Introduction: Nepal cannot afford renal replacement therapy for End Stage Renal Disease due to lack of resources. Early diagnosis of Chronic Kidney Disease and its risk factors may reduce the need of renal replacement therapy.Methods:A community-based screening on, 3218 people ≥20 years were assessed by door-to-door survey in Dharan, Nepal. Health status, lifestyle habit, physical examination and blood pressure were evaluated. Spot urine was examined for proteins and glucose by dipstick. Fasting blood glucose and serum creatinine were measured in a subset of 1000 people and the prevalence of Chronic Kidney Disease was evaluated.Results: Overweight, obesity, hypertension, diabetes and proteinuria were found in 20%, 5.0%, 38.6%, 7.5%, and 5.1% respectively. In the subset group, Chronic Kidney Disease was detected in 10.6%. Multivariate analysis indicated age (P <0.0001) and diabetes (P = 0.027) as statistically significant predictors for Chronic Kidney Disease. Total of 848 patients entered the management program of lifestyle modification and pharmacologic intervention. Glycemic and blood pressure control was achieved in 60% and 72%, respectively. Regression or stabilization of proteinuria was reported in 52% of patients. Conclusions: Burden of Chronic Kidney Disease and cardiovascular risk factors are high in Dharan. Reasonable control of blood sugar, hypertension and proteinuria was achieved in this program. Findings indicate that activation a large prevention and intervention program to tackle Chronic Kidney Disease and Cardiovascular Disease in Nepal is needed.Keywords: chronic kidney disease; community-screening; diabetes; hypertension; intervention; Nepal.

Background and Aims: Glomerular disease is the one of the major cause of end stage kidney disease in Nepal. We have undertaken this study to know the spectrum of glomerular disease in native kidneys in patients attending department of nephrology of Nepal Medical College Teaching Hospital.

Objective B.P. Koirala Institute of Health Sciences is the only dialysis center outside the capital city of Nepal. Although the burden of renal failure in Nepal is high, limited resources and dialysis facilities are the major constraint on management of acute renal failure (ARF) and acute dialysis in chronic renal failure (CRF). In the present study, carried out from January 2000 to June 2002, we looked into the prospect of introducing peritoneal dialysis (PD) to the district hospitals for treatment of ARF and acute dialysis in CRF. Patients and Methods We designed a form to evaulate the causes of renal failure and the indications for, complications of, and outcomes of dialysis. During this study, junior doctors in our hospitals completed the forms. Resident doctors were trained to do intermittent peritoneal dialysis (IPD) and were responsible for the carrying out the procedure under supervision, together with a staff nurse. Results A total of 120 patients underwent IPD during the study period, including 66 men and 54 women. The most common indications for acute dialysis in CRF were metabolic acidosis (56%), uremic encephalopathy (45%), and fluid overload (44%). The most common causes of ARF were acute gastroenteritis (20%), sepsis (20%), and septic abortion (16%). Fifteen patients died of sepsis and multi-organ failure. Conclusions Lack of dialysis facilities in the geographic periphery means that most patients present late in the course of their disease, as evidenced by severe metabolic acidosis and uremic encephalopathy. Peritoneal dialysis is a simple procedure, easily tolerated by the patient and requiring less expertise than hemodialysis does. Moreover, nursing staff, technicians, and doctors can be easily trained in the technique. Despite certain limitations, PD still has much potential and can be successfully accomplished in district hospitals and less accessible areas.

Introduction: Co-morbid depression impacts negatively on quality of life in Chronic Kidney Diseasepatients. It is unclear if self-reported depression rating scales can be used accurately for screening.The aim of this study was to estimate prevalence of depression in patients on hemodialysis usingPatient Health Questionnaire-9 and compare Patient Health Questionnaire-9, Max Hamilton Ratingscale and International Classification of Disease-10 for diagnosis of depression. Methods: It was descriptive cross-sectional study conducted from November 2017 till June 2018.Ethical approval was taken from Ethical Review Board, Nepal Health Research Council. Informedand written consent was taken. Patients undergoing hemodialysis at Nepal Medical College for >3 months duration were included in study. Patients on hemodialysis were asked to fill validatedNepali translated version of Patient Health Questionnaire -9. Psychiatrist administered MaxHamilton Rating scale for diagnosis and categorization of depression and confirmed depressionbased on International Classification of Disease -10. Statistical Package for Social Sciences version 20was used for statistical analysis. Results: Total of 100 patients completed study. Median age was 47.5 years. Prevalence of depressionwas 78 (78%) using Patient Health Questionnaire-9 and 65 (65%) using Max Hamilton Rating scaleand 51 (51%) using International Classification of Disease -10. Mean depression in males using PatientHealth Questionnaire -9 was 7±4.33 and in females was 11.04±5.90. The most common symptom wasfatigue among 82 (82%). Conclusions: There is a high prevalence of depression in patients with Chronic Kidney Disease onhemodialysis compared to general population.

Introduction: Dialysis nurses should have a good knowledge regarding hemodialysis treatment. The status of Nepalese dialysis nurses on this aspect is unknown. This study was done to assess the knowledge and practice on different aspects of the hemodialysis treatment. Methods: We distributed questionnaires to the participants of a conference held on September 24, 2016 in Kathmandu. We included 94 out of 116 participants who were giving care to dialysis patients. We calculated mean and standard deviation for continuous variables and frequencies and percentage for the responses and compared counseling with different parameters. Results: Response rate was >96%. Fifty-nine respondents (64%) were from age group 20-29 years. Only 39 (42%) received formal nursing training in hemodialysis. Seventy-one (78%) respondents always counseled patients regarding fluid intake. Thirty-seven (96%) trained nurses always counseled the importance of regular dialysis. Seventy-six (81.7%) respondents did counseling on vaccination against Hepatitis B. Counseling on vaccination against influenza and pneumococcus was 50%. When comparing educational status, respondents below bachelor level did more frequent counseling than level above (p=0.03). All the respondents knew the importance of hand washing and BP monitoring during hemodialysis. Ninety-one (96.7%) respondents knew how to deal with BP changes during hemodialysis. Seventy-three (77.6%) respondents were very confident on managing complications. Only 31(33%) respondents knew how to deal with patients on continuous ambulatory peritoneal dialysis. Conclusions: Dialysis nurses have knowledge on basic procedures of hemodialysis but there is a space for improvement in counseling and dealing with complications to provide quality service to hemodialysis patients. Keywords: counseling; hemodialysis; Nepal; nurse.

The risk of cardiovascular disease is higher in chronic kidney disease patients compared to the general population and its impact is higher in developing countries compared to the developed countries. With this background in mind, we aimed to evaluate the prevalence of different cardiovascular risk factors in patients on maintenance hemodialysis in a tertiary care center. Chronic kidney disease patients aged 18 years and above who were under maintenance hemodialysis in the hemodialysis unit of Nepal Medical College were included in the study. Pre-dialysis venous blood samples from the participants were collected and analyzed for serum calcium, phosphorus, total protein, albumin and hemoglobin. Calcium phosphate product was calculated. Out of 100 study participants, 52% were male and 48% were female. Age-wise distribution showed 38% of the participants were below 40 years. The mean age of the participants was 45.86 ± 14.4 years. Ninety-three percent had hypertension and 29% had diabetes mellitus. Hypocalcemia was present in 80%, hyperphosphatemia was seen among 81% and high calcium phosphate product was present in 33% of the participants. Low hemoglobin (< 10gm/dL) was found in 86%. The cardiovascular risk trend in the Nepalese chronic kidney disease population is fairly different compared to the western population. Participants were younger. Prevalence of hypertension and diabetes was high. The high prevalence of anemia might be due to unaffordability of the participants for regular erythropoietin therapy. Inadequately managed hyperphosphatemia despite the widespread use of phosphorus binders, is still a major clinical challenge in patients on hemodialysis.

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Retinal detachment is a rare, but well-known cause of visual impairment in patients with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. With supportive care, patients usually improve, with complete recovery of vision. Bedside ultrasonography of the orbit can be helpful for early detection of retinal detachment in these patients. Here, we present a case of HELLP syndrome presenting with severe visual symptoms. Retinal detachment was detected with point-of-care ocular sonography, which was confirmed with ophthalmoscopic examination. The patient was reassured of the favorable prognosis. Early initiation of aggressive supportive care was followed by progressive improvement of vision, which correlated with sonographic evidence of resolution of detachment. Her vision recovered completely in 2 weeks.