(s)
- N M Nayak
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - S Madhumitha
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R A Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Venkataraman
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - S Balasubramaian
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Seshadri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - V Vadamalai
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - B S Rao
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - P C Kowdle
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - N Ramakrishnan
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - M K Mani
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
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Annigeri RA, Nandeesh V, Karuniya R, Rajalakshmi S, Venkataraman R, Ramakrishnan N. Impact of dialysis practice patterns on outcomes in acute kidney injury in Intensive Care Unit. Indian J Crit Care Med 2016; 20:14-20. [PMID: 26955212 PMCID: PMC4759988 DOI: 10.4103/0972-5229.173682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim: Recent advances in dialysis therapy have made an impact on the clinical practice of renal replacement therapy (RRT) in acute kidney injury (AKI) in Intensive Care Unit (ICU). We studied the impact of RRT practice changes on outcomes in AKI in ICU over a period of 8 years. Subjects and Methods: AKI patients requiring RRT in ICU referred to a nephrologist during two different periods (period-1: Between May 2004 and May 2007, n = 69; period-2: Between August 2008 and May 2011, n = 93) were studied. The major changes in the dialysis practice during the period-2, compared to period-1 were introduction of prolonged intermittent RRT (PIRRT), early dialysis for metabolic acidosis, early initiation of RRT for anuria and positive fluid balance and use of bicarbonate-based fluids for continuous RRT (CRRT) instead of lactate buffer. The primary study outcome was 28-day hospital mortality. Results: The mean age was 53.8 ± 16.1 years and 72.6% were male. Introduction of PIRRT resulted in 37% reduction in utilization of CRRT during period-2 (from 85.5% to 53.7%). The overall mortality was high (68%) but was significantly reduced during period-2 compared to period-1 (59% vs. 79.7%, P = 0.006). Metabolic acidosis but not the mode of RRT, was the significant factor which influenced mortality. Conclusions: Adaption of PIRRT resulted in 37% reduction of utilization of CRRT. The mortality rate was significantly reduced during the period of adaption of PIRRT, possibly due to early initiation of RRT in the latter period for indications such as anuria and metabolic acidosis.
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Affiliation(s)
- Rajeev A Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | | | | | - Ramesh Venkataraman
- Department of Nephrology, Critical Care Unit, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Nagarajan Ramakrishnan
- Department of Nephrology, Critical Care Unit, Apollo Hospitals, Chennai, Tamil Nadu, India
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Annigeri RA, Rajagopalan M, Mani RM, Kaveripattu SS. Cytomegalovirus infection inducing flare of Behcet's disease with possible recurrence of glomerulonephritis after renal transplantation. Indian J Nephrol 2016; 26:45-8. [PMID: 26937079 PMCID: PMC4753742 DOI: 10.4103/0971-4065.157418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of young male with end-stage renal disease due to type III membranoproliferative glomerulonephritis (GN) and clinical features consistent with Behcet's disease (BD). He developed flare of BD 3 months after deceased donor renal transplantation following cytomegalovirus infection, in the form of oral and genital ulcers. He also had GN characterized by mild mesangial proliferation, neutrophilic infiltration and subepithelial, mesangial and intramembranous electron dense deposits, which could possibly be attributed to recurrence of renal disease due to BD. The clinical flare of BD was treated with colchicine with good response.
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Affiliation(s)
- R A Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - M Rajagopalan
- Department of Dermatology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R M Mani
- Department of Pathology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - S S Kaveripattu
- Department of Pathology, Apollo Hospitals, Chennai, Tamil Nadu, India
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Abstract
Pure red cell aplasia (PRCA) due to neutralizing antibodies can rarely develop following treatment with epoetin. The treatment of this condition is generally unsatisfactory and immunosuppression is often recommended, which improves chances of hematological recovery. We describe a case of PRCA due to neutralizing anti-epoetin antibodies following therapy with epoetin-α in a 68-year-old man on hemodialysis. He presented with severe transfusion-dependent anemia and was initially treated with prednisolone and oral cyclophosphamide. However, within 2 weeks the immunosuppressive drugs had to be stopped due to complications, following which he remained transfusion dependent. Subsequently, he was given two doses 700 mg each of rituximab following which there were hematological recovery and resolution of anti-epoetin antibodies.
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Affiliation(s)
- S A Mahajan
- Department of Nephrology, Apollo Hopsitals, Chennai, Tamil Nadu, India
| | - N Nandagopal
- Department of Nephrology, Apollo Hopsitals, Chennai, Tamil Nadu, India
| | - M Soni
- Department of Pathology, Apollo Hopsitals, Chennai, Tamil Nadu, India
| | - R A Annigeri
- Department of Nephrology, Apollo Hopsitals, Chennai, Tamil Nadu, India
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Annigeri RA, Parameswaran A. Zygomycosis Presenting as Acute Bilateral Renal Artery Thrombosis in a Healthy Young Male. J Assoc Physicians India 2015; 63:77-79. [PMID: 26591179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a case of acute renal artery thrombosis due to disseminated zygomycosis in a healthy young adult male.The diagnosis of renal artery occlusion was made on contrast-enhanced CT (CECT) and confirmation of etiology was made only on post mortem biopsy. We suggest that the presence of vascular thrombosis on CECT in a patient presenting with febrile illness should be regarded as an indicator of possible infection by angiotropic fungi, such as zygomycosis, which could help clinician to pursue histological diagnosis aggressively.
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Abstract
Recent reports indicate that statins can cause nephrotoxicity. However, the mechanisms of nephrotoxicity remain unclear. We report a case of acute kidney injury (AKI) in a 54-year-old man following the administration of atorvastatin Renal biopsy showed acute interstitial nephritis. Atorvastatin was withdrawn and he was treated with corticosteroid following which renal function recovered. When he was rechallenged with rosuvastatin 6 months later following an episode of acute myocardial infarction, he developed AKI again indicating class effect of statin for nephrotoxicity.
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Affiliation(s)
- R A Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R M Mani
- Department of Pathology, Apollo Hospitals, Chennai, Tamil Nadu, India
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Nayak R, Annigeri RA, Vadamalai V, Seshadri R, Balasubramanian S, Rao BS, Kowdle PC, Mani MK. Accuracy of spot urine protein creatinine ratio in measuring proteinuria in chronic kidney disease stage 3 and 4. Indian J Nephrol 2013; 23:428-33. [PMID: 24339521 PMCID: PMC3841511 DOI: 10.4103/0971-4065.120340] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We studied the accuracy of spot urine protein creatinine ratio (SpUr-PCR) to assess 24 h urine protein excretion (24 h-UP) in patients with chronic kidney disease (CKD). A total of 100 proteinuric CKD patients of stages 3 and 4 were studied. 24 h urine was collected to measure 24 h-UP and creatinine. A random day time urine sample was analyzed to measure the PCR. A formula to estimate 24 h creatinine excretion was derived from linear regression analysis and a correction factor was introduced to assess whether this improves the accuracy of the SpUr PCR in predicting 24 h-UP. Accuracy of the SpUr-PCR was assessed by Pearson's correlation, regression analysis, and Bland Altman analysis. Mean age was 51.85 ± 12 years and 81% of the patients were male. SpUr-PCR predicted 24 h-UP with good accuracy (r = 0.86 on a data transformed to a logarithmic scale, P < 0.001) and there was a good agreement between these two measures of proteinuria. However, SpUr-PCR was inaccurate in the subgroup with nephrotic range proteinuria (r = 0.35, P = 0.062), but when a correction factor for 24-h urine creatinine (24 h-UCr) was introduced, the accuracy of SpUr-PCR improved significantly in this group (r = 0.45, P = 0.013). Introduction of the correction factor improved the degree of agreement between these two measures in women, but not the correlation. Overall, SpUr-PCR accurately predicted 24 h-UP. Adding a correction factor for 24 h-UCr improved correlation in the subgroup of patients with the nephrotic range proteinuria and the degree of agreement in female patients, and hence may be used in expressing proteinuria measured by SpUr-PCR to improve its accuracy in them.
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Affiliation(s)
- R Nayak
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
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Annigeri RA. Urinary biomarkers in acute kidney injury. Apollo Medicine 2013. [DOI: 10.1016/j.apme.2013.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Annigeri RA. Medical therapy is best for atherosclerotic renal artery stenosis: Arguments for. Indian J Nephrol 2012; 22:1-4. [PMID: 22279335 PMCID: PMC3263056 DOI: 10.4103/0971-4065.91177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Atherosclerotic renal artery stenosis (ARAS) is a common condition that causes hypertension and reduction in the glomerular filtration rate and is an independent risk factor for death. Despite high technical success, the clinical benefit of renal artery (RA) angioplasty with stenting in ARAS remains doubtful. The published randomized clinical trials provide no support for the notion that renal angioplasty with stenting significantly improves blood pressure, preserves renal function, or reduces episodes of congestive heart failure in patients with ARAS. RA stenting is associated with procedure-related morbidity and mortality. Agents to block the renin-angiotensin-aldosterone system improve outcome and should be a part of a multifaceted medical regimen in ARAS. Medical therapy effectively controls atherosclerotic renovascular disease at all levels of vasculature and hence is the best therapy for ARAS.
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Abstract
We report a case of rickets due to Dent's disease in a two-year-old boy. He was treated with sodium phosphate, calcitriol and potassium citrate supplements, following which there was a remarkable improvement in mobility, growth and bony deformities. The hypercalciuria associated with Dent's disease was effectively corrected using hydrochlorothiazide.
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Affiliation(s)
- R A Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, India
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Annigeri RA, Limesh M. Defining deficiency of vitamin D based on 25(OH)D concentration: is it real? Nephrology (Carlton) 2009; 14:767; author reply 767-8. [PMID: 20025688 DOI: 10.1111/j.1440-1797.2009.01206.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ganesan MV, Annigeri RA, Shankar B, Rao BS, Prakash KC, Seshadri R, Mani MK. The protein equivalent of nitrogen appearance in critically ill acute renal failure patients undergoing continuous renal replacement therapy. J Ren Nutr 2009; 19:161-6. [PMID: 19218043 DOI: 10.1053/j.jrn.2008.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To assess the nutritional status of critically ill patients with acute renal failure on continuous renal replacement therapy (CRRT) and their protein needs by estimating the protein equivalent of nitrogen appearance (PNA). DESIGN Prospective, observational study. SETTING A 74-bed intensive care unit in a single tertiary care hospital. PATIENTS Twenty-five consecutive critically ill patients with acute renal failure on CRRT. METHODS The patients were studied over a period of 24 hours, at initiation on CRRT. The nutritional status was assessed by anthropometry and bioimpedance analysis. The PNA was estimated using the Bergstrom equation and PNA was normalized to body weight. RESULTS The mean age was 58.2 +/- 17 years and 20 (80%) were male. The mean weight was 67 +/- 12 kg, body mass index was 25 +/- 3.5 kg/m(2), and triceps and subscapular skin fold thickness were 13 +/- 4.6 mm and 15 +/- 2.5 mm, respectively. Bioimpedance studies showed that the total body water was increased at 61.7 +/- 5.5% and body fat was 31.8 +/- 5.4%. The PNA was 103 +/- 35 g/day and normalized PNA was 1.57 +/- 0.4 g/kg/day. The mean protein intake was 0.56 +/- 0.38 g/kg/day, resulting in mean net negative protein balance of 1.0 +/- 0.6 g/kg/day. CONCLUSIONS Malnutrition was uncommon in patients with acute renal failure at the time of initiation on CRRT, but their total body water was increased. They exhibited hypercatabolism and the mean normalized PNA was 1.57 g/kg/day. A large negative nitrogen balance was observed in them, since their protein intake was suboptimal.
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Srinivas S, Annigeri RA, Mani MK, Rao BS, Kowdle PC, Seshadri R. Estimation of glomerular filtration rate in South Asian healthy adult kidney donors. Nephrology (Carlton) 2008; 13:440-6. [PMID: 18518932 DOI: 10.1111/j.1440-1797.2008.00967.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIM We evaluated the performance of serum creatinine based equations to estimate glomerular filtration rate (GFR) in South Asian healthy renal donors. METHODS GFR by 99mTc-diethylenetriamine pentaacetic acid (DTPA) renogram (mGFR) in 599 renal donors was measured. GFR was estimated using a six variable modification of diet in renal disease formula (MDRD1), a four variable MDRD formula (MDRD2), Cockcroft-Gault creatinine clearance (CG CrCl), Cockcroft-Gault glomerular filtration rate (CG GFR) and the Mayo Clinic formula (Mayo GFR). The performance of various prediction equations was compared for global bias, precision (R(2)) and accuracy (percentage of estimated GFR (eGFR) falling within 15% and 30% of mGFR). RESULTS The mean age was 37.4 +/- 11 years and 48.2% were male. The mGFR was 95.5 +/- 11.6 mL/min per 1.73 m(2). The bias (mL/min per 1.73 m(2)) was 7.5 +/- 0.9, -9.0 +/- 0.75, 13.1 +/- 0.9, 7.5 +/- 0.9 and 23.4 +/- 0.76 for CG CrCl, CG GFR, MDRD1, MDRD2 and Mayo GFR, respectively. R(2) was 0.082 for CG CrCl and MDRD1, 0.081 for CG GFR and MDRD2 and 0.045 for Mayo GFR. The percentages of eGFR falling within 15% and 30% of mGFR were 50.5 and 80.1 for CG CrCl, 65.8 and 84 for CG GFR, 50 and 74 for MDRD1, 54.3 and 80.1 for MDRD2 and 32 and 63.4 for Mayo GFR. Overall CG GFR performed better in estimating GFR in all subjects. CONCLUSION The CG GFR equation was better than other equations to estimate GFR in South Asian healthy renal donors. We propose a new equation derived from the regression model in our study population to estimate GFR in a South Asian healthy adult population.
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Annigeri RA, Ganesan VM. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) and neurological crisis due to acute intermittent porphyria, successfully treated with haemodialysis. J Assoc Physicians India 2007; 55:667-669. [PMID: 18051744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report an eighteen year old female, a case of acute intermittent porphyria with syndrome of inappropriate antidiuretic hormone secretion, as presenting feature for its rarity. The neurological crisis was successfully treated with haemodialysis.
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Affiliation(s)
- R A Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, India
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Sanjay S, Annigeri RA, Gopalakrishnan R. Refractory hyperkalaemia due to trimethoprim, successfully treated with fludrocortisone. J Assoc Physicians India 2007; 55:74-5. [PMID: 17444347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report a case of intractable hyperkalaemia in an elderly patient with myeloma, who received conventional dose of trimethoprim-sulfamethoxazole and hyperkalaemia resolved following therapy with fludrocortisone. We recommend monitoring of serum potassium in high-risk patients receiving conventional doses of trimethoprim-sulfamethoxazole for 5 or more days.
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Affiliation(s)
- S Sanjay
- Departments of Nephrology, Apollo Hospitals, Chennai, India
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Prakashan KP, Annigeri RA, Chu M, Bargman JM, Vas SI, Oreopoulos DG. Local application of mupirocin at the peritoneal catheter exit site prevents early postoperative infections and should become standard practice. Perit Dial Int 2001; 21:526-7. [PMID: 11757842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Annigeri RA, Prakash GK, Balasubramaniyam R, Balasubramaniam S, Prakash KC, Kavitha MK. 'O' set connector system in CAPD. J Assoc Physicians India 1996; 44:602-5. [PMID: 9251369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
51 CAPD patients (age 55.5 +/- 14.5 yrs, 35 male, 16 female) on CAPD using 'O' set were studied retrospectively during the period January 1993 to April 1995. Etiology of ESRD was Diabetic nephropathy-25(49%) and the other causes-26(51%). The total duration of observation on 'O' set was 553 patient months, the mean duration was 10.8 +/- 6.1 months. 24 patients (47%) developed total of 30 episodes of peritonitis. The incidence of peritonitis was 18.4 patient months per episode of peritonitis. The organisms responsible for peritonitis were Gram positive-6(20%), Gram negative-3(10%), Fungal-1(3.3%), Mycobacterial-1(3.3%), Eosinophilic-1(3.3%), Sterile-12(40%) and unknown-6(20%) 2 patients of bacterial peritonitis and a patient with tuberculous peritonitis died while rest of the patients responded favourably to antibiotics. 13(52%) diabetic patients and 11(42%) non-diabetic patients had peritonitis (p-NS) and the peritonitis rates in diabetics and non diabetics were 18.3 and 18.6 patient months per episode respectively (p-NS). Exit site infection was seen in 5 patients (10%) (Staph aureus-4, Enterococci-1) and all responded to antibiotic therapy. 7 patients had total of 10 episodes of symptomatic accidental intraperitoneal sodium hypochlorite instillation, none had any long term adverse effects. The 'O' set procedure was done by self in 10(20%) and by others in 41(80%) cases. The peritonitis rates when performed by self and others were 18.5 and 18.4 patient months per episode respectively (p-NS). The cost of being on CAPD using 'O' set, Y-bag and twin bag were Rs. 1,50,000, 2,10,000 and 3,72,000 per annum respectively and cost of maintenance haemodialysis was 1,36,800 per annum. The cost of CAPD using 'O' set was comparable to that of maintenance haemodialysis. The 'O' set connector system in CAPD is found to be safe, cost effective and efficient.
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