In resource limiting counties, it is a common observation that patients with chronic kidney disease have undergone twice a week dialysis even though they need thrice a week dialysis regime. This not only increases the burden on hospital emergencies but also affects the quality of life of the patients. The current analysis aims to access the quality of life, biochemical variables, and adverse events in patients on twice a week dialysis having renal urea clearance less than 2 mL/min/1.73 m2 (Kr < 2 mL/min/1.73 m2) as compared to those undergoing twice weekly dialysis having Kr > 2 mL/min/1.73 m2. This investigation was carried out at the Services Hospital in Lahore's Department of Nephrology and Hemodialysis Center. The study involved a total of sixty participants. They were then split into two separate groups. Thirty participants in Group A were on dialysis twice a week and had Kr > 2 mL/min/1.73 m2, whereas in Group B, participants with the same age and sex were also on dialysis twice a week but had Kr< 2 mL/min/1.73 m2. According to the 2006 Kidney Disease Outcome Quality Initiative (KDOQI) Clinical Practice Guidelines, individuals with renal urea clearance (Kr) less than 2 mL/min/1.73 m2 should not undergo twice-weekly hemodialysis. Therefore, Group B was not following the advised weekly dialysis schedule. The primary goal of the study was to assess the difference in biochemical variables and the last six-month emergency visit for dialysis and the second goal was to determine the quality of life by using the Sf-12 QoL questionnaire. The trial involved a total of sixty participants receiving twice-weekly dialysis. Males made up 59% of the study's participants. The participants' average age was 42.18 ± 18.10 years. Group A had a mean age of 38.9 ± 17.6 years, while group B had a mean age of 41.2 ± 14.9 years. Systolic blood pressure was considerably higher in group B compared to group A according to the clinical data (p=0.04). The biochemical examination revealed that group B had significantly lower levels of albumin than group A (p=0.001) and significantly higher levels of urea and calcium (p=0.01 and 0.046, respectively) than group A. It was discovered that group B had significantly more hospital visits than group A (p=0.003). Using the SF-12 to measure quality of life, there was no discernible difference between the groups. The patients were on twice a week dialysis despite their renal urea clearance of less than 2 mL/min/1.73 m2 having compromised clinical and biochemical parameters. They also have a poor quality of life and also a greater number of emergency visits.

ABSTRACT… Dysnatremias (hyponatremia and hypernatremia) are common electrolyte disorders encountered in pediatric critical care patients. The spectrum of both hypo-and hypernatremia varies from mild to severe, being life threatening occasionally. We carried out a study to determine the etiology, epidemiology and effect of dysnatremias on outcomes of pediatric critical care patients. Objectives: To determine the etiology, epidemiology and effect of dysnatremias on outcomes of pediatric critical care patients. Study Design: Prospective, observational study. Setting: Paediatric Intensive Care Unit (PICU) Services Hospital Lahore. Period: October 2014 to March 2015. Results: 185 patients were included. 19 (10.3%) patients had hyponatremia and 22 (11.9%) patients had hypernatremia. A weak but significant inverse relationship between presentation serum sodium and mortality was observed (r = -0.39, n=185, p= <0.001, two-tailed). Conclusions: Presentation serum sodium may influence the outcomes of the patients admitted to the pediatric intensive care unit.

In developing countries like Pakistan, it is observed that the patients who are on dialysis do not follow the prescribed frequency of dialysis which has increased the morbidity, mortality, and burden on nephrology emergencies. To identify the most common factors associated with the refusal of recommended thrice-a-week dialysis. This observational study was carried out between June 1 and August 14, 2022, in the Department of Nephrology and Hemodialysis at the Services Hospital Lahore. The WHO calculator (version 1.1) was used to determine the sample size of 137. The patients in this study comprised those on maintenance twice-weekly hemodialysis who were anuric and advised for thrice-weekly dialysis but declined it. The senior faculty of the nephrology unit created a form with demographic information and a questionnaire to evaluate the likely reasons. The reason was categorized into three categories including socioeconomic psychology and healthcare-related factors. Using the program SPSS, the data was examined (V. 25). Mean and median were used to describe quantitative factors, and frequency or percentage were used to convey qualitative data. Based on the inclusion criteria, a total of 137 people were included in this study. 62% of the sample in our study were men. Our cohort's median age was 49.54 ± 9.50 years. 52% of the participants were in the 36 to 55 age range. 68 % of the patients who declined three times weekly dialysis were married. Only 28% of patients had higher education, while only 46% had a high school diploma and 19% had none at all. 71% of the people in our research were employed, yet the majority made less than twenty thousand PKR per month. Among the healthcare-related factors, the most common factor was the unavailability of dialysis centres (66.2%). From the results of the study, we can conclude that the lack of education and support from the organization they work for, increase responsibilities after married, low socioeconomic status and inadequate healthcare facilities are the major hurdle in compliance for advised thrice a week dialysis. These factors along with the nature of disease cause many psychological problems that further worsen the situation.

Dysnatremias (hyponatremia and hypernatremia) are common electrolytedisorders encountered in pediatric critical care patients. The spectrum of both hypo- andhypernatremia varies from mild to severe, being life threatening occasionally. We carried outa study to determine the etiology, epidemiology and effect of dysnatremias on outcomes ofpediatric critical care patients. Objectives: To determine the etiology, epidemiology and effectof dysnatremias on outcomes of pediatric critical care patients. Study Design: Prospective,observational study. Setting: Paediatric Intensive Care Unit (PICU) Services Hospital Lahore.Period: October 2014 to March 2015. Results: 185 patients were included. 19 (10.3%) patientshad hyponatremia and 22 (11.9%) patients had hypernatremia. A weak but significant inverserelationship between presentation serum sodium and mortality was observed (r = - 0.39,n=185, p= <0.001, two-tailed). Conclusions: Presentation serum sodium may influence theoutcomes of the patients admitted to the pediatric intensive care unit.