Anemia is a common complication of CKD, contributing to adverse clinical outcomes, such as increased cardiovascular events, hospitalization rates, and mortality. Ferric carboxymaltose (FCM), has emerged as the preferred intravenous iron formulation, especially in patients with hemodialysis-dependent CKD (HD-CKD). Despite the widespread use of FCM, There is no consensus for intravenous (IV) FCM dosing and monitoring in India. A Delphi study was conducted in two phases to address these gaps. In the first phase, a literature review identified unmet clinical needs, resulting in 15 consensus statements evaluated by 70 experts using a 5-point Likert scale. The second phase involved an in-person meeting with 20 experts, where live polling achieved a >= 70% consensus on 10 statements, with the remaining statements revised for further validation. Key recommendations include initiating IV iron therapy when the transferrin saturation (TSAT) is <= 30% and the serum ferritin level is <= 500 ng/mL. FCM dosing should be weight-based (15 mg/kg) with a maintenance dose of 100-200 mg every 2-4 weeks. Regular monitoring of hemoglobin, TSAT, and serum ferritin levels is recommended to ensure effective management. This consensus introduces the novel I2M2 approach, i.e., Investigate, Initiate, Monitor, and Maintain, as a structured framework for managing iron deficiency anemia (IDA). Furthermore, this consensus offers practical guidance for optimizing treatment in IDA patients with HD-CKD within the Indian healthcare context.

Four Gram-negative bacteria, viz. Pseudomonas aeruginosa HL_CHRF_S30, Klebsiella quasipneumoniae HL_CHRU_S36A, Enterobacter bugandensis HL_CHRU_S49, and Acinetobacter haemolyticus HL_CHRU_S74 were isolated from the biofilm of the catheter tip of 152 renal failure patients. Multiple antibiotic-resistant gene cassettes were predicted by whole-genome analysis of these Gammaproteobacteria to develop antibiotic resistance.

INTRODUCTION:Kidney transplantation is the preferred treatment for end-stage renal disease. Donor kidney volume (DKV) and its adjustment to recipient body surface area (BSA), termed nephron dose (DKV/BSA), may influence graft function based on the nephron dosing hypothesis. This study evaluated the impact of nephron dose on recipient estimated glomerular filtration rate (eGFR) at 1 year. MATERIALS AND METHODS:A prospective observational study was conducted on 130 living donor kidney transplants at a tertiary care center (August 2022 to July 2023). Donor kidney volume was measured via computed tomography angiography and 3-dimensional volumetric analysis. Nephron dose (mL/m²) was calculated and correlated with recipient eGFR (Chronic Kidney Disease Epidemiology Collaboration 2021) at baseline, 3, 6, and 12 months. A ≥30% eGFR decline from peak was defined as significant deterioration. RESULTS:The mean DKV was 103.2 ± 20.9 mL, with a mean nephron dose of 64.5 ± 14.7 mL/m². A significant positive correlation was observed between nephron dose and eGFR, strongest at baseline (r = 0.436) and persisting at 1 year (r = 0.184). Receiver operating characteristic curve analysis identified a nephron dose cutoff of 61.88 mL/m², predicting >30% eGFR decline with 79.3% sensitivity and 54.1% specificity (area under the curve = 0.634, P = .028). CONCLUSION:Donor kidney volume relative to recipient size significantly predicts graft function at 1 year. Incorporating nephron dose into preoperative planning may optimize donor-recipient matching and improve long-term outcomes.

Background: The modified Ponticelli regimen (mPR) with cyclical steroids and cyclophosphamide is first-line therapy for primary membranous nephropathy (PMN). While low-dose rituximab (RTX) has been effective in inducing remission in PMN, there is a paucity of head-to-head trials comparing it with the first-line regimen. This pilot study aimed to assess the feasibility, safety, and efficacy of low-dose RTX compared with Mpr in PMN. Materials and Methods: In this single-center study, 68 patients with PMN and nephrotic syndrome were randomly assigned to receive either two doses of RTX (500 mg) given 15 days apart or mPR. Results: 15/34 patients (44.12%) in the RTX group and 17/34 patients (50%) in the mPR group had achieved the primary outcome of partial or complete remission at 6 months (Risk difference RD-5.88%, 95% confidence interval CI =-29.57 to 17.80%, p = 0.578). At 12 months, remission rate was 59.27% in the RTX arm and 69.57% in the mPR arm (Risk difference-10.31%, 95% CI =-36.71 to 16.09%, p = 0.444). Adverse events (P = 0.007), including leukopenia, infections, and hyperglycemia, were significantly more frequent in the mPR arm. CD19+ve B-cells were suppressed by 1 month in all patients at this rituximab dose, but 64% had recovery by 6 months. Conclusion: This pilot study suggested that low-dose RTX could achieve sufficient B-cell suppression and short-term remission rates comparable to mPR with fewer adverse events. It demonstrates the feasibility and safety of low-dose RTX in PMN. Further studies with larger cohorts are required to confirm these findings.

Background: Kidney transplant recipients (KTRs) are at higher risk for infections, including parvovirus B19 (PVB19). This virus typically presents within the first-year posttransplant, causing anemia and potentially leading to increased morbidity and graft dysfunction. Materials and Methods: Charts of patients undergoing kidney transplantation between May 2013 and March 2022 were reviewed. Twenty-one patients had PVB19. Their clinical presentation, laboratory parameters, and outcomes were studied. The diagnosis of PVB19 was established by PVB19 DNA Polymerase Chain Reaction (PCR) and bone marrow examination (BME). Results: Prevalence of PVB19 disease was 1.9% (21/1164) with a median onset time of 39 days posttransplantation. The most frequent clinical symptoms were fatigue reported by 76% of patients, followed by fever (47%), dyspnea (23%), and myalgia (33%). All patients (100%) developed anemia, while leukopenia and thrombocytopenia were observed in 14% and 9.5% of patients, respectively. Graft dysfunction was observed in 61.9% (13/21) patients. Diagnosis was confirmed by PCR in 20 out of 21 patients. One patient had a typical viral inclusion on BME. Immunosuppression, especially antiproliferative, was reduced in all patients. Eight patients received intravenous immunoglobulin, eight received packed cell blood transfusion, and seven received erythropoietin therapy. All patients recovered, with a median time of 30 days for hemoglobin levels to normalize. One patient had graft loss secondary to graft rejection. Conclusion: PVB19, while uncommon, can be a significant cause of refractory anemia, particularly within the first-year posttransplant. Diagnosing PVB19 infection with PCR is crucial, and the primary treatment involves reducing immunosuppressants, especially antiproliferative agents.

This guideline addresses the use of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) in patients >18 years with chronic kidney disease (CKD) and anemia in South Asia (Bangladesh, Bhutan, Nepal, India, Pakistan, Sri Lanka). It also summarizes recommendations for anemia treatment for individual HIF-PHI molecules under two categories: dialysis-dependent and non-dialysis-dependent CKD patients. The recommendations do not apply to pediatric (≤12 years) and adolescent (12 to 18) patients or those with primary anemia or anemia secondary to other causes such as blood loss, cancer (any type), polycystic kidney disease and infectious diseases.

Staphylococcus aureus CHRFS5, S. aureus HL_CHRU_S18, S. epidermidis S48B, S. epidermidis HL_CHRU_S16, S. hominis S19, S. haemolyticus HL_CHRU_S79, and S. warneri HL_CHRU_S111 were isolated from the biofilm of catheter tip of renal failure patients. Whole genome sequencing predicted the presence of multiple antibiotic-resistant gene cassettes.

Anemia is common in patients with CKD and ESKD, with a 50% prevalence in the USA and higher in India. The overall prevalence of anemia in CKD is twice the general population, increasing with CKD progression. The last guidelines for anemia in India were published in 2013 by the Indian Society of Nephrology (ISN). There is a need for revised guidelines/consensus statements incorporating the significant developments in patient monitoring and treatment, which have occurred in the last decade to guide evidence-based clinical practice, especially for the Indian population. We searched PubMed/Medline, Embase, Web of Science Core Collection, and CINAHL databases to perform a systematic review of the literature examining anemia prevention and treatment in adult CKD/ESKD patients, with 29 studies identified out of 1668 records screened. We then performed data extraction to write consensus guidelines and rationale, with supplemental literature evidence discussing the diagnosis and management of CKD and ESKD anemia patients in an Indian context.

Micrococcus luteus HL_Chru_C3 was isolated from the hemodialysis tunneled cuffed catheter tip of renal failure patients. Whole-genome sequencing (WGS) revealed a 2,494,573 bp genome with 12 contigs, 72% GC content, and 2,240 protein-coding genes. The computational prediction of penicillin-binding proteins and biofilm-forming signaling gene cassettes may contribute to the resistance mechanisms.

BackgroundManaging osteoporosis (OP) in chronic kidney disease (CKD) presents significant challenges due to altered bone metabolism. Given the lack of robust clinical trial data and a notable knowledge gap exists among nephrologists regarding an optimal management in this population, an expert consensus is crucial for developing tailored management strategies. This study aimed to gather an expert opinion to bridge this gap and establish consensus recommendations on the diagnosis and management of osteoporosis in CKD patients.MethodsA panel of 13 Indian and 1 international experts, including nephrologists and endocrinologists, participated in a structured survey and discussion process. Thirteen Indian experts provided their opinion on key clinical issues, including screening, diagnosis, and treatment strategies for osteoporosis in CKD. Consensus was achieved in a single round of voting, and recommendations were formulated based on the level of agreement among the panelists.ResultsThe expert panel reached a strong consensus (80-100% agreement) on several critical recommendations. It was agreed that osteoporosis in CKD is often asymptomatic, with fragility fractures being less common, and thus, early screening using dual-energy X-ray absorptiometry (DXA) is essential. The panel emphasized the importance of evaluating bone turnover status using serum biomarkers such as bone-specific alkaline phosphatase (BSAP) and intact parathyroid hormone (iPTH) to guide treatment decisions. Tailored treatment strategies were recommended, with a judicious use of bisphosphonates and denosumab, depending on the patient’s estimated glomerular filtration rate (eGFR) and bone turnover state. The management of renal osteodystrophy (ROD) was deemed necessary before addressing CKD-induced osteoporosis.ConclusionThis expert consensus provides critical insights and guidance for the management of osteoporosis in CKD. The recommendations emphasize individualized treatment approaches, the importance of early screening, and the integration of multidisciplinary care. These findings aim to fill existing knowledge gaps and improve clinical outcomes for CKD patients with osteoporosis.

Background: Patients with obstructive uropathy frequently require haemodialysis prior to undergoing deobstructive surgical procedures. However, there are limited data on the necessity of preoperative dialysis and its impact on clinical outcomes. This study aims to evaluate the role of dialysis before deobstructive procedures and its influence on postoperative outcomes. Materials and Methods: This retrospective observational study included all patients who underwent deobstruction procedures between January 2017 and September 2022 and had renal failure (serum creatinine > 4 mg/dL). A comparator group included patients undergoing deobstruction procedures with either serum creatinine > 3 times baseline, > 4 mg/dL, or anuric for more than 12 hours, but who did not require dialysis. The primary outcome assessed was renal recovery, and secondary outcomes included (1) incidence of acute left ventricular failure, (2) presence of hyperkalaemia (serum potassium > 6 mEq/L) and metabolic acidosis (serum bicarbonate < 18 mEq/L) postprocedure, (3) type of anaesthesia used (general, spinal, or local), (4) intraoperative bleeding > 500 mL or need for packed cell volume (PCV) transfusion within 1 week postprocedure, and (5) duration of hospitalisation following the procedure. Conclusions: The need for dialysis prior to deobstruction procedures was primarily determined by the presence of chronic kidney disease, hyperkalaemia, and uremic symptoms. Patients who did not undergo dialysis had a higher risk of perioperative bleeding. Local anaesthesia was more commonly used in patients who required dialysis. Importantly, preoperative dialysis did not significantly influence renal recovery following the procedure. Level of evidence: Not applicable

Catheter-related bloodstream infections create a significant challenge in healthcare system, often complicated by antibiotic resistance and biofilm formation of multi-drug resistance and virulent bacterial pathogens. This study focused on biofilm-forming efficiency, and underlying genetic mechanisms in Micrococcus luteus HL_Chru_C3, isolated from a hemodialysis catheter tip. The isolate exhibited resistance to multiple antibiotic classes, including beta-lactams and glycopeptides. Biofilm assays revealed that M. luteus HL_Chru_C3 formed optimum biofilms at high concentration of carbohydrates (500 mM), and pH 5 but there was no significant role of mineral salts. Whole-genome sequencing and bioinformatic analysis using CARD, KAAS, and KEGG databases identified genes associated with antibiotic resistance (ftsI, pbp1a/2, vanY, alr, ddl, murF, mraY, and murG), quorum sensing (genes from the opp family, sec, cylA, ccfA, phnA, phnB, phzC, rpfB, clp, and toxE), and biofilm formation (phnA, phnB, cyaB, vfr, vps, glgC, wecB, wecC, and cysE). The predicted mechanisms of action for these genes, based on homology to other organisms, suggest complex interactions contributing to the observed phenotypes. This study provides an insight into the genetic basis of antibiotic resistance and biofilm formation in M. luteus HL_Chru_C3 isolated from a hemodialysis catheter, highlighting the need for effective infection control strategies to combat CRBSIs.