Chronic kidney disease (CKD) is an irreversible progressive health problem often associated with ... more Chronic kidney disease (CKD) is an irreversible progressive health problem often associated with cardiovascular complication, bone mineral metabolism disorder, uremic toxin deposition, and immune dysregulation. The gut microbiome is an important modulator of immune function and performs a plethora of functions inside the host body. Several factors such as diet, antibiotic use, environmental pollutant modulates the composition of Gut microbiota. An intervention with dietary substances may be a therapeutic strategy to modulate the healthy Gut microbiota composition and slowing the progression of CKD.
IntroductionAngiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (AR... more IntroductionAngiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are the antihypertensive drug class of choice in patients with chronic kidney disease (CKD). Head-to-head comparisons of the renal or non-renal outcomes between ACEI/ARB users and nonusers have not been conducted in all population groups. We examined the renal and cardiovascular outcomes in users and nonusers enrolled in the Indian Chronic Kidney Disease (ICKD) Study.MethodsA total of 4,056 patients with mild-moderate CKD were studied. Patients were categorized as ACEI/ARB users or nonusers. Major adverse kidney events [ESKD (end stage kidney disease), ≥50% decline in eGFR and kidney death], all-cause mortality, and cardiovascular mortality were analyzed over a median follow-up period of 2.64 (1.40, 3.89) years between the two groups.ResultsOut of a total of 4,056 patients, 3,487 (87%) were hypertensive. The adjusted sub-hazard ratio (SHR) and 95 % CI for ACEI /ARB users was 0.85 (0.7...
Background and Aims Infections are a significant cause of morbidity in the form of graft loss and... more Background and Aims Infections are a significant cause of morbidity in the form of graft loss and mortality in RTR. Several factors in the pre and peri transplant period increase the susceptibility to PTI, affecting the overall graft and patient survival. Method An observational study of 644 adult RTR (=>18yrs) between Jan 2010 and Dec 2015, followed till Jun 2019. The primary objective was to study the epidemiology of risk factors of PTI. The secondary objective was to evaluate transplant outcomes. Results PTI were seen in 83.1%, of which majority (64%) occurred in the first year. Of all infections, 55.5% were bacterial, 18.5% viral, 10.8% parasitic, 8% fungal, and remaining 7.1% mycobacterial. UTI (37.4%) was most common infection with E. Coli (18.9%) being the commonest cause. Relative risk with PTI for graft dysfunction was 3 times higher (95% CI 1.70-3.57, p=0.00), 3 times higher for graft failure (95% CI 1.35-4.93, p=0.002) compared to non-PTI group and death was 3 times hi...
Background Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwid... more Background Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwide. There is a lack of information on epidemiology and progression of CKD in low–middle income countries. The Indian Chronic Kidney Disease (ICKD) study aims to identify factors that associate with CKD progression, and development of kidney failure and cardiovascular disease (CVD) in Indian patients with CKD. Methods ICKD study is prospective, multicentric cohort study enrolling patients with estimated glomerular filtration rate (eGFR) 15–60 mL/min/1.73 m2, or >60 mL/min/1.73 m2 with proteinuria. Clinical details and biological samples are collected at annual visits. We analysed the baseline characteristics including socio-demographic details, risk factors, disease characteristics and laboratory measurements. In addition, we compared characteristics between urban and rural participants. Results A total of 4056 patients have been enrolled up to 31 March 2020. The mean ± SD age was 50.3 ...
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 27, 2017
There are no reports of de novo donor-specific antibody monitoring by a low-cost solid-phase cros... more There are no reports of de novo donor-specific antibody monitoring by a low-cost solid-phase crossmatch assay using donor lysate after renal transplant. We prospectively evaluated 121 complement-dependant cytotoxicity crossmatch-negative living-donor kidney transplant recipients for development of de novo donor-specific antibodies (class I and II HLA) by solid-phase crossmatch Luminex assay after transplant. Of 121 recipients in our study group, 26 (21.5%) developed de novo donor-specific antibody within 3 months after transplant. Fifteen (58%) of these 26 recipients developed class II de novo donor-specific antibody, 8 patients (30%) developed class I, and 3 (12%) developed both class I and class II. Of the remaining 95 patients (79%) who did not develop de novo donor-specific antibody, 6 (33.3%) had antibody-mediated rejection with glomerulitis (2 with C4d-positive disease). Donor-specific antibody was detected by Luminex solid-phase crossmatch in 18 patients (5 with class I, 11 w...
Chronic kidney disease (CKD) is an irreversible progressive health problem often associated with ... more Chronic kidney disease (CKD) is an irreversible progressive health problem often associated with cardiovascular complication, bone mineral metabolism disorder, uremic toxin deposition, and immune dysregulation. The gut microbiome is an important modulator of immune function and performs a plethora of functions inside the host body. Several factors such as diet, antibiotic use, environmental pollutant modulates the composition of Gut microbiota. An intervention with dietary substances may be a therapeutic strategy to modulate the healthy Gut microbiota composition and slowing the progression of CKD.
IntroductionAngiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (AR... more IntroductionAngiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are the antihypertensive drug class of choice in patients with chronic kidney disease (CKD). Head-to-head comparisons of the renal or non-renal outcomes between ACEI/ARB users and nonusers have not been conducted in all population groups. We examined the renal and cardiovascular outcomes in users and nonusers enrolled in the Indian Chronic Kidney Disease (ICKD) Study.MethodsA total of 4,056 patients with mild-moderate CKD were studied. Patients were categorized as ACEI/ARB users or nonusers. Major adverse kidney events [ESKD (end stage kidney disease), ≥50% decline in eGFR and kidney death], all-cause mortality, and cardiovascular mortality were analyzed over a median follow-up period of 2.64 (1.40, 3.89) years between the two groups.ResultsOut of a total of 4,056 patients, 3,487 (87%) were hypertensive. The adjusted sub-hazard ratio (SHR) and 95 % CI for ACEI /ARB users was 0.85 (0.7...
Background and Aims Infections are a significant cause of morbidity in the form of graft loss and... more Background and Aims Infections are a significant cause of morbidity in the form of graft loss and mortality in RTR. Several factors in the pre and peri transplant period increase the susceptibility to PTI, affecting the overall graft and patient survival. Method An observational study of 644 adult RTR (=>18yrs) between Jan 2010 and Dec 2015, followed till Jun 2019. The primary objective was to study the epidemiology of risk factors of PTI. The secondary objective was to evaluate transplant outcomes. Results PTI were seen in 83.1%, of which majority (64%) occurred in the first year. Of all infections, 55.5% were bacterial, 18.5% viral, 10.8% parasitic, 8% fungal, and remaining 7.1% mycobacterial. UTI (37.4%) was most common infection with E. Coli (18.9%) being the commonest cause. Relative risk with PTI for graft dysfunction was 3 times higher (95% CI 1.70-3.57, p=0.00), 3 times higher for graft failure (95% CI 1.35-4.93, p=0.002) compared to non-PTI group and death was 3 times hi...
Background Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwid... more Background Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwide. There is a lack of information on epidemiology and progression of CKD in low–middle income countries. The Indian Chronic Kidney Disease (ICKD) study aims to identify factors that associate with CKD progression, and development of kidney failure and cardiovascular disease (CVD) in Indian patients with CKD. Methods ICKD study is prospective, multicentric cohort study enrolling patients with estimated glomerular filtration rate (eGFR) 15–60 mL/min/1.73 m2, or >60 mL/min/1.73 m2 with proteinuria. Clinical details and biological samples are collected at annual visits. We analysed the baseline characteristics including socio-demographic details, risk factors, disease characteristics and laboratory measurements. In addition, we compared characteristics between urban and rural participants. Results A total of 4056 patients have been enrolled up to 31 March 2020. The mean ± SD age was 50.3 ...
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 27, 2017
There are no reports of de novo donor-specific antibody monitoring by a low-cost solid-phase cros... more There are no reports of de novo donor-specific antibody monitoring by a low-cost solid-phase crossmatch assay using donor lysate after renal transplant. We prospectively evaluated 121 complement-dependant cytotoxicity crossmatch-negative living-donor kidney transplant recipients for development of de novo donor-specific antibodies (class I and II HLA) by solid-phase crossmatch Luminex assay after transplant. Of 121 recipients in our study group, 26 (21.5%) developed de novo donor-specific antibody within 3 months after transplant. Fifteen (58%) of these 26 recipients developed class II de novo donor-specific antibody, 8 patients (30%) developed class I, and 3 (12%) developed both class I and class II. Of the remaining 95 patients (79%) who did not develop de novo donor-specific antibody, 6 (33.3%) had antibody-mediated rejection with glomerulitis (2 with C4d-positive disease). Donor-specific antibody was detected by Luminex solid-phase crossmatch in 18 patients (5 with class I, 11 w...
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Papers by Narayan Prasad