Abstract Background and Aims Evaluation of Health-related quality of life (HRQoL) is an important, albiet neglected component of health care in patients with End Stage Renal Disease (ESRD). RAND-36 is a validated scoring system for evaluating HRQoL. Patients on hemodialysis experience decrease in various aspects of HRQoL. Various disease related and socio-economic factors influence HRQoL. There is limited data on HRQoL among patients of ESRD on hemodialysis from Indian subcontinent. In the present study, we aim to evaluate the HRQoL using RAND-36 score & the factors which influence it’s various aspects. In addition, we aim to evaluate patient perception of ease of access to dialysis related health care and its impact on RAND-36 score. Method This cross sectional, multi-centric study was performed in Nov 2020. A random sampling was employed to select the study participants. Patients with history of psychiatric illness, significant impairment of hearing, speech, or cognitive disturbances were excluded. RAND 36-Item Health Survey (Version 1.0) was used and circulated amongst dialysis patients across 10 dialysis centres in hospitals across India. Final scores were calculated using standard guidelines. A proprietary software from Bloom Value Corporation was used for data capture by electronic means and Power BI was used for analysis. Results 257 ESRD patients on hemodialysis completed the survey. Mean age was 52.9 years. 65.4 % participants were males, 39.69% were Diabetics and 75.88% had hypertension. Accessibility to healthcare was reported by 36% and 27.7% patients as ‘excellent‘ and ‘very good’ respectively. The mean scores in various scales were Physical Functioning (PF) 47.27±27.87 %, Role limitations due to physical health (RP) 54.18 ± 40.97 % , Role limitations due to emotional problems (RE) 55.38 ± 43.57 %, Energy/fatigue (EF) 49.80 ± 19.38 %, Emotional wellbeing (EW) 57.71 ± 22.04 %, Social functioning (SF) 58.02 ± 25.32%, Pain (BP) 68.28 ± 23.52 % and General Health (GH) 48.11 ±16.43%. Lower PF Scores were seen with higher age (NS), ≥ 2 comorbidities (NS). PF scores were higher in patients with Government insurance and higher perception of healthcare accessibility (NS). RP Scores were higher in males and with advancing age (NS). Employed patients had lower RP scores (p=0.009). RE scores were lower in patients with ≥ 2 comorbidities (NS) and among Employed patients (p=0.04). EF Scores were higher in males (p=0.07) and lower in patients with ≥ 2 comorbidities (NS). EW scores were higher in males (p=0.09) and among patients with higher perception of healthcare accessibility (NS). SF Scores were higher in males (p=0.08) and with higher perception of healthcare accessibility (NS). BP Scores were higher among patients with≥ 2 comorbidities (p=0.04) and higher perception of healthcare accessibility (NS). GH scores were higher with Government Insurance availability and higher perception of healthcare accessibility (NS). Conclusion To our knowledge this is the first multi-centric study conducted amongst ESRD patients in India, evaluating HRQoL using RAND36 scores. There is significant heterogeneity in patient reported outcomes and it’s determinants. Government Insurance support and a higher perception of healthcare availability have positive impact on many aspects of HRQoL. This is a valuable tool in executing patient centred care.

Tuberculosis is a leading cause of morbidity and mortality worldwide. Tuberculous peritonitis in patients on Continuous Ambulatory Peritoneal Dialysis (CAPD), though uncommon, has been reported from different parts of the world. Hemophagocytic lymphohistiocytosis (HLH) is a rare systemic inflammatory disorder characterized by uncontrolled proliferation of lymphocytes & histiocytes and is reported to have high mortality. Secondary forms of HLH have been described for various diseases. Here, we report a case of HLH secondary to Tuberculous peritonitis in a patient of End Stage Renal Disease (ESRD) on CAPD. A 49 years old male ESRD patient, on CAPD presented with peritonitis and was initially managed with antibiotics. He required catheter explantation in view of refractory peritonitis and was switched to haemodialysis. The patient continued to have low grade fever, yellowish discharge from infra-umbilical CAPD catheter explantation surgical wound along with lower abdominal pain & tenderness. He was lost to follow up and presented again after 1 month with fever, weight loss, multiple cutaneous ecchymotic spots and copious amount of yellowish discharge from infra-umbilical surgical wound. On examination, he had fever, conjunctival pallor, hepatosplenomegaly and a 5 cm infra-umbilical midline poorly healed discharging surgical scar with surrounding skin erythema and induration. Blood investigations revealed Hb 5.1 gm/dl, TLC 1500/uL, Plts 32000/uL, Ferritin 1053 ng/ml, TG 350 mg/dl, LDH 650 U/l, Bil T/D 1.3/1.0 mg/dl, OT/PT 160/174 IU/l, ALP 219 U/l, GGT 238 U/l, TP/Alb 5.2/2.5 gm/dl, APTT C/T 27.9/63.0, INR 1.27. NCCT abdomen revealed hepatosplenomegaly, loculated collection in right subphrenic region extending into the abdominal and pelvic cavity, anterior abdominal wall defect infero-right lateral to the umbilicus and generalised increased density in mesenteric fat. Diagnostic sub-phrenic fluid Aspirate analysis revealed a yellow turbid fluid with TLC 22300, ADA 106 U/L and positive Real Time PCR for Mycobacterium tuberculosis complex. Aspirate pyogenic and fungal cultures were sterile. Bone marrow evaluation revealed marked degree of histiocytic hemophagocytosis. Patient fulfilled six out of eight criteria for diagnosis of HLH. He was started on Anti Tubercular Treatment along with dexamethasone. He gradually became afebrile with resolution of infra-umbilical wound discharge, improvement in clinical and laboratory parameters. We report a case of HLH secondary to Tuberculous peritonitis in a patient of ESRD. The patient was on CAPD and required catheter explantation in view of Refractory peritonitis. Despite explantation and adequate antibiotics, he continued to have fever, discharge from surgical wound, pain abdomen, weight loss and poor appetite. Further evaluation revealed evidence of Tuberculous Peritonitis. In addition, the patient fulfilled six out of eight criteria for diagnosis of HLH. The patient was managed with Anti Tubercular Treatment along with Dexamethasone and he showed a gradual improvement in overall clinical and laboratory parameters. Secondary HLH may occur after Tuberculous peritonitis in patient of ESRD on CAPD. Refractory peritonitis with hyperferritenemia, cytopenias, hypertriglyceridemia should raise the suspicion for HLH. Timely identification and treatment of HLH may improve patient outcomes.

Diffuse Large B Cell Lymphoma is the commonest subtype of Non-Hodgkin’s Lymphoma. It may present with primary nodal or extranodal involvement. Up to 40% of patients present with primary extranodal involvement, the commonest involved sites being gastrointestinal tract, testes, central nervous system, thyroid, nose, sinuses, skin, breast, bone and respiratory tract. Skeletal Muscle is a rare site of primary lymphomatous involvement. We present a case of Diffuse Large B Cell lymphoma primarily involving the skeletal muscles and breast, initially managed as a case of acute pyogenic myositis with sepsis with Multiple Organ Dysfunction Syndrome. In addition, the patient had hypercalcemia, cortical vein thrombosis, proteinuria and renal dysfunction, which were all speculated to be paraneoplastic in etiology.

INTRODUCTION AND AIMS: Decision Making Tools (DMTs) use is nowadays considered as the most accurate method to avoid patients bias to choice and to facilitate an optimal information process.Objectives: To analyze the impact of a structured modality information program with the use of DMTs on type of renal replacement therapy (RRT) choice and start.METHODS: Observational, prospective, open and international registry.All predialysis patients (pts) with CKD G4-G5 and pts after an unplanned dialysis start (if noninformed before) were recruited to undergo a DMTs process for RRT choice.Process included: personal values evaluation, RRT information with different tools, staff deliberation support and patient s modality election.Results are shown as the percentage of pts who reached a certain stage related to the total number of pts under evaluation RESULTS: 1934 pts (mean age 61 y.) from 49 clinics (cl.) in Poland (PL, 19 cl.), Romania (RO, 12 cl.),Hungary (HU, 10 cl.), Germany (DE, 7 cl.) and Argentina (AR, 1 cl.) aimed modality information through DMTs from Aug 2014 to June 2017.Staff considered PD as contraindicated in 29% of total pts, hence optimal candidates for HD/PD were 1377 pts.(mean age 60y.and 44% prone for a home therapy).Early referral (3 m. in clinic before process started): 52%.Different aids were used: written information (97% of pts), DVD in 19-37% (except AR, 3%) and HD/PD utility visits in 40-76% (except DE, 16%).Relatives' participation in the process was 82% (45-90% by countries).Most pts (93%) considered the program as useful.PD choice (33%) varied among countries: 12% (RO), 28% (PL), 37% (HU), 66% (DE) and 94% (AR).For pts who already started dialysis (n¼781), PD as chronic RRT was 29% (8% after an unplanned HD start); 9% (RO), 27% (PL), 35% (HU), 55% (GE) and 88% (AR).CONCLUSIONS: Use of DMTs at the time of RRT modality choice complies with patient empowerment.Impact on PD take-on varied among countries.One third of the suitable patients for both dialysis modalities were ascribed to PD. Modality information should always be delivered through a structured information process based on decision sharing (patients-relatives-staff).