To study the effect of individualized dialysate sodium on interdialytic weight gain and blood pressure. Methodology: It was a Prospective study. Duration: 2 years from January 2019 to December 2020. In this study, about 50 patients on maintenance hemodialysis for at least six weeks and IDWG more than 3kg were enrolled. Patients receiving maintenance hemodialysis in Narayana Medical College and Hospital Nellore were enrolled in the present study. Results: Fifty patients who met the inclusion criteria were enrolled in our study. These include 33(66%) males and 17(34%) females with a mean age of 51.58 years. The mean duration of HD in our study was 16.92 months. The most common cause of ESRD in our study was Diabetic Nephropathy (54%); other causes include Chronic Glomerular Nephritis (18%), Chronic Interstitial Nephritis (8%), and CKD of unknown cause in 20% of patients. Dialysate sodium in standard phase (Phase I) was kept constant at 138meq/L, whereas mean dialysate sodium in individualized sodium Phase (Phase II), calculated by multiplying mean pre-HD sodium by 0.95 (Donnan coefficient), was 128meq/L. The Mean pre-HD sodium level was almost similar in both phases, but there was a 3meq/L difference in the mean post-HD sodium level in standard and individualized phases. There was a significant reduction in mean IDWG by 0.63 kg in Phase II, and there was also a significant reduction in mean UF requirement by 0.55 kg in the individualized sodium phase (Phase II) when compared with the standard phase (Phase I). There was a significant reduction in post-HD diastolic blood pressure by 3mmHg in the individualized sodium phase (Phase II) compared with the standard phase (Phase II). There was a reduction in intradialytic complications in Phase II when compared with Phase I. Despite the low dialysate sodium concentrations, there was no increase in hypotension episodes in the individualized sodium phase (Phase II). Conclusion:We conclude that individualizing dialysate sodium in hemodialysis patients significantly reduced interdialytic weight gain, ultrafiltration requirement, and blood pressure.

In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices.