Browsing by Author "Akhilesh Jaiswal"

Now showing 1 - 2 of 2

Community-acquired acute kidney injury in India: data from ISN-acute kidney injury registry
(Elsevier Ltd, 2024) Narayan Prasad; Akhilesh Jaiswal; Jeyakumar Meyyappan; Natrajan Gopalakrishnan; Arpita Roy Chaudhary; Edwin Fernando; Manish Rathi; Shivendra Singh; Mohan Rajapurkar; Tarun Jeloka; Jai Kishun; Valentine Lobo
Background: Acute kidney injury (AKI), particularly community-acquired AKI (CA-AKI), is a major health concern globally. The International Society of Nephrology's “0 by 25” initiative to reduce preventable deaths from AKI to zero by 2025 is not achievable in low and middle income countries, such as India, possibly due to a lack of data and measures to tackle this urgent public health issue. In India, CA-AKI predisposes younger patients to hospitalization, morbidity, and mortality. This is the first multicenter, prospective, cohort study investigating CA-AKI and its consequences in India. Methods: This study included data from patients with CA-AKI (>12 years of age) housed in the Indian Society of Nephrology-AKI registry, involving 9 participating tertiary care centers in India, for the period between November 2016 and October 2019. The etiological spectrum and renal and patient outcomes of CA-AKI at the index visit and at 1-month and 3-month follow-ups were analyzed. The impact of socioeconomic status (SES) on outcomes was also analyzed. Findings: Data from 3711 patients (mean [±SD] age 44.7 ± 16.5 years; 66.6% male) were analyzed. The most common comorbidities included hypertension (21.1%) and diabetes (19.1%). AKI occurred in medical, surgical, and obstetrical settings in 86.7%, 7.3%, and 6%, respectively. The most common causes of AKI were associated with sepsis (34.7%) and tropical fever (9.8%). Mortality at the index admission was 10.8%. Complete recovery (CR), partial recovery (PR), and dialysis dependency among survivors at the time of discharge were 22.1%, 57.7%, and 9.4%, respectively. Overall, at 3 months of follow-up, mortality rate, CR, PR, and dialysis dependency rates were 11.4%, 72.2%, 7.2%, and 1%, respectively. Multivariate analysis revealed that age >65 years, alcoholism, anuria, hypotension at presentation, thrombocytopenia, vasopressor use, transaminitis, and low SES were associated with mortality at the index admission. Interpretation: Sepsis and tropical fever were the most common causes of CA-AKI. Presentation of CA-AKI to tertiary care units was associated with high mortality, and a significant number of patients progressed to CKD. Individuals with a low SES had increased risk of mortality and require immediate attention and intervention. Funding: This study was funded by the Indian Society of Nephrology. © 2024 The Authors
Protocol and Methods: Role of Levothyroxine on the Progression of Chronic Kidney Disease in Subclinical Hypothyroid Populations (LP‑CKD) – A Multicenter Randomized Controlled Trial
(Wolters Kluwer Medknow Publications, 2023) Narayan Prasad; Shivendra Singh; Vivek Kumar; Manisha Sahay; Arpita Ray Chaudhury; Manas Ranjan Behera; Ravi Shankar Kushwaha; Deependra Yadav; Sonam Gautam; Akhilesh Jaiswal
Introduction: Subclinical hypothyroidism (SCH) is highly prevalent and associated with chronic kidney disease (CKD). However, it is still unanswered whether the restoration of euthyroid status in these patients will be beneficial in retarding a decline in glomerular filtration rate in early CKD patients. We aim to evaluate the efficacy of levothyroxine therapy versus placebo in slowing estimated glomerular filtration rate (eGFR) decline among CKD patients (stage 2–4) with SCH. Methods: This study will be a multicentric, double‑blind, randomized, parallel‑group, placebo‑controlled study. A total of 500 CKD patients, 250 patients in the treatment group and 250 patients in the placebo group, will be randomized. The randomization between the treatment arm and placebo arm will be performed as per the computer‑generated random number table in a 1:1 ratio. The sample size was calculated based on the assumed reduction in eGFR after 1‑year follow‑up in the treatment and placebo groups of 10% and 25%, respectively, at a minimum two‑sided 99% confidence interval and 90% power of the study and considering 20% loss on follow‑up. Each patient will be followed every 3 months for at least 1 year after randomization. Individuals completing 1‑year follow‑up visits will be considered for analysis. The baseline and follow‑up data will be compared between the treatment and placebo groups. The study will evaluate the efficacy and safety of levothyroxine therapy versus placebo in slowing eGFR decline among CKD patients (stage 2‑4) with SCH. The primary endpoint will be the end of follow‑up of the patients, reduction of eGFR by ≥50% from a baseline of that patient, or development of ESKD or death of the patients. The secondary endpoint will be any cardiovascular event or arrhythmia after the institution of the drug. © 2023 Wolters Kluwer Medknow Publications. All rights reserved.