{"title":"Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors for Anemia in Dialysis-Dependent Chronic Kidney Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Jyoti Tyagi, Manveen Kaur, Samiksha Ingale, Raja Ramachandran, Priti Meena, Divya Bajpai, Soumyadeep Bhaumik","doi":"10.25259/ijn_379_23","DOIUrl":"10.25259/ijn_379_23","url":null,"abstract":"<p><p>Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are oral drugs for patients with renal anemia. This study aimed to synthesize evidence on HIF-PHIs for anemia in dialysis-dependent chronic kidney disease (DD-CKD) patients. We searched PubMed, CINAHL, and Cochrane Central Register of Controlled Trials databases and trial registries for randomized controlled trials (RCTs) reporting HIF-PHIs versus erythropoietin-stimulating agents (ESA) for anemia in DD-CKD patients. Two authors independently conducted screening, data extraction, and assessed risk of bias. We used RevMan 5.3 software for meta-analysis using standard methods. Certainty of evidence was assessed by Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). We included 20 RCTs involving 14,999 patients with anemia of kidney disease. The studies included roxadustat (n = 9), daprodustat (n = 5), vadadustat (n = 2), molidustat (n = 2), enarodustat (n = 1), and desidustat (n = 1). Overall, daprodustat as an alternative to ESAs reported a substantial net benefit while roxadustat showed more damage than benefit as compared to ESAs. While other HIF inhibitors demonstrated little to no difference or small benefit, daprodustat reduces the need for intravenous iron supplementation up to 52 weeks as compared to ESAs [Odds Ratio (OR): 0.77 (95% CI 0.53-1.13); p = 0.18; two studies; 674 participants; moderate certainty evidence]. Roxadustat increased treatment-emergent adverse events up to 6-52 weeks as compared to ESAs [OR: 1.45 (95% CI 1.08-1.96); p = 0.01; six studies; 1715 participants; moderate certainty evidence]. The study provided evidence on the use of HIF-PHIs for treating renal anemia in DD-CKD patients as an alternative to ESAs.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"198-216"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Peritoneal Dialysis in India is Dying-Is Weaning from the Ventilator Likely?","authors":"Tarun Kumar Jeloka, Narayan Prasad, Amit Gupta","doi":"10.25259/IJN_548_2024","DOIUrl":"10.25259/IJN_548_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"123-126"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How to Give Dietary Advice to Patients with Kidney Disease?","authors":"Archana Sinha, Narayan Prasad","doi":"10.25259/IJN_139_2024","DOIUrl":"10.25259/IJN_139_2024","url":null,"abstract":"<p><p>Patients with chronic kidney disease (CKD) display a variety of metabolic and nutritional irregularities, with majority of patients already being malnourished before starting dialysis. The screening, assessment and monitoring of nutritional status using an amalgamation of valid, complementary methods is crucial. Early and suitable dietary intervention is vital for preventing, diagnosing and treating malnutrition. All the misconceptions and myths about diet and food need to be resolved. Patient-centric realistic meal plans and dietary counseling are initiated at the early stages of CKD and the commencement of dialysis, with regular follow-ups on an ongoing basis with diet diaries that help prevent malnutrition. This review article will discuss the practical and simple dietary approaches for counseling patients to increase dietary compliance and meet the recommended requirements.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"178-186"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of Standard and Global Coagulation Tests in Hemodialysis Patients.","authors":"Smita Divyaveer, Sarah Chahal, Madhuri Kashyap, Madhumita Premkumar, Kushal Kekan, Arunima Sen, Kanchan Prajapati, Prabhat Chauhan, Ritika Bansal, Arun Prabhahar, Jasmina Ahluwalia, Narender Kumar, Nabhajit Mallik, Deepy Zohmangaihi, Harbir Singh Kohli","doi":"10.25259/ijn_473_23","DOIUrl":"10.25259/ijn_473_23","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is associated with an increased tendency of bleeding and thrombosis. There are multiple factors that interact with each other to cause either in CKD patients. Conventional or standard coagulation tests (SCT) have several limitations. Global coagulation test (GCT), such as Sonoclot, gives a real-time detailed analysis of coagulation status.</p><p><strong>Materials and methods: </strong>This is a prospective observational cross-sectional study of 50 adult CKD stage 5D (dialysis) patients conducted from January 2020 to January 2022. Clinical details were noted and blood samples were taken for conventional and global coagulation tests prior to dialysis. Correlation between SCT and GCT as well as clinical hemostatic events was analyzed.</p><p><strong>Results: </strong>Fifty patients were enrolled. Bleeding and thrombosis occurred in 7 and 5 patients, respectively. There was a significant correlation between some SCT and GCT parameters. None of the SCT parameter derangement was associated with any thrombotic episodes except increased fibrinogen level which was associated with thrombotic events. On the contrary, patients with hypocoagulability according to SCT actually had thrombotic events. Parameters of GCT, such as clot rate, time to peak, and platelet function were significantly associated with thrombotic episodes.</p><p><strong>Conclusion: </strong>SCT and GCT parameters do not correlate with each other. SCT is not associated with clinically significant bleeding and thrombotic events. Some GCT parameters are associated with thrombotic events. GCT are real time and are better than SCT to reflect the coagulation status in patients on dialysis.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"259-264"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anti-Glomerular Basement Membrane Antibody Disease: Clinicopathologic Profile and Outcomes.","authors":"Manoj Kumar, Varadharajan Jayaprakash, Natarajan Gopalakrishnan, Thanigachalam Dineshkumar, Ramanathan Sakthirajan, Jeyachandran Dhanapriya","doi":"10.25259/IJN_110_2024","DOIUrl":"10.25259/IJN_110_2024","url":null,"abstract":"<p><strong>Background: </strong>Anti-glomerular basement membrane antibody disease is a rare autoimmune disease caused by antibodies to α3 chain of type 4 collagen. Patients presenting with severe renal involvement requiring dialysis have poor response to treatment.</p><p><strong>Materials and methods: </strong>We conducted a retrospective and prospective study at Institute of Nephrology, Madras Medical College, Chennai, India by analyzing the data of patients with biopsy-proven anti-GBM antibody disease treated from January 2013 to December 2019.</p><p><strong>Results: </strong>There were 2,949 kidney biopsies in the study period and 92 showed crescentic glomerulonephritis (GN). Of those, 20 patients (10 males) had anti-GBM antibody disease. Mean age was 40.75 ± 14.75 years. Rapidly progressive renal failure was the most common mode of presentation (95%); five (25%) patients had diffuse alveolar hemorrhage (DAH) and nineteen patients (95%) required dialysis at presentation. Seven patients (35%) were positive for anti-neutrophil cytoplasmic antibody (anti-myeloperoxidase in six and anti-proteinase 3 in one). Of the twelve patients (60%) who received immunosuppression (cyclophosphamide, steroids, and plasma exchange), two patients (10%) attained remission, and two patients (10%) expired due to sepsis. Crescentic GN was the predominant pathology in kidney biopsy in 19 patients (95%). Mesangial hypercellularity with deposition of IgA and C3 in mesangium was present in one patient.</p><p><strong>Conclusion: </strong>In our study, anti-GBM antibody disease accounted for 21.7% of crescentic GN. Majority of patients presented late, requiring dialysis. Patient survival was 90%, while renal survival was only 10%. One patient had co-occurrence of IgA nephropathy with anti-GBM antibody disease.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"265-269"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lia Sarah Anish, Aishwarya P Lakshmi, S Mathini, R Ram
{"title":"\"Jogger's Nephritis\" After Pilgrimage.","authors":"Lia Sarah Anish, Aishwarya P Lakshmi, S Mathini, R Ram","doi":"10.25259/IJN_480_2024","DOIUrl":"10.25259/IJN_480_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"313-314"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intravascular Hemolysis During Therapeutic Plasma Exchange Using 5% Human Albumin: What is Missed?","authors":"Abhilasha Soni, Manish Chaturvedy, Rajesh Jhorawat, Nitin Bajpai","doi":"10.25259/IJN_437_2024","DOIUrl":"10.25259/IJN_437_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"312-313"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Turning Challenges into Opportunities: A Conversation with Patient Living with Dialysis and His Path to Entrepreneurship.","authors":"Aditya S Pawar, Kamal D Shah","doi":"10.25259/IJN_459_2024","DOIUrl":"10.25259/IJN_459_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"315-318"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabina Yusuf, Suceena Alexander, Sanjeet Roy, Grace Rebekah, Elenjickal Elias John, Athul Thomas, Jeethu Joseph Eapen, Vinoi George David, Santosh Varughese
{"title":"Glomerulonephritis After Renal Transplatation in South Asia - Single Center Experience Over 5 Decades.","authors":"Sabina Yusuf, Suceena Alexander, Sanjeet Roy, Grace Rebekah, Elenjickal Elias John, Athul Thomas, Jeethu Joseph Eapen, Vinoi George David, Santosh Varughese","doi":"10.25259/IJN_39_2024","DOIUrl":"10.25259/IJN_39_2024","url":null,"abstract":"<p><strong>Background: </strong>With significant advances in the understanding of transplant immunology and a reduction in rejection rates, significant improvements in kidney allograft survival have been seen. The problem of recurrent and denovo glomerular diseases after transplantation affecting graft outcomes remains and is poorly characterized. This study aimed to analyze the incidence, characteristics, and outcomes of glomerulonephritis (GN) after kidney transplant in the Indian subcontinent.</p><p><strong>Materials and methods: </strong>Data on patients who underwent kidney transplants in our hospital from 1971 to 2018 was analyzed. Patients who had biopsy proven glomerulonephritis after transplant were included in the study. Demographic factors, characteristics of glomerulonephritis after transplant, and patient and graft outcomes were studied.</p><p><strong>Results: </strong>Post-transplant glomerulonephritis was seen in 177 out of 3630 (4.8%) patients. IgA nephropathy (IgAN) was the most common type, followed by focal segmental glomerulosclerosis (FSGS) and thrombotic microangiopathy (TMA). Patients with IgAN and FSGS were younger, and native kidney disease was unknown in the majority (70% in IgAN and 40% in FSGS). Glomerulonephritis was the most common cause of graft loss. A serum creatinine level of ≥2 mg/dL at 1 year post-transplant was significantly associated with the risk of death and graft loss. In addition, the occurrence of glomerulonephritis within a year of transplant and cytomegalovirus (CMV) infection were found to be significant risk factors for death and graft loss, respectively.</p><p><strong>Conclusion: </strong>Post transplant glomerulonephritis can significantly impact patient and graft outcomes. Understanding its etiology and pathogenesis is crucial to enabling its prevention and management and improving the outcomes of kidney transplantation.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"270-276"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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