Background Patients with chronic kidney disease (CKD) have a heightened susceptibility to tuberculosis infection (TBI). Latent TBI can progress to active tuberculosis (TB). We used Interferon-Gamma Release Assay (IGRA) to determine the frequency of TBI in patients with CKD. Materials and Methods Data were used from patients with CKD (18–65 years) attending OPD and IPD of MY Hospital, Indore, Madhya Pradesh, who underwent IGRA as the primary diagnostic tool over 1 year. Patients with CKD with active TB, immunocompromised status, or on immunosuppression were excluded. Investigations (chest radiograph, sputum AFB if indicated) were done to rule out active TB. Results Of the 250 participants, 17.6% (95% CI: 12.9%–22.3%) tested positive for IGRA, with the majority in CKD stage V, with no significant association between CKD stage and IGRA positivity ( p = 0.740). There was a negative association between BCG vaccination and IGRA positivity results (Chi-square p =0.012; Fisher’s Exact Test p =0.013). There was a significant direct relationship between IGRA positivity and dialysis duration ( p < 0.001). Conclusion The prevalence of TBI among patients with CKD was 17.6% (95% CI: 12.9%–22.3%), and was related to the duration of dialysis

Background Evidence for treating moderately increased albuminuria [A2, urinary albumin-creatinine ratio (ACR) 30–299 mg/g] in normotensive patients with diabetes remains unclear. KDIGO supports the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARBs), whereas ADA recommends against it in this population. We conducted a systematic review evaluating ACEi/ARB therapy in normotensive patients with diabetes with moderately increased albuminuria. Methods This systematic review was registered in PROSPERO (CRD42024571295). A comprehensive search was performed across PubMed, Embase, Cochrane, Scopus, and ClinicalTrials.gov. Randomized controlled trials involving normotensive patients with type 1 or type 2 diabetes and moderately increased albuminuria, comparing ACEi/ARB with placebo, were included. The primary outcome was a reduction in albuminuria; the secondary outcome was a change in estimated glomerular filtration rate (eGFR). Weighted mean differences (WMD) with 95% CI were calculated and pooled using a random-effects model. Results Thirteen RCTs involving 1374 participants met the inclusion criteria; nine trials used ACEi, and four used ARB. ACEi/ARB therapy significantly reduced albuminuria in both type 1 (-64.78% [95% CI -81.56, -47.99]; I2=73%, p <0.001) and type 2 diabetes (-60.09% [95% CI -80.93, -39.25]; I2=92%, p <0.0001). Four ACEi trials reported progression/regression outcomes. A 75% reduction in risk of progression to macroalbuminuria (A3) was observed (OR 0.25; 95% CI 0.13–0.49; I2=0%, p =0.99). Conclusion ACEi/ARB therapy in normotensive patients with diabetes with moderately increased albuminuria reduces albuminuria, suggesting potential renoprotection.

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.

Background Sarcopenia in patients with chronic kidney disease (CKD) represents a significant health concern, particularly in Asian populations. This systematic review and meta-analysis aimed to determine the prevalence of sarcopenia using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria and identify associated risk factors in Asian patients with CKD. Materials and Methods We systematically searched PubMed and Scopus databases (January 2019 – November 2024) following PRISMA guidelines. Studies using AWGS 2019 criteria for sarcopenia diagnosis in Asian patients with CKD were included. We screened records, extracted data, and assessed the risk of bias in duplicate. Random-effect models were used to calculate pooled prevalence and odds ratios. This study is registered with PROSPERO, Reg No. CRD42024606055. Results Analysis of 43 studies (15,832 patients) revealed an overall sarcopenia prevalence of 25% (95% CI: 20-30%). Prevalence varied significantly by region (Japan: 38%; Malaysia: 5%) and treatment modality (dialysis: 30%; non-dialysis: 14%). Patients undergoing peritoneal dialysis showed the highest prevalence (40%, 95% CI: 32-49%). Significant risk factors included age (OR: 1.06, 95% CI: 1.05-1.07), male sex (OR: 1.35, 95% CI: 1.09-1.68), hypertension (OR: 2.72, 95% CI: 2.24-3.32), and diabetes mellitus (OR: 2.29, 95% CI: 1.94-2.71). Higher BMI showed a protective effect (OR: 0.85, 95% CI: 0.82-0.88). Conclusion Sarcopenia affects approximately one-quarter of Asian patients with CKD, with a higher prevalence in dialysis populations. The identified risk factors and regional variations provide valuable insights for targeted screening and intervention strategies in clinical practice.

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.