Background Among the dialysis population, left ventricular hypertrophy (LVH) is becoming a major cause of cardiovascular death, mainly due to myocardial infarction, heart failure, and arrhythmias. Electrocardiography (ECG) is a cheap and easily available test to detect the presence of left ventricular hypertrophy. The basic purpose of this study was to assess the frequency of left ventricular hypertrophy among the maintenance hemodialysis patients by applying different voltage criteria for the diagnosis of LVH and its relationship with various biophysical and biochemical parameters. Methods A total of 68 patients of end-stage renal disease (ESRD) were included in the study who were on maintenance hemodialysis at the dialysis center of Sughra Shafi Hospital. Baseline characteristics were recorded from the patients' data. Blood samples were drawn and electrocardiographs were taken, both before and after hemodialysis.

Background: Arteriovenous fistula (AVF) is the vascular access of choice for End-Stage Renal Disease (ESRD) patients on maintenance hemodialysis. Arteriovenous fistula is the vascular access of choice for adequate hemodialysis.AVF dysfunction is one of the most important causes of morbidity and mortality in these patients. Aim: To access the frequency of dysfunctional AFVs using clinical examination among end-stage renal disease patients on thrice-weekly maintenance hemodialysis. Study design: Cross-sectional study Place and duration of study: Dialysis Unit, Nephrology Department, Sir Ganga Ram Hospital, Lahore from 21st January 2019, to 21st July 2019. Methodology: 177 patients who had end-stage renal disease and were on maintenance hemodialysis were enrolled. Fistulas were examined clinically. The presence and types of dysfunctional AVF were recorded. Results: Fifty three (29.9%) were females and 124 (70.1%) were females with mean age was 48±13.29 years. There were 44.1% diabetic, 91.0% hypertensive, and 44.1% both diabetic and hypertensive. The frequency of dysfunctional arteriovenous fistula was 30.5%. 123 (69.5%) patients had normal fistula, 13 (7.3%) had signs of outflow obstruction, 23 (13.0%) had aneurysm, 5 (2.8%) had signs of inflow obstruction, and 13 (7.3%) had a weak or absent thrill/bruit however no infection or steal syndrome was present. Conclusion: The frequency of dysfunctional arteriovenous fistula among patients on thrice-weekly maintenance hemodialysis is 30.5% on physical examination. Periodic physical assessment of AVF can reduce fistula failure rates. Key words: End-stage renal disease, Haemodialysis, Arteriovenous fistula

CKD 5 underwent hemodialysis post CABG. AKI had a significant correlation with prolonged ICU stay of more than 48 hours (p value 0.021).Amongst the 191 patients, percentage of patients having AKI with recent myocardial infarction of less than 90 days pre CABG, was higher (38.6%) as compared to those without AKI(25.9%). Percentage of patients developing AKI with diastolic dysfunction and LVEF <35% was greater (72% and 13.6%) as compared to those not developing AKI (60% and 8.2%). Patients developing AKI with infections and arrhythmias post CABG were more (15.9% and 29.5%) as compared to those not developing AKI with infections and arrhythmias. (7.4%and 19%)- Table 3. 6 patients were operated on pump while 185 had beating heart(off pump) surgeries. 3/6(50%) patients on pump had AKI, while 41/185 (22%) off pump patients had AKI. Amongst the CKD group, only 2 patients had on pump surgery and both developed AKI (100%) while off pump 36/70 (51%) had AKI.In the CKD cohort, increased incidence of AKI was observed with the following risk factors as compared to non CKD patients with similar risk factors : Infection(57.1%), bleeding(50%), diabetes mellitus (DM) (55.3%), Shock(33.3%), post op arrhythmias(52.9%), recent MI(less than 90 days pre CABG(59.2%), LV EF<35% (62.5%) and diastolic dysfunction (57.4%)- Table 4. Conclusions: Post CABG CKD patients are at a higher risk of per operative AKI as compared to those without CKD. The chances of AKI are more with worsening CKD Stage. Patients with diastolic dysfunction, EF less than 35% and recent MI<90 days pre CABG are at a high risk of developing AKI. Post op arrhythmias and infections in the ICU are important precipitating factors for AKI post CABG. POSTER SESSION: EPIDEMIOLOGY, OUTCOMES AND HEALTH SERVICES RESEARCH IN DIALYSIS -1 (MODERATED)Introduction: Worldwide, home haemodialysis (HHD) has been advocated mainly for independent and relatively healthy dialysis patients; however, this is not the practice locally. The number of dialysis patients with multi comorbidities, debilitated, bed and home bound has largely increased leading to a significant burden on the active hospital beds, on the outpatient dialysis units and on health care providers as well. Nurse assisted home haemodialysis (NAHHD) is thus introduced to overcome this problem. We present our one-year outcome with (NAHHD) both at home and in long-term care facilities. Methods: Haemodialysis patients who were fulfilling the National Insurance Company criteria for HHD were accepted in the (NAHHD) programme. These criteria include mainly frail, disabled, bed and home bound patients requiring special transportation from their home to the dialysis unit. Our portable dialysis machine is used to deliver haemodialysis therapy at patient home or at long term care facilities by well experienced haemodialysis nurses. Dialysate solution volume, length and weekly number of the dialysis sessions were calculated by dose calculator with a targeted weekly std Kt/V of $ 2. Patients who were on this modality for at least three mont...

Background: Cardiovascular disease (CVD) is the leading cause of death in the dialysis population. Among other risk factors abnormalities in lipid metabolism occur in patients with all stages of chronic kidney disease (CKD). The most common dyslipidemia in CKD and dialysis is hypertriglyceridemia, whereas the total cholesterol concentration can be normal or low, perhaps due in part to malnutrition. Although  hypertriglyceridemia that occurs in CKD may not significantly increase coronary risk, other changes may contribute to the accelerated atherosclerosis. We tried to find out how many patients in our setup on thrice weekly hemodialysis are suffering from dyslipidemia and whether taking treatment or not. Methodology: Cross sectional study conducted at dialysis center of Sir Ganga Ram Hospital, Lahore including all seventy patients with ESRD undergoing regular HD three times a week, 4 hours per session. Random blood samples (Non-fasting) were collected before dialysis for lipid profile including serum triglyceride, LDL, HDL and total cholesterol. Results: Out of 70 patients only 3 (4.4%) patients were on statins for dyslipidemia. Triglycerides were high in 41.4%, total cholesterol was low in 61.4%, and HDL was low in 34.3%. Conclusion: Hypertriglyceridemia is major lipid abnormality among hemodialysis patients.

Background: Nail disorders are common in patients with chronic kidney disease on maintenance hemodialysis. Even though there are some studies regarding nail disorders in peritoneal dialysis and renal transplant patients, to the best of our knowledge, sparse local data is present on nail disorders among maintenance hemodialysis patients. Aim: To determine the frequency of nail disorders in patients with chronic kidney disease on maintenance hemodialysis. Study design: Cross-sectional study Place and duration of study: Dept of Nephrology, Sir Ganga Ram Hospital, Lahore from 1st February 2019 to 1st August 2019. Methodology: Two hundred and ninety two cases were enrolled. The nails of the patients were inspected and shot by utilizing a 10-megapixelcamera. The photos were subsequently reviewed independently by two dermatologists and one nephrologist. Results: There were 198 (67.8%) males and 94 (32.2%) females. The mean age was 47.3±12.4 years. The overall frequency of nail disorder in patients with chronic kidney disease on maintenance hemodialysis was 197(67.5%). According to nail disorders distribution, 119(40.8%) had half and half nail, while 56(19.2%) had splinter hemorrhage, 47(16.1%) had absent lunula, 16 (5.5%) had chromonychia, 15(5.1%) had Beau’s line, 19(6.5%) had melanonychia and 52(17.8%) had onycholysis. Conclusion: The frequency of nail problems in CKD patients treated by hemodialysis is 67.5%. This finding highlights the need for nail evaluation as a component of periodic examination in hemodialysis patients. Key words: Chronic kidney disease, Haemodialysis, Nail disorders.