Browsing by Author "Sishir Gang"

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Clinical perspectives towards improving risk stratification strategy for renal transplantation outcomes in Indian patients
(Wolters Kluwer Medknow Publications, 2022) Vijay Kher; Vivek B. Kute; Sarbeswar Sahariah; Deepak S. Ray; Dinesh Khullar; Sandeep Guleria; Shyam Bansal; Sishir Gang; Anil Kumar Bhalla; Jai Prakash; Abi Abraham; Sunil Shroff; Madan M. Bahadur; Pratik Das; Urmila Anandh; Arpita Ray Chaudhury; Manoj Singhal; Jatin Kothari; Sree Bhushan Raju; Dilip Kumar Pahari; G. Vishwanath Siddini; G. Sudhakar; Santosh Varughese; Tarun K. Saha
Graft loss and rejections (acute/chronic) continue to remain important concerns in long-term outcomes in kidney transplant despite newer immunosuppressive regimens and increased use of induction agents. Global guidelines identify the risk factors and suggest a framework for management of patients at different risk levels for rejection; however, these are better applicable to deceased donor transplants. Their applicability in Indian scenario (predominantly live donor program) could be a matter of debate. Therefore, a panel of experts discussed the current clinical practice and adaptability of global recommendations to Indian settings. They also took a survey to define risk factors in kidney transplants and provide direction toward evidence- and clinical experience-based risk stratification for donor/recipient and transplant-related characteristics, with a focus on living donor transplantations. Several recipient related factors (dialysis, comorbidities, and age, donor-specific antibodies [DSAs]), donor-related factors (age, body mass index, type - living or deceased) and transplantation related factors (cold ischemia time [CIT], number of transplantations) were assessed. The experts suggested that immunological conflict should be avoided by performing cytotoxic cross match, flow cross match in all patients and DSA-(single antigen bead) whenever considered clinically relevant. HLA mismatches, presence of DSA, along with donor/recipient age, CIT, etc., were associated with increased risk of rejection. Furthermore, the panel agreed that the risk of rejection in living donor transplant is not dissimilar to deceased donor recipients. The experts also suggested that induction immunosuppression could be individualized based on the risk stratification. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Indian chronic kidney disease study: Design and methods
(Blackwell Publishing, 2017) Vivek Kumar; Ashok Kumar Yadav; Sishir Gang; Oommen John; Gopesh K. Modi; Jai Prakash Ojha; Rajendra Pandey; Sreejith Parameswaran; Narayan Prasad; Manisha Sahay; Santosh Varughese; Seema Baid-Agarwal; Vivekanand Jha
Aim: The rate and factors that influence progression of chronic kidney disease (CKD) in developing countries like India are unknown. A pan-country prospective, observational cohort study is needed to address these knowledge gaps. Methods: The Indian Chronic Kidney Disease (ICKD) study will be a cohort study of approximately 5000 patients with mild to moderate CKD presenting to centres that represent different geographical regions in India. Time to 50% decline in baseline estimated glomerular filtration rate, need of renal replacement therapy or any new cardiovascular disease (CVD) event or death from CVD are the primary end points. Value of Study: This study will provide the opportunity to determine risk factors for CKD progression and development of CVD in Indian subjects and perform international comparisons to determine ethnic and geographical differences. A bio-repository will provide a chance to discover biomarkers and explore genetic risk factors. © 2016 Asian Pacific Society of Nephrology
Nonmedical factors and health-related quality of life in CKD in India
(American Society of Nephrology, 2020) Gopesh K. Modi; Ashok K. Yadav; Arpita Ghosh; Kajal Kamboj; Prabhjot Kaur; Vivek Kumar; Shobhit Bhansali; Narayan Prasad; Manisha Sahay; Sreejith Parameswaran; Santosh Varughese; Sishir Gang; Shivendra Singh; Dipankar Sircar; Natarajan Gopalakrishnan; Ajay Jaryal; Sanjay Vikrant; Seema Baid Agarwal; Vivekanand Jha
Background and objectives Patient-reported outcomes have gained prominence in the management of chronic noncommunicable diseases. Measurement of health-related quality of life is being increasingly incorporated into medical decision making and health care delivery processes. Design, setting, participants, & measurements The Indian Chronic Kidney Disease Study is a prospective cohort of participants with mild to moderate CKD. Baseline health-related quality of life scores, determined by the standardized Kidney Disease Quality of Life 36 item instrument, are presented for the inception cohort (n52919). Scores are presented on five subscales: mental component summary, physical component summary, burden, effect of kidney disease, and symptom and problems; each is scored 0–100. The associations of socioeconomic and clinical parameters with the five subscale scores and lower quality of life (defined as subscale score <1 SD of the sample mean) were examined. The main socioeconomic factors studied were sex, education, occupation, and income. The key medical factors studied were age, eGFR, diabetes, hypertension, and albuminuria. Results The mean (SD) subscale scores were physical component summary score, 4369; mental component summary score, 48610; burden, 61633; effects, 87613; and symptoms, 90620. Among the socioeconomic variables, women, lower education, and lower income were negatively associated with reduced scores across all subscales. For instance, the respective b-coefficients (SD) for association with the physical component summary subscale were 22.6 (23.4 to 21.8), 21.5 (22.2 to 20.7), and 21.6 (22.7 to 20.5). Medical factors had inconsistent or no association with subscale scores. The quality of life scores also displayed regional variations. Conclusions In this first of its kind analysis from India, predominantly socioeconomic factors were associated with quality of life scores in patients with CKD. © 2020 by the American Society of Nephrology.
Prescription Practices in Patients With Mild to Moderate CKD in India
(Elsevier Inc., 2021) Narayan Prasad; Ashok Kumar Yadav; Monica Kundu; Jasmin Sethi; Ajay Jaryal; Dipankar Sircar; Gopesh K. Modi; Kajal Kamboj; Manisha Sahay; Natarajan Gopalakrishnan; Prabhjot Kaur; Sanjay Vikrant; Santosh Varughese; Seema Baid-Agrawal; Shivendra Singh; Sishir Gang; Sreejith Parameswaran; Vivek Kumar; Arpita Ghosh; Vivekanand Jha
Introduction: Patients with chronic kidney disease (CKD) require multiple medications. There is no information on prescription patterns or the use of evidence-based therapies for management of CKD from low-middle-income countries. Using baseline data from the Indian CKD (ICKD) cohort, we describe the drug prescription practices in patients with mild to moderate CKD. Methods: The ICKD study is a prospective, observational cohort study of mild to moderate kidney disease across 11 centers in India. We analyzed all the prescriptions captured at enrollment in the ICKD study. Drugs were categorized into 11 different groups. We provide descriptive data on prescription details and evaluate the appropriateness of medication use. Results: Complete prescription data were available in 3966 out of 4056 (97.8%) subjects enrolled in the ICKD database. Most patients had stage 3 CKD, 24.9% had diabetic kidney disease, 87% had hypertension, and 25.5% had moderate to severe proteinuria. Renin-angiotensin-aldosterone system blockers were prescribed in less than half (47.9%) and in 58.8% of patients with proteinuric CKD. Metformin was prescribed in 25.7% of diabetic subjects with CKD. Only 40.4% of patients were taking statins; 31.1% and 2.8% subjects with anemia were receiving iron and erythropoiesis-stimulating agents, respectively. Conclusion: This study highlights the missed opportunities for improving outcomes through appropriate prescriptions of drugs in patients with CKD. There is need for dissemination of evidence-based guidelines and institution of sustainable implementation practices for improving the overall health of patients with CKD. © 2021 International Society of Nephrology
Renin-angiotensin blocker use is associated with improved cardiovascular mortality in Indian patients with mild-moderate chronic kidney disease—findings from the ICKD study
(Frontiers Media S.A., 2022) Narayan Prasad; Ashok Kumar Yadav; Monica Kundu; Ajay Jaryal; Dipankar Sircar; Gopesh Modi; Manisha Sahay; Natarajan Gopalakrishnan; Sanjay Vikrant; Santosh Varughese; Seema Baid-Agrawal; Shivendra Singh; Sishir Gang; Sreejith Parameswaran; Arpita Ghosh; Vivek Kumar; Vivekanand Jha
Introduction: Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are the antihypertensive drug class of choice in patients with chronic kidney disease (CKD). Head-to-head comparisons of the renal or non-renal outcomes between ACEI/ARB users and nonusers have not been conducted in all population groups. We examined the renal and cardiovascular outcomes in users and nonusers enrolled in the Indian Chronic Kidney Disease (ICKD) Study. Methods: A total of 4,056 patients with mild-moderate CKD were studied. Patients were categorized as ACEI/ARB users or nonusers. Major adverse kidney events [ESKD (end stage kidney disease), ≥50% decline in eGFR and kidney death], all-cause mortality, and cardiovascular mortality were analyzed over a median follow-up period of 2.64 (1.40, 3.89) years between the two groups. Results: Out of a total of 4,056 patients, 3,487 (87%) were hypertensive. The adjusted sub-hazard ratio (SHR) and 95 % CI for ACEI /ARB users was 0.85 (0.71, 1.02) for MAKE, 0.80 (0.64, 0.99) for a 50% decline in eGFR, and 0.72 (0.58, 0.90) for ESKD. For cardiovascular mortality, ACEI/ARB users were at lower risk (SHR = 0.55, 95% CI: 0.34, 0.88). Diuretic users were at increased risk of all-cause mortality (HR = 1.95, 95% CI: 1.50, 2.53) and cardiovascular mortality (adjusted SHR = 1.73, 95% CI: 1.09, 2.73). There was non-significant association between the use of other antihypertensives and any of the end points. Discussion: ACEI/ARB use is associated with slower rate of decline in eGFR in those with CKD stage 1-3. ACEI/ARB users had a significantly lower risk of renal outcomes, and cardiovascular mortality. Copyright © 2022 Prasad, Yadav, Kundu, Jaryal, Sircar, Modi, Sahay, Gopalakrishnan, Vikrant, Varughese, Baid-Agrawal, Singh, Gang, Parameswaran, Ghosh, Kumar and Jha.
The Indian Chronic Kidney Disease (ICKD) study: baseline characteristics
(Oxford University Press, 2022) Vivek Kumar; Ashok Kumar Yadav; Jasmine Sethi; Arpita Ghosh; Manisha Sahay; Narayan Prasad; Santosh Varughese; Sreejith Parameswaran; Natarajan Gopalakrishnan; Prabhjot Kaur; Gopesh K. Modi; Kajal Kamboj; Monica Kundu; Vivek Sood; Neeraj Inamdar; Ajay Jaryal; Sanjay Vikrant; Saurabh Nayak; Shivendra Singh; Sishir Gang; Seema Baid-Agrawal; Vivekanand Jha
Background: Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwide. There is a lack of information on epidemiology and progression of CKD in low-middle income countries. The Indian Chronic Kidney Disease (ICKD) study aims to identify factors that associate with CKD progression, and development of kidney failure and cardiovascular disease (CVD) in Indian patients with CKD. Methods: ICKD study is prospective, multicentric cohort study enrolling patients with estimated glomerular filtration rate (eGFR) 15-60 mL/min/1.73 m2, or >60 mL/min/1.73 m2 with proteinuria. Clinical details and biological samples are collected at annual visits. We analysed the baseline characteristics including socio-demographic details, risk factors, disease characteristics and laboratory measurements. In addition, we compared characteristics between urban and rural participants. Results: A total of 4056 patients have been enrolled up to 31 March 2020. The mean ± SD age was 50.3 ± 11.8 years, 67.2% were males, two-thirds of patients lived in rural areas and the median eGFR was 40 mL/min/1.73 m2. About 87% were hypertensive, 37% had diabetes, 22% had CVD, 6.7% had past history of acute kidney injury and 23% reported prior use of alternative drugs. Diabetic kidney disease, chronic interstitial nephritis (CIN) and CKD-cause unknown (CKDu) were the leading causes. Rural participants had more occupational exposure and tobacco use but lower educational status and income. CIN and unknown categories were leading causes in rural participants. Conclusions: The ICKD study is the only large cohort study of patients with mild-to-moderate CKD in a lower middle income country. Baseline characteristics of study population reveal differences as compared with other cohorts from high-income countries. © 2021 The Author(s) 2021.
What do we know about chronic kidney disease in India: First report of the Indian CKD registry
(2012) Mohan M. Rajapurkar; George T. John; Ashok L. Kirpalani; Georgi Abraham; Sanjay K. Agarwal; Alan F. Almeida; Sishir Gang; Amit Gupta; Gopesh Modi; Dilip Pahari; Ramdas Pisharody; Jai Prakash; Anuradha Raman; Devinder S. Rana; Raj K. Sharma; R.N. Sahoo; Vinay Sakhuja; Ravi Raju Tatapudi; Vivekanand Jha
Background: There are no national data on the magnitude and pattern of chronic kidney disease (CKD) in India. The Indian CKD Registry documents the demographics, etiological spectrum, practice patterns, variations and special characteristics. Methods. Data was collected for this cross-sectional study in a standardized format according to predetermined criteria. Of the 52,273 adult patients, 35.5%, 27.9%, 25.6% and 11% patients came from South, North, West and East zones respectively. Results: The mean age was 50.1 14.6 years, with M:F ratio of 70:30. Patients from North Zone were younger and those from the East Zone older. Diabetic nephropathy was the commonest cause (31%), followed by CKD of undetermined etiology (16%), chronic glomerulonephritis (14%) and hypertensive nephrosclerosis (13%). About 48% cases presented in Stage V; they were younger than those in Stages III-IV. Diabetic nephropathy patients were older, more likely to present in earlier stages of CKD and had a higher frequency of males; whereas those with CKD of unexplained etiology were younger, had more females and more frequently presented in Stage V. Patients in lower income groups had more advanced CKD at presentation. Patients presenting to public sector hospitals were poorer, younger, and more frequently had CKD of unknown etiology. Conclusions: This report confirms the emergence of diabetic nephropathy as the pre-eminent cause in India. Patients with CKD of unknown etiology are younger, poorer and more likely to present with advanced CKD. There were some geographic variations. © 2012 Rajapurkar et al; licensee BioMed Central Ltd.