Introduction: Kidney replacement therapy in chronic kidney disease patients can result in catastrophic health costs, pushing them into poverty in lower middle-income countries. There are only limited studies from India focusing on the financial hardship of these patients. Data on direct nonmedical and indirect cost of hemodialysis (HD) are also limited. This study aims to find the different components of cost for HD and its association with quality of life (QOL) among HD patients. Methods: Primary objective was to find the cost of HD, which include direct medical, direct nonmedical and indirect cost. Secondary objective was to study

IntRoductIonDapsone is an antibiotic belonging to sulfone group with potent anti-inflammatory and immunosuppressive properties. [1] Dapsone was traditionally used as an anti-leprosy drug and later, its use has been expanded to conditions such as acne vulgaris, dermatitis herpetiformis, thrombocytopenic purpura, and pemphigoid. [2] Dapsone is metabolized in the liver through cytochrome P-450 pathway to metabolites which are potent oxidants, responsible for the adverse hematological effects such as methemoglobinemia. Here, we report a case of methemoglobinemia secondary to use of dapsone for the treatment of chronic immune thrombocytopenia (c ITP) and also discuss the relevant pathophysiology, clinical presentation, and management. Since the incidence of dapsone-induced methemoglobinemia is rare, our aim here is to enhance awareness about this life-threatening adverse event. Few studies (six case reports) were identified from India using the MeSH terms (Dapsone, Methemoglobinemia) in Pubmed from 2008 to 2018 to the best of our knowledge. [3] case RepoRt A 53-year-old female belonging to the middle class socioeconomic strata, residing in the rural area in Kerala with no habits, was diagnosed with immune thrombocytopenia in 2009. She was treated with steroids and later was put on a second line agent azathioprine which was stopped subsequently. In 2017, she presented to us with a relapse and was given dapsone at a dose of 3 mg /kg/day [150 mg/day] with folic acid 2.5 mg/day. Two weeks later, she had presented to the emergency department with complaints of fatigability and excessive tiredness. Her past medical history included hypertension and type II diabetes mellitus. She is not glucose-6-phosphate dehydrogenase (G6PD) deficient. There is no significant family history.Dapsone, a sulfone group antibiotic, was traditionally used for the treatment of leprosy. It has potent anti-inflammatory and immunosuppressive properties. Hence later, its use has been expanded to conditions such as acne vulgaris, dermatitis herpetiformis, chronic immune thrombocytopenia, pemphigoid, malaria, and cutaneous leishmaniasis. Dapsone is less expensive and effective second-line treatment used in chronic immune thrombocytopenia (c ITP). It is metabolized in the liver by cytochrome P-450 enzymes to potent oxidants that are responsible for the adverse hematological complications like methemoglobinemia. We hereby report a case of dapsone-induced methemoglobinemia in an adult female patient used for the treatment of c ITP. She presented with hypoxia, fatigability, and improved subsequently on low-dose intravenous methylene blue. The patient was discharged without any complications. Initial assessment at Emergency services was suggestive of probable adverse drug reaction according to the WHO causality assessment scale and Naranjo algorithm. The preventability assessment was unpreventable according to Schumock and Thornton preventability assessment scale. A key to the diagnosis of methemoglobinemia is cyanosis with low-oxygen saturation and normal ...

BACKGROUND: Chronic kidney disease (CKD) is a worldwide public health problem associated with an eight- to ten-fold increase in cardiovascular mortality. Among patients with CKD, on drug treatment, we aimed to determine the characteristics, etiology, patterns and rates of drug use, and outcomes and factors determining the outcomes at 6 months. METHODS: We conducted an observational follow-up study on inpatients with CKD at a tertiary care teaching hospital in South India. We collected data on patient characteristics, comorbidities, treatments at baseline, and treatments and outcomes at 6 months. We used Chi-squared tests and Cochran's Q-test to compare categorical variables, t -tests to compare continuous variables, and a multivariable logistic regression analysis to estimate the determinants of the outcome. RESULTS: We recruited 305 patients with the mean age 52.98 (±14.89) years, 73.1% were male and 55.4% patients were from a lower-middle socioeconomic background. About 72.1% were in CKD Stage 5 and 37.0% had diabetic nephropathy. Antihypertensives (84.6%) were the most common drug class prescribed, followed by multivitamins (65.2%), proton-pump inhibitors (64.9%), and antidiabetic drugs (32.5%). There was no significant difference in rates of drug use over 6 months. Increased serum creatinine (odds ratio [OR]: 1.29 [1.04, 1.60]; P = 0.017) and lower estimated glomerular filtration rate (eGFR) (OR: 38.23 [3.92, 372.06]; P = 0.002) predicted progression of CKD, and antiplatelets reduced progression (OR: 0.278 [0.09, 0.85]; P = 0.026). CONCLUSION: Diabetic nephropathy was the most common cause of CKD. There was no change in treatments over 6 months. Low eGFR predicted progression and use of antiplatelets reduced progression of CKD. Large multicenter studies are needed to study the variability in patient characteristics, treatment and outcomes to obtain a national picture, and to enable policy changes.