Background Assessment of quality of life (QOL) of patients with end-stage renal disease has become increasingly important, both in order to evaluate the influence of the disease on patients and the type of renal replacement therapy they require. Therefore, in this study, we aimed to assess QOL in patients undergoing hemodialysis and evaluated the effects of various sociodemographic factors affecting QOL of such patients in Nepal. Methods A cross-sectional study was conducted among 150 patients with chronic kidney disease undergoing hemodialysis at two major centers in Nepal. Demographic data including age, sex, ethnicity, educational status, marital status, employment, income, duration of illness, and duration on hemodialysis were collected. QOL was assessed using the World Health Organization Quality of life (WHOQOL-BREF) questionnaire. Four domains (physical, psychological, social, and environmental) and two items (overall perception of QOL and health) of the WHOQOL-BREF were the primary end points of this study. Bivariate relationship between sociodemographic factors and QOL scores were analyzed using independent samples t -test and one-way analysis of variance. Multiple linear regression analysis was performed to determine independent predictors of QOL. Results Following QOL scores were recorded: environmental domain (53.17±15.59), psychological domain (51.23±18.61), social domain (49.86±21.64), and physical domain (45.93±16.90). Older age was associated with a better QOL score in the social domain ( p =0.005), and employed patients scored better in the environmental domain ( p =0.019). Unemployed patients and those of the Terai/Madhesi ethnic group had significantly low scores in overall perception of health ( p <0.05) as compared to other groups. Low income status and increased duration on hemodialysis were found to be the only independent negative predictors of QOL in patients with hemodialysis ( p <0.05). Conclusion Patients with chronic kidney disease on dialysis had overall low QOL scores in all four domains. Age, ethnicity, employment status, income, and duration on hemodialysis affected one or more domains of QOL in such patients. Low income status and increased duration on hemodialysis were the only independent negative predictors of QOL of patients on maintenance hemodialysis.

Introduction: Coronavirus disease pandemic has affected large number of peopleglobally and has continued to spread. Preparedness of individual nations and the hospitals isimportant to effectively deal with the surge of cases. We aimed to obtain nation wide data fromNepal, about hospital preparedness for COVID-19. Methods: Online questionnaire was prepared in accordance with the Center for Disease Controlrecommendations to assess preparedness of hospitals for COVID-19. The questionnaire wascirculated to the over 800 doctors across the nation, who are the life members of six medical societies. Results: We obtained 131 completed responses from all seven provinces. Majority of respondentshad anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that theirhospital had policy to receive suspected or proven cases with COVID-19. Presence of isolationward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presenceof airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124(94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6(4.6%) respondents. Conclusions: It is apparent that most of the hospitals are not well prepared for management ofpatients with COVID-19. Resource allocation and policy making should be aimed to enhance nationalpreparedness for the pandemic.

Background Very less is known about health-related quality of life (HRQOL) among patients with kidney diseases in Nepal. This study examined HRQOL among haemodialysis and kidney transplant recipients in Nepal. Methods The Nepali version of World Health Organization Quality of Life Instruments -(WHOQOL-BREF) questionnaire was administered using face to face interviews among end stage renal disease (ESRD) patients, from two large national referral centers in Nepal. The differences in socio-demographic characteristics among ESRD patients were examined using the Chi-square test. The group differences in quality of life (QOL) were examined using the Mann-Whitney U test and Kruskal-Wallis tests. Results Of the 161 participants, 92 (57.1%) were renal transplant recipients and 69 (42.9%) patients were on maintenance haemodialysis. Hypertension (70.9%) was the most common co-morbidity among ESRD patients. Haemodialysis patients scored significantly lower than the transplant recipients in all four domains as well as in overall perception of quality of life and general health. Ethnicity (p = 0.020), socio-economic status (p < 0.001), educational status (p < 0.001) and employment status (p = 0.009) were significantly associated with the overall QOL in ESRD patients. Across patient groups, educational status (p = 0.012) was positively associated with QOL in dialysis patients, while urban residence (p = 0.023), higher socio-economic status (p < 0.001), higher educational status (p = 0.004) and diabetes status (p = 0.010) were significantly associated with better QOL in transplant recipients. Conclusion The overall QOL of the renal transplant recipients was higher than that of the patients on maintenance haemodialysis; this was true in all four domains of the WHOQOL-BREF. ESRD patients with low HRQOL could benefit from targeted risk modification intervention.

BackgroundThe current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. It is not known whether same cumulative dose of IVC would be effective when given over six months.MethodsWe carried out a prospective, observational study on 41 patients of biopsy-proven lupus nephritis (class III, IV, V or mixed). For induction, patients received six pulses of monthly IVC (500 mg each), along with steroid. Patients were followed up monthly until one month beyond completion of the sixth pulse. The outcomes assessed were complete remission (proteinuria < 200 mg/day or urine albumin nil with serum albumin >35 gm/L, stable estimated glomerular filtration rate (eGFR) if normal at baseline or increase in eGFR by 25 % if abnormal at baseline and normal urinary sediment), response (complete or partial remissions), complications of therapy and death.ResultsTwenty two patients (53.7 %) had class IV nephritis. Eighteen patients (43.9 %) achieved complete remission, 16 (39.0 %) achieved partial remission, yielding an overall response rate of 82.9 %. Nephrotic range proteinuria (UTP ≥ 3 g/day) and severe hypoalbuminemia (serum albumin < 20 g/L) at baseline influenced remission (p <0.05). Infection, seen in 12 patients (29.3 %), was the most common complication. Four deaths (9.6 %) were observed, all due to infection.ConclusionsFor induction phase treatment, Nepalese patients with lupus nephritis responded favorably to steroid and low dose IVC of 3 grams given as six monthly pulses.

Background and aims: Prevalence of various types of kidney diseases in Nepalese population has largely been unknown. Knowledge of the prevalence of specific type kidney disease in renal patients has important implications in starting the treatment modalities and prognostification of these patients. We tried to find out the various types of kidney diseases in patient population undergoing kidney biopsy at our centre.