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BACKGROUND AND AIMS Prevention of catheter related blood stream infection (CRBSI) is a major challenge in hemodialysis (HD) patients. Efficacy of 70% ethanol as a catheter lock solution for the treatment of tunnelled cuff catheter's (TCC's) CRBSI is widely studied [1, 2]. Prophylactic use of ethanol lock was limited to small number of studies especially involving paediatric and home parenteral nutrition (HPN) patients [3] and studies in chronic HD patients with TCCs [4, 5]. But its role in prophylaxis of CRBSI for non-tunnelled catheter (NTC's) is less explored. METHOD We conducted a single centre prospective study from May 2019 to May 2020. A total of 62 patients of end-stage renal disease (ESRD) requiring NTC's for the initiation of HD in emergency or maintenance of HD while waiting for the creation or maturation of an already created arteriovenous fistula (AVF) or for TCC insertion were included. The study population was divided into two groups, Group A (n = 31) received 70% ethanol with heparin 2000 IU as a catheter lock solution. Group B (n = 31) received standard heparin 2000 IU as a catheter lock. RESULTS The primary endpoint of the study was the rate of CRBSI, in group A 6.5% (n = 2) it was significantly lower compared with group B 25.8% (n = 8), (P = 0.038) and when the CRBSI rate/1000 days was calculated, for group A it was 2.2/1000 catheter days and for group B it was 9.6/1000 catheter days (P = 0.04). The mean duration of catheter survival was not significantly different for group A (29.97 ± 6.7) days and group B (26.42 ± 8.04) days. CONCLUSION 70% ethanol lock along with heparin may be safe and effective as a catheter lock for prophylaxis of CRBSI.

BACKGROUND AND AIMS Probiotics are being coprescribed in the management of chronic kidney disease (CKD). Few studies have reported that probiotics could slow down the progression of CKD by regulating the intestinal flora and by reducing the uremic toxins. [1,2] Objective of our study is to assess the effect of probiotics on uremic toxins production and inflammation in patient suffering from CKD stage 3 and 4. METHOD Patients of either sex, aged 18–75 years, suffering from CKD stage 3 and 4 were enrolled. Study was conducted at Department of Nephrology, Guwahati Medical College and Hospital (GMCH), Guwahati, Assam. Patients received 1 capsule containing 45 billion of colony forming units of probiotics twice a day for 180 days. Patients were evaluated at day 0, 90 and 180. Parameters such as serum creatinine, blood urea, uric acid, C-reactive protein (CRP), hemoglobin and albumin were recorded at each visit. RESULTS During period of May 2019 to May 2020, 102 patients were enrolled and followed for 180 days. Significantly higher number of males 67 (66%) than 35 (34%) females is reported (P = 0.024). CKD stage 3 and 4 is reported in 41 (40% ) and 61 (60%), respectively. Insignificant drop of serum creatinine of -0.17 (on day 90, P = 0.146) and -0.23 (on day 180, P = 0.135) compared with baseline Sr. creatinine 2.53 ± 0.56 (mean ± SD) is reported. Significant drop in blood urea is reported on day 90 (-2.97, P = 0.014) and on day 180 (-3.60, P < 0.001) compared with baseline 52.11 ± 26.90 (mean ± SD). The reduction in CRP on day 90 and day 180 from baseline was found to be statistically significant (P = 0.037, 0.011). However, reduction in uric acid and increase in hemoglobin and albumin did not reach significance on day 90 and day 180. CONCLUSION Probiotics supplementation lead to decrease in blood urea and CRP. However, its effect on serum creatinine, hemoglobin, uric acid and albumin did not reach statistical significance. More randomized controlled trials are required to prove the efficacy of probiotics to retard CKD progression.

BACKGROUND AND AIMS Chronic kidney disease (CKD) patients and renal allograft recipients (RARs) are at increased risk for severe coronavirus disease 2019 (COVID-19). Acute kidney injury (AKI) can develop in a patient with COVID-19 infection. Data regarding the outcome of COVID-19 patients affected with renal disease are scarce, especially from northeastern part of India. METHOD We conducted a single-centre, retrospective, observational study, involving hospitalized COVID-19 affected patients with renal disease in Gauhati Medical College, Guwahati between 1 July 2020 and 30 June 2021. Patients with various forms of kidney disease including AKI, CKD, RAR and glomerulonephritis were included. The main aim of the study was to describe the outcome (in-hospital mortality) in this group of patients. RESULTS The study included a total of 384 patients with most patients in the elderly age group (73.7% above 45 years). Most of the patients were male (n = 288, 75%). Those with renal disease were grouped under AKI, CKD, RAR, systemic lupus erythematosus with lupus nephritis (LN) and rapidly progressive GN (RPGN) (20.3%, 75%, 3.4%, 1% and 0.3%, respectively). The mean duration of stay at the hospital was 8.1 days with maximum duration for RAR patients with a mean of 11.2 days. A total of 199 patients (51.8%) died. Mortality data were not available for 19 patients who got transferred to various other departments after recovering from COVID-19. Mortality rates for AKI, CKD, RAR and LN were 37.2%, 55.2%, 53.8% and 75%, respectively. One patient with RPGN also died. CONCLUSION COVID-19 affects patients of all age and sex. CKD patients and those on immunosuppressive agents are at higher risk for mortality.