NepMed Repository :: Browsing by Author "Sigdel, Mahesh R"

Browsing by Author "Sigdel, Mahesh R"

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Assessment of Volume Status Using Body Composition Monitor for Blood Pressure Control in Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Trial
(Institute of Medicine, 2023) Dhakal, Niraj; Sapkota, Nisha K; Sigdel, Mahesh R
ABSTRACT Introduction: Optimal fluid balance and blood pressure control have been shown to improve outcomes in hemodialysis population. We investigated the effectiveness of body composition monitor (BCM) to target dry weight in maintenance hemodialysis (MHD) patients for blood pressure (BP) control and intradialytic adverse events. Methods: A total of 61 consenting adults under MHD were randomly allocated into either BCM group or Clinical Method group. Target dry weight was set every 4-weekly based on BCM report or clinical assessment; dry weight was adjusted with 200-500 ml/session reduction or increment of ultrafiltration in addition to interdialytic weight gain. Outcomes were analyzed in terms of BP control, anti-hypertensive medicine score, and intradialytic adverse events. Results: During 12 weeks of study period, systolic blood pressure (p<0.001), diastolic blood pressure (p=0.01) and mean arterial pressure (p<0.001) significantly decreased from baseline in BCM group but there were no significant changes in Clinical Method group. Lower blood pressure was achieved in BCM group as compared to Clinical Method group. There was a significant decrease from baseline in anti-hypertensive medicine score in the BCM group (p<0.001) but not in the clinical method group (p=0.34). There were significantly fewer events of cramps in the BCM group as compared to the Clinical Method group (p=0.04). Conclusion: BCM guided volume management in MHD patients was more effective than volume management based on clinical judgment only in controlling blood pressure and decreasing anti-hypertensive medicine burden and intradialytic cramps. Keywords: Body composition monitor; hemodialysis; hypertension
Factors Affecting Readmission in Hospitalized Patients with Chronic Kidney Disease: a Single Center Study
(Institute of Medicine, 2022) Wagle, Abhishesh; Sigdel, Mahesh R
ABSTRACT Introduction: Chronic Kidney disease (CKD) in itself and the associated comorbidities together put the patients at increased risk of hospitalization. We aimed to study the factors associated with hospital readmission within 30 days of discharge in hospitalized patients with CKD. Methods: This was a single center descriptive observational study conducted in Tribhuvan University Teaching Hospital (TUTH), Kathmandu. Hospitalized CKD patients were evaluated for sociodemographic parameters, clinical profile and laboratory parameters; they were asked over the phone after 30 days of discharge if they had repeat hospitalization. Readmission rates were calculated and factors at admission associated with repeat hospitalization were analyzed. Results: Out of 337 CKD patients 307 could be contacted. Fifty patients (16.28%) needed readmission. Readmission rate was higher in patients older than 75 years and between ages 25 to 50. Patients who were undergoing dialysis at TUTH (OR 3.324 CI 1.239-8.917, p=0.017), who belonged to Newari community (OR 2.85 CI 1.17-6.9, p=0.020) and those from Kathmandu valley (1.94,CI 0.94-3.99) had higher odds of readmission. Hypertension, diabetes mellitus and tuberculosis as a comorbidity had increased odds of readmission of (1.51,CI 0.60-3.77), (1.48, CI 0.79-2.76), (1.569,CI 0.441-4.468) respectively. Hemoglobin less than 9 gm/dl and serum albumin less than 35 gm/l had higher odds of readmission of (1.109 95% CI 0.605-2.033) and (1.877,95%CI 0.869-4.054) respectively. Conclusion: Overall 30 day readmission rate of Hospitalized CKD patients was 16.28%. Elderlies, those with medical comorbiditites, anemic and hypoalbuminemic patients tended to have increased odds of readmission. Keywords: CKD, readmission, repeat hospitalization
Metabolic Syndrome in patients with Urinary Tract Stone Disease: A Hospital based Single Center Study
(Institute of Medicine, 2023) Ali, Rushudulla; Sigdel, Mahesh R
ABSTRACT Introduction; Patients with urinary tract stones (UTS) are at increased risk of developing metabolic syndrome (MetS). Assessment for MetS could be useful for patients presenting with UTS. We assessed the prevalence of MetS and each of its components in patients with UTS. Correlation of 24-hour urinary, serum calcium and uric acid levels with components of MetS were also done. Methods: A cross-sectional study was conducted at Tribuvan University Teaching Hospital, Institute of Medicine from August 2021 to July 2022. After the approval from the Institutional Review Committee, 118 consenting adult patients with unilateral or bilateral UTS who fulfilled inclusion criteria were studied. Results: Thirty-five (29.7%) stone formers had MetS. Among them, 23 (65.7%) were males, and 12 (34.3%) females. The mean body mass index of patients with MetS was 25.96 ± 4.62 kg/m2. In patients with MetS, 24 (68.8%) had high blood pressure and impaired plasma FBS. Twenty-one (60.0%) patients had increased serum triglyceride levels, and 54.3% had reduced HDL-cholesterol. Systolic blood pressure had a significant correlation with hypercalciuria (P=0.01) and hyperuricemia (P=0.046). Serum triglyceride levels were significantly correlated with hypercalcemia (P=0.045). The mean estimated glomerular filtration rate (eGFR) of the study population was 83.48 ± 32.37 mL/min/1.73 m2. Conclusion: Urinary tract stone disease are associated with metabolic syndrome. Assessment for metabolic syndrome should be considered in patients with urinary tract stone disease. Keywords: Hypercalciuria; hypercalcemia; hyperuricemia; hypertension; metabolic syndrome; Renal stone disease
Post-Transplant Erythrocytosis in Live Donor Kidney Transplant Recipients: A Retrospective Single Center Study
(Institute of Medicine, 2020) Maharjan, Suresh; Chhetri, Santosh; Khatri, Bikash; Sapkota, Nisha; Sigdel, Mahesh R
ABSTRACT Introduction: Post-transplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin>17 g/dl and/or PCV>51% in kidney transplant recipients. The incidence of PTE varies from 5% to 17%, with occasional life-threatening thromboembolic complications. We aimed to study the prevalence, risk factors and complications of PTE. Methods:We conducted a retrospective single center study in 132 kidney transplant recipients who had undergone live donor kidney transplantation at Tribhuvan University Teaching Hospital, Nepal, between October 2017 and March 2019. Prior approval was obtained from Institutional Review Committee of Institute of Medicine. Patients with hemoglobin>17 g/dl were defined as PTE group, and others as non-PTE group. The pattern of hemoglobin, serum creatinine, pre-transplant hemoglobin, native kidney disease, immunosuppression medications, rejection episodes, and new onset diabetes after transplantation were analyzed and compared between two groups. Results: Out of the 132 kidney transplant recipients, PTE was diagnosed in 28 (21.2%) patients, out of which 27 patients (96.4%) were male and 1 (3.6%) were female with the mean time of onset at 7 months after transplantation. Patients with erythrocytosis had a relatively shorter duration of pre transplant dialysis (p=0.001). The mean pre transplant Hb and Hct in PTE group was 9.72g/dl and 30.35% whereas in non PTE group 10.02 g/dl and 31.31%. Thromboembolic and any other PTE related complications were not observed. Seventeen patients of PTE (60.7%) were treated with ACE Inhibitors and 11 (39.9%) patients did not require any treatment. Conclusion: Post-transplant erythrocytosis was seen in nearly one fifth kidney transplant recipients at mean time of seven months post-transplantation; was more common in male with good graft function, and short duration of pre transplant dialysis. Response to ACE inhibitors was good. Keywords: Erythrocytosis, recipient, renal transplant
Ultrasonographic Assessment of Renal Parameters in Apparently Healthy Medical Students of A University Hospital
(Institute of Medicine, 2023) Thapa, Sushma; Khanal, Ujjwal P; Paudel, Sharma; Sigdel, Mahesh R
ABSTRACT Introduction: Ultrasonography is a commonly used medical imaging technique to evaluate the kidneys and has become the preferred modality for the assessment of renal pathology. However, limited data are available on the normal renal parameters in Nepalese adults. The aim of this study was to establish normal reference ranges for renal size in healthy medical students using ultrasonography. Methods: A total of 100 healthy undergraduate medical students (64 males; 36 females) between the first and internship years (age 19-29 years) were studied. Ultrasonography was performed using a single and specific ultrasound machine with 1-7MHz transducer. Results: The study showed the left kidney was slightly longer than the right (10.46 ± 0.68cm vs 10.13 ± 0.65cm; p=0.04), but the right kidney had a significantly larger thickness (2.80 ± 0.76cm vs 2.99 ± 0.68cm; p=0.01) and volume. A strong positive correlation was found between the renal parameters of one side with another side (Length: r=0.63,p<0.001; Breadth: r=0.42, p<0.001; Thickness: r=0.51, p<001; Volume: r=0.57, p<0.001). There were significant differences in renal length and volume based on sex, height, weight, and body mass index while other parameters were not significant. Weight was found to affect renal length more than height. Conclusion: The left kidney was slightly longer than the right kidney. There was a strong positive correlation between the right and left kidney parameters. The study also found significant associations between renal length and height, weight, and body mass index. Keywords: Renal size; ultrasonography

Browsing by Author "Sigdel, Mahesh R"

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