European Journal of Cardiovascular Medicine

Background: The danger of chronic kidney disease (CKD) is rising quickly worldwide and has become a main health crisis and most of these patients die from cardiovascular disease (CVD) prior to progression to end stage renal disease (ESRD), therefore, Poor cardiovascular outcomes in CKD patients have encouraged nephrologists to search for biomarkers that may improve risk stratification in this population. The aim of this study was to assess serum brain natriuretic peptide (BNP) hormone and cardiac troponin T (cTnT) levels in CKD patients and to determine their involvement with cardiovascular diseases. Methods: This analytical case control study was conducted at Ibn sina and Military hospitals in the period from February 2016 to March 2019, (n = 150) clinically diagnosed CKD patients (age range between 22 - 76 years, 105 males and 45 females), and (n = 150) healthy subjects were included as controls. Serum BNP hormone and cardiac troponin T (cTnT), were estimated by Cobas E-411® fully automated analyzer, serum creatinine by Cobas C-311® fully automated analyzer, hemoglobin by Sysmix, glomerular filtration rate (GFR) was calculated by Cocroft-Gault formula and blood pressure was measured by using mercuric sphygmomanometer. Results: Serum BNP, cTnT, creatinine, systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI) were significantly higher in CKD patients than in controls, while hemoglobin and GFR were significantly lower. Moreover, serum BNP, cTnT, SBP and DBP were significantly higher in CKD patients with cardiovascular disease (CVD) than CKD patients without CVD. In addition, serum BNP, at cutoff level of 240 pg/ml, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 87%, 90%, 52% and 92%, respectively in relation to CVD, while serum cTnT, at cutoff level of 0.1 ng/ml, the sensitivity, specificity, PPV and NPV were 80%, 57%, 46% and 74%, respectively. Furthermore, there was an association between elevated BNP levels and CVD outcomes in patients with CKD, since it is a strong risk factor for CVD (OR: 1.48, p. value 0.031). Conclusions: BNP levels are significantly associated with cardiovascular events (left ventricular hypertrophy and systolic dysfunction) in patients who have CKD and are on maintenance hemodialysis (HD)

Introduction-Chronic kidney disease (CKD) is one of the multifactorial diseases. CKD outcomes are based on many factors and once developed disease tends to progress to end stage renal disease. Many studies have proven relationship of bone minerals and non-protein nitrogenous (NPN) substances with CKD but data showing an association of these parameters with progression of disease is inadequate. Material and method- The study consisted of 88 CKD patients enrolled from kidney hospitals of Lucknow in the period between November 2020 to April 2021. Same number of control was also taken for comparison. Calcium, phosphorus and uric acid was analysed from the blood sample taken from both the groups. GFR was estimated and patients were classified into different stages of CKD. Chi-square test was applied to see the association and ANOVA & Post-hoc Tukey test were used to find the mean difference of parameters among different stages of CKD patients and the control group. For these tests, P-value less than 0.05 was considered statistically significant. Result- Females were found to be affected more by advance stage of CKD than their male counterparts. Hypocalcemia, hyperphosphatemia and hyperuricemia was the general finding in all the CKD stages when compared to control. Mean Ca of stage4 or 5 was significantly lower than stage3 and control group. Mean level of P of stage5 was higher than that of stage3 or 4 of CKD. Similarly, difference in mean uric acid between all the pairs was significant except between control and CKD stage 3. Conclusion- Our study found deranged Ca, P and uric acid levels along with advancement of CKD stages. Correcting these parameters may be of value in the management of CKD to stop its progression

Introduction: Acute kidney injury frequently occurs secondary to diuretics, intravenous radio contrast agents, paracentesis, gastrointestinal bleeding or infection and the development of Hepatorenal Syndrome (HRS) secondary to the progression of Liver Cirrhosis and elevation of portal pressure is not uncommon in the patients with Liver Cirrhosis. In several studies of AKI in such patients, those with serum Creatinine (Cr) levels of more than 1.3 to 1.5mg/mL have a poor prognosis. In early stages of HRS its possible to recover or delay deterioration of renal function with aggressive treatment . Though  Serum Creatinine is most widely used for measurement of GFR in clinical practice, it is greatly influenced by non renal factors, such as muscle atrophy and protein intake, especially in patients with Liver Cirrhosis. This study focusses on such scenarios where Cystatin C as a Novel Biomarker is superior to serum creatinine in predicting the incidence of Hepatorenal Syndrome in liver cirrhosis patients. Material and Methods: This is a Descriptive study was included about 100 patients diagnosed with Liver Cirrhosis in the Department of General Medicine at Mahatma Gandhi Medical College and Research Institute from July 2021 to December 2022. Detailed history, detailed clinical examination, complete blood count, liver function test, serum Cystatin C, Serum Urea, Creatinine, USG Abdomen, CT Abdomen if necessary, Endoscopy, Portal Venous Doppler. Results: Most of the patients in this study belong to the age group between 41 to 50 years (29 out of 100 patients). Patients belonging to age group between 31-40 are equally high. In this study, Males were more commonly affected when compared to female patients (88% were males & 12 % female patients.).  Out of the 100 patients in the study population, 24 patients developed Hepatorenal syndrome ( 19 belonged to Type 1 HRS & 5 belonged to  type 2 HRS). The Novel Biomarker Serum Cystatin C was Elevated in 92 % of the patients and was in the high normal limit in the remaining . On the other hand almost 97 % of patients had Normal serum Creatinine levels when it was done initially, only 3 % had  raised Creatinine level.  24 patients had increased Serum Creatinine levels only when followed up. Comparison between Cystatin C and Serum Creatinine in HRS patients showed a statistical significant P Value of < 0.001. The Sensitivity of Cystatin was 92 % and specificity was 80% in the Hepatorenal Syndrome Patients. Conclusion: Serum Cystatin C as a novel biomarker is a good predictor of Hepatorenal Syndrome (in early stages) in Liver Cirrhosis patients. It is superior to serum Creatinine in prediciting renal injury earlier in Liver Cirrhosis patients than serum Creatinine which varies with age, sex and with body mass etc. This study shows Cystatin C is more specific and sensitive marker of renal function in Liver Cirrhosis patients.

Background:  Over the past few decades, the percentage of patients with end-stage renal disease brought on by diabetes has steadily risen. The most popular biochemical parameter for routinely estimating GFR is serum creatinine level. Notwithstanding the fact that large increases in serum creatinine can occur before 50% of GFR is lost. It has been discovered that cystatin C is a new, promising marker for the early detection of renal diseases. To investigate the connection between microalbuminuria and serum cystatin C for the early detection of renal impairment in type 1 diabetic patients. Methods: From April 2021 to January 2022, a cross-sectional study was carried out at Department of Biochemistry, T R R, Institute of Medical Sciences, Sangareddy, Telangana, India. They were split into two groups, Group I with diabetes diagnosed for less than five years and Group II with diabetes diagnosed for more than five years. The Albumin Creatinine Ratio was used to classify the patients in each group as cases and controls. The levels of serum urea, creatinine, cystatin C, hemoglobin A1c, and urine ACR were estimated. Microsoft Excel was used to conduct the statistical analysis. Results: In the study, 80 patients with type 1 DM were enrolled. Cystatin C levels in cases with type 1 DM lasting longer than five years were found to be statistically significant (0.88±0.43 compared to 0.65±0.38). Over a period of more than five years, a statistically significant positive correlation between cystatin C and ACR (r=0.4, p<0.05) was discovered. According to this, serum levels of cystatin C rise as ACR values rise. There was no noticeable difference in cystatin C levels in patients with type 1 diabetes for less than five years. Conclusion: In patients with Type 1 Diabetes Mellitus who have had the condition for longer than five years, Cystatin C levels in the blood may be utilised as an early sign of renal impairment. However, in our study, patients with Type 1 diabetes who have had the disease for less than five years do not show any significance for Cystatin C.

Chronic kidney disease is a silent epidemic of the 21 centuries. Surveys have suggested that as many as 16% of the adult population have CKD1. The most common, non –renal, chronic disorder in patients with ESRD are gastro intestinal disorders2, accompanying ESRD including those receiving renal replacement therapy. Among upper gastrointestinal lesions caused by chronic kidney disease gastritis, esophagitis, gastric ulcer are the most prevalent lesions. Here an attempt is being made to study the upper gastro intestinal changes in chronic kidney disease and evaluate their relationship with the stage of CKD or GFR. Methodology: We conducted a cross sectional study on 50 patients of, who are diagnosed to have chronic kidney disease and being presented to opd and admission in Navodaya Medical College and Research Center, Raichur over a period of one year. All patients with chronic kidney disease who underwent upper gastrointestinal endoscopy were included in the study. Results: 50 patients were included in the study with mean age and males 28 and 22 females. Among 50 patients 42 patients manifested with upper-gastrointestinal lesion among them erosive gastritis 13(26%) is most common upper gastrointestinal lesion followed by gastro esophageal reflux disease with or without duodenitis 8 (16%), duodenal ulcer ,gastric ulcer 4(8%) each, pangastritis 3(6%), GERD with gastritis, erosive duodenitis, erosive esophgitis, pale gastric mucosa 2(4%) each, angiodysplasia and hiatus hernia 1(2%) each. Conclusion: Majority of the patients with chronic kidney disease have upper gastrointestinal involvement on endoscopic evaluation. Erosive gastritis is the most common lesion Esophageal and duodenal involvement are less common than the gastric lesions. Upper gastrointestinal findings are frequently observed in chronic kidney disease patients on dialysis. Early diagnosis and management of these upper gastrointestinal lesions in CKD can reduce mortality and morbidity and prevent fatal complication like massive upper gastrointestinal bleed.

Aim :To Evaluate the Diagnostic Efficiency of Cystatin C As a marker of Early Renal injury in patients of Type 2 Diabetic in comparison with Creatinine. Materials and Methods : 100 proven cases of type 2 Diabetes categorized into 3 groups. Normoalbuminuria (48), microalbuminuria (32) & macroalbuminuria (20). 50 age and sex matched healthy controls. Fasting plasma glucose(FPG), serum Creatinine, serum Cystatin C, urine dipstick analysis for protein, urine albumin, urine creatinine & calculated UACR were estimated. Glomerular filtration rate was estimated by Cystatin C concentrations according to Chronic Kidney Disease Epidemiology (CKD-EPI) equation and Creatinine eGFR according to Modification of Diet in Renal Disease (MDRD). Results : There was raised levels of FPG , serum Creatinine & serum Cystatin C significantly (p<0.01) with increasing duration of Diabetes. The eGFR of Cystatin C was lower than that of Creatinine eGFR in cases but in controls it was more. The calculated sensitivity of Cystatin C eGFR was 91%,specificity was 94% and overall accuracy(OA) was 92% and these results are better than that of Creatinine eGFR with 84% sensitivity ,88% specificity and 85% OA. The eGFR cystatin c showed higher sensitivity, high specificity & higher accuracy than eGFR creatinine in studied diabetic subjects. Cystatin C showed more significant correlation with Cys C e GFR, (r = −0.99, p<0.001) than serum creatinine e GFR ( r= −0.86,p<0.001) in diabetic patients. Conclusion:The results of present study showed Cystatin C was more sensitive than creatinine thereby making se Cystatin.

Background- chronic kidney disease (CKD) is a public health problem worldwide with a global prevalence of 11 to 13%¹. It is a pathophysiological process with multiple etiologies, resulting in inexorable attrition of nephron number and function leading to end stage renal disease. Cardiovascular diseases (CVD) are becoming the major cause of morbidity and mortality in most of the developing countries; including India in patients of chronic kidney disease³. Aim- To assess left ventricular functional status on echocardiography in chronic kidney disease patients. Methods and materials- This is a Observational Cross-sectional study, done in cases of chronic kidney disease admitted under medicine department & those attending the medical OPD of Deen Dayal Upadhyay Hospital, New Delhi, for a period of 2 years from November 2017 to November 2019. CKD patients were selected on basis of selection criteria as mentioned above. All patients were be clinically evaluated thoroughly. After taking informed consent, these individuals were subjected to the following investigations. GFR Estimation was be done using Modification of Diet in Renal Disease (MDRD) equation and staging of CKD was done on the basis of estimated GFR as per KDIGO guidelines. Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± SD and median. The data was entered in MS EXCEL spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results- Majority of the patients included were in stage 3 (44%) followed by stage 4 (35%) CKD. The mean blood urea was 89.14 ± 24.28 mg/dl, mean serum creatinine was 3.14±1.46mg/dl, mean eGFR was 26.96± 13.31, mean LVEF was 49.92± 9.23 & mean e/a ratio was 1.13 ± 0.53. Systolic dysfunction was present in 24% of CKD patients. Systolic dysfunction was present in 6% of mild/moderate CKD patients & in 42% of severe CKD patients. The association of systolic dysfunction between these two groups was statistically significant (p = <0.0001). In the mild/moderate CKD group out of 50 patients only 3 had systolic dysfunction & it was of the mild variety in all three of them. In the severe CKD group out of 50 Patients, 21 had systolic dysfunction of which maximum patients had moderate systolic dysfunction (41.67%) followed by mild and severe systolic dysfunction in 29.17% patients each. The association of severity of systolic dysfunction between these two groups was statistically significant. Diastolic dysfunction was present in 58% CKD patients, 46% of mild/moderate CKD patients & in 70% of severe CKD patients. The association of diastolic dysfunction between these two groups was statistically significant (p = 0.026). In this study E/A ratio < 0.8 was seen in 34% of mild/moderate CKD group patients & in 24% of severe CKD group patients and the association between these two groups was statistically not significant. E/A ratio of 0.8-2 with an E/e’ ratio >10 was seen in 30% of severe CKD group patients & in 10% of mild/moderate CKD group patients and the association between these two groups was statistically significant. E/A ratio > 2 was seen in 16% of severe CKD group patients & in 2% of mild/moderate CKD group patients and the association between these two groups was statistically significant. Conclusion- Echocardiography is a cost effective, noninvasive and easily reproducible diagnostic test which can detect early changes in the cardiac parameters. This is important for risk stratification and early preventive measures. Thus, echocardiographic screening of CKD patients has both therapeutic and prognostic implications. All asymptomatic CKD patients should undergo a routine echocardiographic evaluation.

Introduction Coronary artery bypass grafting (CABG) is a highly successful surgical treatment for the relief of angina and prolongs life in patients with coronary artery disease (CAD). Preoperative renal dysfunction is a significant risk factor that influences the outcome in patients undergoing CABG surgery. Mild renal dysfunction is an adverse prognostic indicator in patients with coronary artery disease. Several studies showed that patients with mild renal dysfunction have an increased risk of dying within 30 days after coronary surgery. Patients with renal dysfunction who require CABG represent a complex group of patients with accelerated atherosclerosis and advanced cardiovascular disease. Methods And Materials This is a prospective study was conducted in the Department of Cardiothoracic and vascular surgery, Yashoda Hospital, Secunderabad. OPCAB was performed with the Octopus-Evolution tissue stabilizer system device for target coronary artery stabilization. A mean systemic arterial pressure was maintained around 65 to 70 mmHg throughout the procedure. An intracoronary shunt  was used in all target coronaries greater than 1.25mm in diameter during construction of distal anastomosis. Humidified carbon dioxide blower /mister was used to disperse the blood from the anastomotic site while constructing the distal anastomoses Results The mean age in mild group was 59.05±7.60 and 56.37±9.06 in normal group, p=0.15. In mild group 16 (40.00) were females and 24 (60.00) were males whereas 10(25.00) were females and 30 (75.00) were males in normal group, p=0.15(figure 2). Preoperative variables such as BMI>30 (p=0.30), Smoking (p=1.00), Hypertension (p=0.33), Diabetes mellitus (p=0.57), Hyperlipidaemia (p=0.63), COPD (p=0.80), preoperative MI (p=0.81) were compared between the mild and normal groups and none of the baseline variables were significant between the groups Conclusions There was no significant difference in the patients undergoing off-pump CABG with normal renal function and mild renal dysfunction in terms of short-term mortality, myocardial infarction, stroke, or renal failure requiring dialysis. Off-pump CABG is more reno-protective for patients with normal renal function but for patients with mild renal dysfunction may need preoperative assessment of renal function by GFR in addition to serum creatinine levels to stratify the risk for postoperative renal dysfunction and to optimize measures for renal preservation during surgical myocardial revascularization

Background: Two of the most prevalent metabolic disorders in the world are diabetes mellitus (DM) and hypothyroidism. Both illnesses are becoming much more common, and if left untreated, they can have long-term consequences. Aim: this study aimed to evaluate the relationship between thyroid related hormones and vascular complication in type 2 diabetes mellitus patients in a tertiary level hospital. Methods: This cross-sectional study included one hundred Types 2 DM patients. Thyroid function tests were performed on the subjects. TSH was divided into three levels: 0.27–2.49 mU/L, 2.5–4.2 mU/L, and >4.2 mU/L. Every participant had their risk for diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy evaluated. TSH levels and microvascular consequences of type 2 diabetes were examined in relation to each other. Results: The TSH level and HbA1c did not significantly correlate (P>0.05). Microvascular disease affected 72% of the patients overall. There was no discernible correlation between TSH levels and neuropathy or retinopathy. There was no statistically significant correlation (P>0.05) between the presence of microalbuminuria and macroalbuminuria and elevated TSH levels. Higher TSH levels were shown to be significantly correlated with both diabetic kidney disease and reduced GFR (P<0.05). Conclusions: Since elevated TSH levels in Type 2 DM patients may be a sign of underlying microvascular problems, it is desirable to screen all patients for thyroid dysfunction.

Background: Diabetes mellitus, a major public health concern, is closely linked to chronic kidney disease (CKD), traditionally assessed through albuminuria. However, emerging evidence highlights the presence of renal impairment even in normoalbuminuric patients. This cross-sectional observational study, conducted at a tertiary care hospital in South India, evaluated glomerular filtration rate (GFR) using the MDRD formula in 185 normoalbuminuric diabetic patients (25 with Type 1 and 160 with Type 2 diabetes). A striking 79.5% of participants exhibited reduced GFR despite the absence of albuminuria—60% in the Type 1 group and 82.5% in the Type 2 group. The study revealed that early renal dysfunction is common among diabetics without proteinuria, particularly in newly diagnosed Type 2 diabetics, many of whom also presented with cardiovascular and microvascular complications. These findings challenge the classical reliance on albuminuria as a sole marker for diabetic kidney disease and underscore the clinical relevance of non-albuminuric diabetic kidney disease (NA-DKD). The integration of GFR estimation into routine diabetes care is strongly recommended for timely detection and intervention. While the study was limited by its single-center, cross-sectional design and reliance on the MDRD formula, it contributes valuable insight into the early detection of renal compromise in the diabetic population.