♦ Objectives: We studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up. ♦ Methods: We followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m 2 ) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m 2 ; overweight, 23 -24.9 kg/m 2 ; normal, 18.5 -22.9 kg/m 2 (reference category); and underweight, <18.5 kg/m 2 . The outcomes of interest were compared between the groups. ♦ Results: Of the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality (p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate (p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients. Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient-months (95% CI: 20.9 to 31.0 patient-months), 50 patient-months (95% CI: 33.6 to 66.4 patient-months), 57.7 patient-months (95% CI: 33.2 to 82.2 patient-months), and 49 patientmonths (95% CI: 18.4 to 79.6 patient-months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients. ♦ Conclusions: In our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.

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Non-Condon effects in vibrational spectroscopy refers to the dependence of a molecule's vibrational transition dipole and polarizability on the coordinates of the surrounding environment. Earlier studies have shown that such effects can be pronounced for hydrogen-bonded systems like liquid water. Here, we present a theoretical study of two-dimensional vibrational spectroscopy under the non-Condon and Condon approximations at varying temperatures. We have performed calculations of both two-dimensional infrared and two-dimensional vibrational Raman spectra to gain insights into the temperature dependence of non-Condon effects in nonlinear vibrational spectroscopy. The twodimensional spectra are calculated for the OH vibration of interest in the isotopic dilution limit where the coupling between the oscillators is ignored. Generally, both the infrared and Raman line shapes undergo red shifts with decrease in temperature due to strengthening of hydrogen bonds and decrease in the fraction of OH modes with weaker or no hydrogen bonds. The infrared line shape is further red-shifted under the non-Condon effects at a given temperature, while the Raman line shape does not show any such red shift due to non-Condon effects. The spectral dynamics becomes slower on decrease of temperature due to slower hydrogen bond relaxation and, for a given temperature, the spectral diffusion occurs at a faster rate upon inclusion of non-Condon effects. The time scales of spectral diffusion extracted from different metrics agree well with each other and also with experiments. The changes in the spectrum due to non-Condon effects are found to be more significant at lower temperatures.

BackgroundThere is an increased prevalence of hypothyroidism in chronic kidney disease (CKD) patients as the glomerular filtration rate falls. However, there is a paucity of Indian data in this respect.MethodsA cross-sectional analysis was performed based on the database of the information system of a tertiary care hospital in northern India to retrieve results of nephrology CKD outpatients (> 18 years of age) from September 2013 to October 2015 to determine the prevalence of hypothyroidism in the non–dialysis-dependent CKD population. Overt hypothyroidism was defined by a thyroid-stimulating hormone (TSH) level > 5.5 mIU/L and free T4 level < 0.89 ng/dL with clinical symptoms. Subclinical hypothyroidism was defined by a TSH level > 5.5 mIU/L and a free T4 level ≥ 0.89 ng/dL.ResultsAmong 1,863 CKD patients, 358 patients underwent biochemical analysis for hypothyroidism. Among these, 143 had biochemical subclinical hypothyroidism and 59 had overt hypothyroidism. Patients in the overt hypothyroid group had significantly higher TSH levels and a lower free T4 level than those in the nonhypothyroid group. Patients with hypothyroidism (both clinical and subclinical) had significantly lower serum albumin and serum calcium levels than those in the nonhypothyroid group. Intact parathyroid hormone was also significantly higher in the hypothyroid groups. An increased prevalence of hypothyroidism was observed in patients with a reduction in the glomerular filtration rate.ConclusionThere is growing evidence of increased prevalence of hypothyroidism in dialysis-independent CKD patients. A number of findings such as lower serum albumin, serum calcium, and hemoglobin levels and higher intact parathyroid hormone levels are seen in this group. Specific treatment can help improve these. Hence, there is a need to formulate guidelines to screen this population for hypothyroidism.