Day 2 :
Keynote Forum
Punit Gupta
B.R.A.M. Hospital Raipur
Keynote: Is Phosphate Level Associated With Increase Risk Of Infections In CKD Patients On Hemodialysis – A Study From Tribal Area Of Chhattisgarh.
Time : 13:50-14:20
Biography:
Punit Gupta, was Profossser in Government medical college hospital (consider to be the tribal of india), raipur, India. He have done bachelor degree in 2000 I.e MBBS, than master degree in General Medicine in 2003 I.e MD, than Superspeciality in Nephrology I.e DM , With PHD DEGREE . He also awarded the prestigious ISPD SCHOLARSHIP and ASN fellowship. He have awarded with APCN developmental award in Malaysia. And also awarded with many oral n poster presentation National and International. He have presented highest number of papers I.e 31 abstract in single conference under his name till date around 175 paper and abstract is presented by him in different conferences.
Abstract:
Objectives: Hyperphosphatemia is highly prevalent in dialysis patients and may be associated with immune dysfunction. The association of serum phosphate level with infection remains largely unexamined.
Material and method: A study group contain total of 100 patients, out of which 25 patients blood culture and central venous catheter tip culture was positive. All Patients were underwent investigation in form of renal function test, C Reactive Protein level, serum phosphorus, blood culture, urine culture, central line tip culture.
Results: Out of 25 patients of renal failure on hemodialysis with sepsis none had serum phosphate level less than 3.5 mg /dl, 4 (26.67%) had serum phosphorus level between 3.5 – 5.5 mg/dl and 11 (73.33%) patients had serum phosphorus level > 5.5 mg/dl. Infections of any type were more frequent among patients with high phosphate levels at baseline, relative to normal. Male sex, advanced age, diabetes, anemia, hypoalbuminemia were found to be risk factors for infections. Gram positive cocci (Staphylococcus aureus) was the most common organism found in blood of 80% patients of renal failure on haemodialysis with sepsis. Incidence of sepsis was high with femoral vein (66.67%) usage and prolonged hemodialysis (more than 21 days). Serum Phosphorus level was high in 73.33% patients and CRP was raised in all 25 patients with sepsis. Most of the patients were euthyroid and their lipid profile was normal.
Conclusions: High phosphate levels may be associated with increased risk for infection, contributing further to the rationale for aggressive management of hyperphosphatemia in dialysis patients.
- Nephrology and Therapeutics
Session Introduction
Seyed Jalil Masoumi
Shiraz University of Medical Sciences, Iran
Title: Factors Influencing Survival Time of Hemodialysis Patients; a Time to Event Analysis Using Parametric Models: a cohort study
Biography:
Abstract:
Background: Survival analysis of patients on maintenance hemodialysis (HD) has been the subject of many studies. No study evaluated the effect of different factors on the survival time of these patients. We aimed to find factors affecting survival by using parametric survival models and the effect of them on the survival time. Methods: As a retrospective cohort study, we evaluated the data of 1408 HD patients and considered the data of patients who had at least 3 months of HD and started HD from December 2011 to February 2016. The data were extracted from Shiraz University of Medical Sciences (SUMS) Special Diseases database. Primary event was death. We applied Cox-adjusted PH to find the variables with significant effect on hazards of death. The effect of various factors on the survival time was evaluated by a parametric event-time model, the one found to have the best fit by Akaike Information Criterion (AIC). Results: Of 428 HD patients eligible for the analysis, 221 (52%) experienced death. With the mean ±SD age of 60±16 years and BMI of 23±4.6 Kg/m2, they composed of 250 men (58%). The median of the survival time (95% CI) was 624 days (550 to 716). The overall 1, 2, 3, and 4 year survival rates for the patients undergoing HD were 74 %, 42 %, 25 %, and 17 %; respectively. By using AIC, AFT log-normal model was recognized as the best functional form of the survival time. Cox-adjusted PH results showed that the amount of ultrafiltration volume (UF) (HR=1.146, P=0.049), WBC count (HR=1.039, P=0.001), RBC count (HR=0.817, P=0.044), MCHC (HR=0.887, P=0.001), and serum albumin (HR=0.616, P<0.001) had significant effect on mortality. AFT log-normal model indicated that WBC (ETR=0.982, P=0.018), RBC (ETR=1.131, P=0.023), MCHC (ETR=1.067, P=0.001), and serum albumin (ETR=1.232, 0.002) had significant influence on the survival time. Conclusions: Considering Cox-adjusted PH and three parametric event-time models, the parametric AFT log-normal had the best efficiency in determining factors influencing HD patients survival. Resulted from this model, WBC and RBC count, MCHC and serum albumin are factors significantly affecting survival time of HD patients.
Key Words: Body Mass Index, erythrocyte count, leukocyte count, renal dialysis, serum albumin, survival analysis, ultrafiltration