Background.Imbalance of serum sodium in the form of hypo and hypernatremia has bad prognostic impact, and linked with increase morbidity and mortality. Covid 19 is a deadly viral infection can be complicated with either of the two state. This increases the complications associated with the covid 19 infection.Material and method.This is the observational cohort study, conducted at The Indus Hospital Karachi, from March 2020 to September 2020. All patients were divided in to three groups on the basis of their serum sodium level, and distribution of variables was observed in all these three groups. To observe the effect of dysnatremias on outcome, binary logistic regression was run and odds ratios with 95% confidence interval were obtained.Results.We included 655 patients, in which 70.7% were male, while 29.3% were female. Mean age was 54 ± 15.5 with minimum of 1 year and maximum of 95 year. Hyponatremia was more common 154(23.5%) than hypernatremia 79(12.1%) patients. Dysnatremia were common in patients of age group of 51 – 65 years (Hyponatremia 72(46.8%) hypernatremia 36(45.6%). Hyponatremia didn’t show any significant effect on the clinical manifestation, critical illness and outcome of the patients except drowsiness (p=0.022). On the other hand hypernatremia had highly significant effect on clinical manifestation, critical illness and outcome of the patients. The patients who had hypernatremia died 16.8 times more than patients with normal sodium (p= 0.001).Conclusion.Dysnatremias has profound impact on the outcome of covid patients. We found development of hypernatremia has devastating effect on patient survival.
Background In an ESRD subset of patients, COVID-19 infection is associated with increased disease burden and higher mortality rates. Methods We conducted a retrospective single-center cohort study in which 43 ESRD patients had a diagnosis of COVID-19. Association of risk factors with mortality was assessed by chi-square test and logistic regression analysis. Data were collected on a structured performa which included variables like age, gender, comorbid conditions, drug history, clinical presentation, hemodynamic status and laboratory parameters. Outcome variables were recovery and death. All patients received standard treatment for COVID-19 according to hospital protocols, along with hemodialysis and continuous renal replacement therapy (CRRT) when needed. Results Those most affected were found to be male, 25 (58.1%), while the number of females affected was 18 (41.9%). The most frequent comorbid condition was hypertension (HTN), seen in 35 (81.4%) patients; however, thromboembolic complications were very few in these patients. The mortality rate in our study was 25.6%, and the population most susceptible to poor outcomes in the ESRD subgroup was elderly people (45.5%), while younger patients recovered the most from COVID-19 (53.1%). Hypoalbuminemia, leukocytosis, lymphopenia and raised LDH were also found to be associated with death in ESRD patients suffering from COVID-19 (81.8, 72.7, 100 and 100%, respectively). In multivariate logistic regression analysis, we found that the odds ratio of dying from COVID-19 was 19.5 times higher in patients aged >65 years as compared to patients aged 18–50 years (p=0.039). Similarly, patients with a high TLC were 24.1 times more likely to die than patients with a normal TLC (p=0.008). Conclusion In our center, the mortality rate of ESRD patients affected with COVID-19 disease was 25.6%, and older age, leukocytosis, lymphopenia, hypoalbuminemia and high LDH were significantly associated with mortality.
Background: The normal axis of calcium, phosphorus, vitamin D, and intact parathyroid hormone (iPTH) come under stress when chronic kidney disease (CKD) progresses beyond stage 3(GFR<30 ml/kg/1.732). This results in increased secretion of iPTH which is known as secondary hyperparathyroidism. This exacerbates further if simultaneous deficiency of nutritional vitamin D (Cholecalciferol) is also found. Secondary hyperparathyroidism results in vascular calcification and increases cardiac mortality. Early intervention in form of dietary modification (low phosphorus, low potassium), correcting vitamin D deficiency along with the addition of active vitamin D (calcitriol) would help in alleviating patients’ suffering and saving costs as well. Material and method: This study was conducted from Jan 2017 to Jan 2018 at The Indus Hospital, Karachi with the age group ≥14 years of either gender who were suffering from chronic kidney disease (CKD). Patients on dialysis, chronic liver disease, and vitamin D supplementation were excluded. Their history, demographic, BMI, Calcium, Phosphorus, Alkaline Phosphatase, 25-Hyydorxyvitamin D, albumin, and intact parathyroid hormone (iPTH) were all noted. Results: 265 patients were enrolled for final analysis in this data with a male to female ratio of 1:1.03 (146/121). Hyperparathyroidism (iPTH> 68 pg/ml) was seen in 190 (71.2%) patients. Mean values of all quantitative variables were not statistically significant when compared hyper parathyroid with normal parathyroid. Hyperparathyroidism was found significant in late CKD in comparison to early CKD (P-value <.001), While vitamin D deficiency was significantly associated with hyperparathyroidism in early CKD but not in late CKD. Conclusion: Hyperparathyroidism is significantly present in CKD which is contributed by CKD progression and vitamin D deficiency.
Objective: To see the efficacy of oral cholecalciferol administered to chronic kidney disease patients with vitamin D deficiency. Methods: The prospective interventional study was conducted at the Indus Hospital, Karachi, from January 11, 2017, to January 10, 2018, and comprised diagnosed pre-dialysis chronic kidney disease patients of either gender aged >14 years having vitamin D deficiency. Oral vitamin D 50,000IU was given weekly to those who had severe deficiency <10ng/ml, and every other week to those with less severe 10-25ng/ml deficiency for 3 months. Improvement in vitamin D level was checked along with other chronic kidney disease markers every month over the 3-month period. Data was analysed using SPSS 24. Results: Of the 186 patients enrolled, 129(%) completed the study; 76(58.5%) males and 53(40.8%) females. Overall, 105(81.4%) patients achieved normal vitamin D levels after 3 months of treatment. Significant negative but weak correlation of phosphate, creatinine and intact parathyroid hormone levels was found with vitamin D (p<0.05). Significant positive but weak correlation was found between albumin and vitamin D levels (p<0.05). Conclusion: Significant efficacy of oral vitamin D in chronic kidney disease patients was seen.
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