Background The Sree Narayandasji Santram Maharaj improving hemodialysis outcomes initiative (SNSMDS) is a prospective, multicenter observational study to assess patient survival and quality of life (QoL) of incident patients on maintenance hemodialysis (MHD). Materials and Methods The study population included patients with incident adult patients staring MHD between April 2019 and December 2022 from 30 dialysis centers across West, Central, and South India. QoL was measured using a detailed EuroQOL-5-Dimensional 3-Level (EQ5D3L) based questionnaire. Results A total of 1039 (728 males and 311 females) patients on MHD were enrolled; the mean age was 49.06 ± 14.96 years (Males: 48.92 ± 15.20 years, Females: 49.37 ± 14.36 years). The survival of a patient on MHD in the present cohort was 94.1%, 86.6%, 77.9%, 58.4%, and 47.1% at 4 months, 8 months, 1 year, 2 years, and 3 years, respectively. In univariate analysis, increasing age (HR 1.014(1.01-1.02), p <0.001) and presence of diabetes (HR 1.614(1.28-2.03), p <0.001) were significantly associated with poor survival, whereas well educated (HR 0.592(0.043-0.82), p =0.002) had increased survival. Multivariate regression analysis revealed 1.5% added risk of death with every year spent on MHD. Insignificant difference is observed in the EQ5D3L score at enrollment (6.47 ± 1.73), and at the end of median follow-up of 12 months (6.49 ± 1.65) ( p =0.837). Conclusion Incident patients on hemodialysis had a 1-year survival rate of 77.9% and a 3-year survival rate of 47.1%. Overall QoL among hemodialysis patients did not improve significantly despite dialysis.

Dyslipidemia plays a critical role in the pathogenesis of both cardiovascular (CVD) and chronic kidney diseases (CKD). Although modifiable, dyslipidemia remains undertreated, probably due to the differences in management across clinical guidelines and the lack of evidence supporting treatment benefits in patients with advanced CKD and those on dialysis. High levels of lipids or changes in their structure are involved in kidney damage due to oxidative stress, inflammation, and lipotoxicity. This review explores the pathophysiology of dyslipidemia in kidney injury and the current strategies for lipid management across different CKD populations, including non-dialysis, dialysis, and kidney transplant recipients. Statins remain the first-line therapy; however, their efficacy is reduced in advanced CKD and patients on dialysis. Emerging therapies, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, bempedoic acid, inclisiran, and icosapent ethyl, offer promising options for patients with statin intolerance or persistent dyslipidemia and have been tested in patients with CKD with a glomerular filtration rate (GFR) > 30 mL/min/m 2 . Newer targets, such as ANGPTL3, APOC3, CETP, and Lp(a), are currently being studied. Effective lipid management in patients with CKD requires a personalized, multidisciplinary approach involving nephrologists, cardiologists, endocrinologists, and primary care physicians to implement evidence-based interventions and improve long-term outcomes.

Background Over the past decade, the therapeutic role of sodium-glucose co-transporter 2 inhibitors (SGLT2i) has evolved from oral hypoglycemic agents to agents with proven cardio- and reno-protective benefits, including use in non-diabetic kidney disease. Despite being one of the four pillars of chronic kidney disease management, real-world prescribing trends remain poorly characterized. Materials and Methods This retrospective observational study analyzed electronic medical records of patients attending the nephrology outpatient department at a tertiary care hospital to determine the proportion of patients prescribed an SGLT2 inhibitor among those with a Class Ia guideline recommendation. Subsequently, an online questionnaire-based survey was conducted among nephrologists to identify barriers to SGLT2i prescription. Results Among 5,701 patients who attended the Nephrology outpatient department in 2024, 399 met the criteria for Class Ia indication for SGLT2i therapy. The overall prescription rate was 20.3%, with 18.7% in patients with diabetes mellitus and 24.7% in those without. Factors significantly associated with SGLT2i prescription included younger age ( p = 0.004), presence of albuminuria ( p = 0.033), concomitant use of renin-angiotensin-aldosterone system (RAAS) inhibitors ( p = 0.002), and higher estimated glomerular filtration rate (eGFR) ( p = 0.026). Among 55 nephrologists who participated in the survey, only 55% reported prescribing SGLT2i in >25% of eligible patients. Conclusion Despite robust evidence supporting their benefits, SGLT2i prescription rates remain suboptimal among patients with Class Ia indications. Strategies such as early nephrology referral and educational initiatives to enhance awareness may improve the uptake of guideline-recommended therapy.

Background The existence of multiple diagnostic criteria results in inconsistencies in the reporting of incidence and outcomes of AKI in children, warranting the need for a single criterion. Materials and Methods We conducted a prospective observational cohort study in a tertiary care hospital, enrolling 502 children aged 1 month to 18 years. We compared the incidence and staging of AKI using serum creatinine (Scr)-based definitions from pRIFLE, AKIN, and KDIGO criteria. We also assessed AKI-associated mortality, need for kidney replacement therapy (KRT), and recovery of kidney function in each group. Results Among 502 children, AKI was identified in 12%, 11%, and 10.8%, respectively, using pRIFLE, AKIN, and KDIGO. All three criteria showed excellent agreement for Stage 1 AKI (κ > 0.98) and substantial agreement for Stages 2–3, with overall inter-definition concordance exceeding κ = 0.90. AKI was significantly associated with higher mortality (ORs 10.9–15.0; p < 0.001), with a consistent increase in KRT requirement with advancing AKI stage across all criteria (KRT requirement in Stage 3: >40% of patients with AKI; p < 0.05 for all definitions). The median AKI duration was 3 days, with ∼68% showing recovery of kidney function at discharge. Venn analysis showed that most cases were identified by all definitions, with pRIFLE detecting seven additional stage 1 AKI cases that did not translate to adverse outcomes. Conclusion All three definitions demonstrate excellent concordance and comparable clinical utility. AKI, irrespective of diagnostic criteria, is strongly associated with mortality and the need for KRT across all definitions.