In Pakistan, patients with chronic kidney disease (CKD) are commonly diagnosed at a late stage. There is little information about the refusal of hemodialysis by hospitalized CKD patients who need hemodialysis (HD) and reasons for acceptance and refusal among these patients. All patients with Stage V CKD who had medical indications to undergo HD and were hospitalized at a tertiary care facility over a six-month period were invited to participate in this study. Patients were surveyed regarding acceptance or refusing of HD and reasons for their decisions. Demographic, socioeconomic, and clinical characteristics of patients were compared between patients who accepted or refused HD. A total of 125 patients were included in the study. The mean age of the patients was 47.9 ±12.1 years. The mean duration of diagnosis of CKD was 2.5 ± 0.6 months. Of all patients, 72 (57.6%) agreed to do HD and 53 (42.4%) refused HD. Patients with arteriovenous fistula in place (27.1 vs. 9.1%, P 0.02) and those in the middle- or higher-income group (64.4% vs. 38.6%, p = 0.03) were more willing to undergo HD. Trust in doctor's advice (86.1%) was the most common reason for acceptance of HD. Frequency of HD per week (52.8%), lifelong and permanent nature of HD (50.9%), advice by family members or friends (37.7%), perception of poor quality of life on HD (35.8%), and fear of HD needles and complications during HD (33.9%) were the most common reasons for refusal. Refusal of HD is common among hospitalized CKD patients with medical indications to undergo HD, especially in lower income group.

Background and Objectives:Hepatitis C and chronic kidney disease (CKD) are major global health problems and are highly prevalent in Pakistan. There is limited information on prevalence of hepatitis C in patients with CKD not yet on dialysis. The objective of this study was to determine the frequency of hepatitis C in hospitalized chronic kidney disease patients at a tertiary care center in Pakistan.Methods:The study design was cross-sectional in nature. Patients between ages of 20-80 years with CKD not previously on renal replacement therapy and who were admitted to nephrology ward at a tertiary care facility were included. Hepatitis C was tested using 3rd generation enzyme linked immunosorbent assay (ELISA). Hepatitis C RNA was tested by polymerase chain reaction (PCR) in patients with positive ELISA.Results:A total of 180 patients were included in the study. Mean age of patients was 48.7±14.9 years. Of all patients, 105 (58.3%) were males and 75 (41.7%) were females, 152 (84.4%) had hypertension, 113 (62.8%) had diabetes mellitus and 26 (14.9%) had known cardiovascular disease. Mean eGFR of patients was 11.4±9.4 ml/min/1.73 m2. Of all patients with CKD, 49 (27.2%) had hepatitis C test positive by ELISA. Hepatitis C PCR testing was done in 39 patients with hepatitis C ELISA positive status and 29 (74.4%) tested positive. Risk factors and clinical characteristics of patients with and without positive hepatitis C antibody by ELISA were similar.Conclusion:A significant proportion of hospitalized CKD patients have hepatitis C. Strict universal infection control measures should be implemented in nephrology wards to prevent transmission of hepatitis C infection.

Background: End stage kidney disease (ESKD) is one of the end results of chronic kidney disease. In center hemodialysis is the most common renal replacement therapy (RRT) for these patients used in Pakistan. It is associated with increased risk of health care-related infections. Hepatitis-C is the frequent blood born viral infection in hemodialysis center. Its frequency is very high in hemodialysis patients as compared to general and even to thalassemia population. Purpose of the study: To assess the gravity of Hepatitis-C viral infection in hemodialysis patients. Methods: A retrospective cross-sectional study done in dialysis center of DHQ hospital Sheikhupura, Punjab, Pakistan in January 2018. All the patients who had started hemodialysis with HCV negative status and had remained on hemodialysis for more than three months were included in the study. Patients with Hepatitis-C positive status, acute kidney disease and on dialysis less than three months were excluded. All patients were tested by enzymes linked immune-sorbent essay (ELISA) method for HCV status. Results: Out of 153 Hepatitis-C negative patients at the time of initiation of dialysis, 60 (39.21 %) converted positive while 93 (60.78 %) were still HCV negative by ELISA method at the time of study. Number of dialysis were having significant p value. Conclusion: Most of the patients had acquired Hepatitis-C infection during in-center hemodialysis. This emphasizes the importance of stringent infection prevention and control practices

Objective:To determine any clinical features associated with an abnormal ultrasound in patients with suspected nephrolithiasis in an out-patient setting.Methods:The study design was cross-sectional in nature. The study was conducted at an out-patient nephrology department of a tertiary care facility over a 3 month period. Patients included in the study were 18-80 years old, who presented with unilateral flank or costovertebral angle pain with or without other clinical features suggestive of renal or ureteric calculus based on clinician’s judgement. Every patient’s history was reviewed to obtain information on age, gender, location and radiation of pain, onset, severity and nature of pain, associated urinary and systemic symptoms and past history of nephrolithiasis. An ultrasound was considered to be abnormal if there was documented presence of renal or ureteric stone and/or unilateral hydronephrosis.Results:A total of 209 patients were included in the study. Of these patients, 126 (60.3%) were males and 83 (39.7%) were females, 60 (28.7%) had prior history of nephrolithiasis. Ultrasound was abnormal in 110 patients (52.9%). On a multivariate logistic regression analysis, only past history of nephrolithiasis (OR 3.3, 95% CI 1.65-6.7) was associated with an abnormal ultrasound.Conclusion:In the absence of any significant clinical predictors use of ultrasound is justified in patients with suspected nephrolithiasis especially in those with prior history of stones.

Haemodialysis (HD) is one of the most common type of renal replacement therapy (RRT) used for end stage kidney disease (ESKD). Hepatitis-C is the most frequent infection in haemodialysis. Early detection of this viral infection can lead to early treatment, lesser morbidity and mortality. PCR test is being used instead of Elisa in centres where HCV infection is more prevalent as PCR for HCV RNA is considered more reliable than Eliza in haemodialysis patients. Objective: To assess the accuracy of Eliza and PCR method for the detection of Hepatitis-C viral infection in haemodialysis patients. Study design: Cross-sectional Study. Settings: Dialysis centre of DHQ hospital Sheikhupura, Punjab, Pakistan in January 2018. Materials and Methods: All patients who were on maintenance haemodialysis for more than six months were included in the study. Patients with acute kidney disease and on dialysis less than six months were excluded. All patients were tested by enzymes linked immune-sorbent essay (ELIZA) and polymerase chain reaction (PCR) method for HCV status. Results: Out of 152 haemodialysis patients tested, 94 (61.84%) cases were positive by both ELIZA and PCR methods while 6 (3.94%) cases with negative ELIZA were PCR positive. Number of dialysis, blood transfusions and serology were important risk factors with significant p value. (<0.05) Conclusion: In centres where Hepatitis-C is more prevalent, PCR for HCV RNA should be preferred over ELIZA method for early detection of HCV viral infection.