Background Chronic kidney disease (CKD) is a major healthcare challenge in India. Expansion of dialysis services without a functional registry leaves a critical gap in patient outcome data. Material and Methods This study evaluated the outcomes of a diverse cohort of patients undergoing maintenance hemodialysis (HD) treated at Apex Kidney Care (AKC), a major Indian dialysis service provider. A cohort of 24,775 patients receiving HD for >90 days between August 2008 and April 2025, at 288 centers across 16 states, was included. HD vintage was calculated from Day 0 and excluded patients who died or exited before Day 90. The primary outcome was patient survival, and factors affecting this were evaluated. Results Patient survival was 87.7% (95% CI, 87–88%) at 1 year and 58.2% (95% CI, 57–59%) at 5 years. The 5-year survival declined with advancing age: <45 years, 73% (95% CI, 72–75); 45–65 years, 61% (95% CI, 59–62); >65 years, 45% (95% CI, 42–49) ( p <0.001). Patients with diabetes formed 39.2% of the cohort and had lower age-adjusted 5-year survival (65% [95% CI 62–67]) compared to the rest (74% [95% CI 73-75], p <0.001). A multivariable Cox proportional hazards (PH) model indicated a 15% higher mortality for females ( p <0.001). Five-year survival was significantly higher for patients receiving >3 dialysis sessions weekly (81%) compared to those receiving <2 sessions (65%). Survival varied by center type (private 79%, public 72%), but center category was not a significant predictor in multivariable analysis ( p = 0.6 ). Conclusion This study establishes long-term survival outcomes for patients on HD in India, Frequency of dialysis emerged as the main dialysis-related factor associated with survival.

Background The outcome of kidney transplantation is determined by multiple factors and infections represent one of the major factors affecting graft and patient survival. Recent COVID-19 pandemic have adversely affected the transplant population. Very little data is available on post-transplant infections and patient survival from India. Materials and Methods In this retrospective observational study, data related to post-transplant infections from patients who had undergone renal transplantation between October 2014 and October 2021 were collected. Results A total of 255 infections episodes were observed in 118 patients. Bacterial infections were the most common (55%) followed by viral (35%), fungal (5%), mycobacterial (4%), and parasitic (1%). The most common bacterial and viral infections were urinary tract infections (70.5%) and COVID-19 (56%), respectively. BK virus and COVID-19 were associated with increased graft loss (p < 0.05). The majority of deaths due to infections were related to COVID-19 infection (71.42%). Kaplan-Meier survival analysis showed 1-, 3-, and 5-year patient survival of 98.23%, 96.36%, and 92.90% and graft survival of 98.14%, 95.97%, and 91.78, respectively. Conclusion Infections with their adverse impact remain a concern in kidney transplant patients. Comparable patient and graft survival to the Western data despite the high infection burden and the COVID-19 pandemic suggests that effective management can reduce the impact of infections on survival.

Objective The study proposes a decision strategy for the choice of arm for placement of an arteriovenous fistula (AVF) in patients with kidney failure who undergo hemodialysis (HD). The possible surgical sites for placement of the AVF are located in the arm and at two locations in each arm, the wrist (distal AVF) and the elbow (proximal AVF). Recommendations are made for the location of the first AVF and subsequent ones, as needed. Method A retrospective analysis of AVFs created between 2015 and 2022 in patients at five HD centers was performed. The study uses qualityadjusted survival, parametric, and nonparametric survival methods. We conducted two surveys to assess the HD patient’s quality of life. In addition, the Cox proportional hazard model is used to suggest a patient-specific strategy. The survival functions are compared using the log-rank and Tarone-Ware tests. Results The results of the multivariate analysis showed that placing AVFs on the non-dominant arm leads to superior patient quality of life compared to the dominant arm. The quality-adjusted survival was also found to be better when AVFs were located on the non-dominant arm. Considering both these aspects and also clinical constraints on the sequence, the optimal sequence is found to be non-dominant distal followed by non-dominant proximal locations, followed by a similar sequence on the dominant hand if required. Conclusion The study identifies criteria for data-driven decision-making as to good locations for AVFs for Hemodialysis and supports clinical experience and practice in this matter.

Kidney exchange programs (KEPs) aim to find compatible kidneys for recipients with incompatible donors. Patients without a living donor depend upon deceased donor (DD) donations to get a kidney transplant. In India, a ©DD donates kidneys directly to a©DD wait-list. The idea of initiating an exchange chain starting from a ©DD kidney is proposed in a few articles (and executed in Italy in 2018), but no mathematical formulation has been given for this merger. We have introduced an integer programming formulation that creates ©DD-initiated chains, considering both paired exchange registry and ©DD allocations simultaneously and addressing the overlap issue between the exchange registry and ©DD wait-list as recipients can register for both registries independently. A long-term simulation study is done to ©analyse the gain of these DD-initiated chains over time. It suggests that even with small numbers of ©DDs, these chains can significantly increase potential transplants.

INTRODUCTION:There are several studies of symptomatic hemodialysis patients with proven COVID-19 infection. However, there is paucity of data on asymptomatic COVID-19 infection in the outpatient hemodialysis population. The true prevalence and transmission of this infection in hemodialysis centres is unknown. This study was conducted across hemodialysis centers by testing all patients and staff for COVID-19 PCR and later for IgG antibody, irrespective of their symptoms.METHODS:All 705 hemodialysis patients and 103 dialysis staff across nine centres, were tested for COVID-19 over a period of 54 days of the pandemic, and for COVID IgG antibody of available enrolled staff and patients, after 8 weeks of study termination.RESULTS:The period prevalence of infection in patients and staff was 7.1% and 14.6% respectively. Mortality in patients was 18%, and all staff recovered. Clustering of patients and staff occurred at 3 of 9 centers. Of 26 HIV positive patients, only one contracted the COVID-19 infection and has recovered. Of those infected, seroconversion occurred in 80% of patients and 83% of staff. Seroconversion also occurred in 16% of patients and 37% of staff, who were asymptomatic and COVID PCR negative during the study period.CONCLUSIONS:Testing a patient only when symptomatic, identified only 26% (13/50) of infected patients. For every single symptomatic patient who tested positive, there were 3 other asymptomatic infected ones. There was a high seroconversion rates in infected subjects. But antibodies also developed in asymptomatic subjects, indicating silent transmission and antibody generation in this population.

Kidney transplantation is the preferred renal replacement therapy for patients with end-stage kidney disease. However, these patients are vulnerable to multiple complications arising out of immunosuppression, comorbidities, and opportunistic infections. We report a case of hemichorea in a transplant recipient. This patient had concurrent polycythemia, new-onset diabetes after transplantation, and was on calcineurin-based immunosuppression. The magnetic resonance imaging ascribed her hemichorea to Non ketotic hyperglycemia (NKH) which recovered completely with prompt treatment of the hyperglycemia.

The principles of ABO compatibility are fundamental to clinical solid organ transplantation, and conventional blood grouping techniques may mislabel patients with rare blood groups. We present a case of a kidney donor and her recipient who were mislabeled by conventional blood grouping methodology due to the presence of weak blood groups in both individuals, which were identified on detailed analysis, thus avoiding the need to undergo unnecessary desensitization protocols. The recipient underwent a successful transplant with the same donor and continues to do well 6 months after the transplant.

Aim: To merge the deceased donor (DD) and the paired kidney exchange (PKE) allocation processes, creating a fusion model. Materials and Methods: One of the DD kidneys are allocated to the first patient on the DD wait-list and the other kidney is allocated to the PKE registry to initiate a chain of swap transplants. The last donor of this PKE chain donates his kidney back to the second patient on the DD wait-list. Results: There was a 28.1% (P < 0.05) increase in the total number of transplants in the fusion model as compared to the standalone DD and PKE allocation. The mean gain ranges from 8.29 to 19.3 (P < 0.05) across various allocation groups for the O recipients, which is disadvantaged in the standalone PKE registry. Similarly, the mean gain ranges from 5.8 to 18.1 (P < 0.05) across various allocation groups for the AB recipients, which is disadvantaged in the standalone DD registry Furthermore, no blood group type is worse off in terms of the opportunity to receive a kidney by the fusion model. Conclusions: The fusion model can potentially increase the number of transplants that can be performed whenever a DD become available. Despite fairness considerations for patients and their living donors participating in the fusion model, this process increases the opportunity to receive a kidney as well as reduces transplant waiting time in both the registries. This would translate into a survival advantage for the patients.

While non-infectious etiologies like chemical irritants are rare causes of epidemics of peritonitis, this possibility should be considered when one encounters an unusual clustering of peritonitis cases. We describe here an epidemic of chemical peritonitis at our center.