The prediction of rapid progression in diabetic kidney disease (DKD) remains a global challenge. This study evaluated the prognostic value of two noninvasive biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and monocyte chemoattractant protein-1 (MCP-1) in identifying rapid DKD progression. In this prospective observational study, 145 T2DM patients with DKD (October 2021-June 2024) were categorized as rapid or nonrapid progressors based on an eGFR decline >5 mL/1.73 m²/year. Baseline urinary(u) NGAL and MCP-1 were measured by ELISA. Clinical profiles, risk factors, and predictive utility of the biomarkers were analyzed. During a median follow-up of 1.3 years, 38.6% were rapid progressors. Hypertension, cardiovascular disease, elevated SBP, high fasting blood sugar, and higher urinary albumin-to-creatinine ratio (uACR) were significantly associated with rapid progression (p < 0.05). Median uNGAL and uMCP-1 levels were higher in rapid progressors (57.6 vs 28.2 ng/ml; 469 vs 220 pg/ml; p = 0.01) and increased with albuminuria severity (p = 0.03 and p = 0.01). Multivariate analysis identified uNGAL, uMCP-1, and uACR as independent risk factors. uMCP-1 showed the highest diagnostic accuracy (AUC 0.94; 94.1% sensitivity; 89.2% specificity at 381.2 pg/ml). uNGAL had an AUC of 0.86 (83.4% sensitivity; 77.3% specificity at 39.8 ng/ml). A combined panel of uMCP-1, uNGAL, and uACR further improved predictability (AUC 0.96). Patients with elevated uNGAL and uMCP-1 levels experienced a greater incidence of rapid progression similar to uACR. uMCP-1 exhibited better diagnostic accuracy than did uNGAL and uACR, with better sensitivity and specificity in identifying rapid progressors. The combination of three noninvasive biomarkers had further improved predictability.

Organ shortage remains a critical challenge in India's transplant landscape, despite established deceased donor organ transplantation (DDOT) programmes. Many potentially viable organs from brain-dead deceased donors (DBDs) are discarded due to uncertainties surrounding donor suitability in specific clinical scenarios. To address this gap, the Indian Society of Organ Transplantation (ISOT) convened a panel of national experts to develop a Delphi consensus statement aimed at guiding transplant professionals on the feasibility of organ donation from DBDs, particularly in complex or marginal donor situations. This position statement presents 19 consensus recommendations based on real-world clinical contexts such as extremes of age, acute kidney injury, infections (including HCV, HBV, HIV, tuberculosis, and tropical diseases), malignancy, diabetes, hypertension, and various surgical anomalies. The guidance is grounded in available literature, registry data, and extensive clinical experience, with the aim of expanding the DBD donor pool across Asia and improving access to transplantation for patients with end-stage organ failure. The consensus does not function as a formal clinical guideline but rather as a practical reference tool, acknowledging the limitations in India-specific data and the contextual differences from Western transplant settings. It encourages critical care and transplant teams to perform structured assessments of organ viability, apply ethical principles, and pursue informed consent in line with local regulations.

Accurate dry weight assessment is crucial for hemodialysis (HD) fluid management, yet traditional clinical methods often lack precision. A significant scientific gap exists in the availability of a standardized multimodal framework for integrating objective tools, leaving clinicians without clear guidance on combining results from multiple devices. To address this gap, this narrative review provides a qualitative clinical synthesis of bioimpedance spectroscopy (BIS), lung ultrasound (LUS), and inferior vena cava diameter (IVCD). A structured literature search was conducted across PubMed, Scopus, and CINAHL for English-language studies published between 2012 and 2024. Studies focusing on dry weight assessment using these tools in adult HD patients were included, and findings from 22 core studies were synthesized narratively. BIS and LUS are valuable tools for identifying fluid overload. BIS assesses systemic fluid distribution across compartments, whereas LUS allows non-invasive detection of extravascular lung water. In contrast, IVCD primarily reflects intravascular volume status. While the integrated use of these tools shows potential clinical utility, individual methods, particularly IVCD, require further validation owing to interpatient variability. A multimodal approach that integrates these objective methods with clinical judgment offers a comprehensive evaluation of dry weight. Integrating these assessment strategies may improve outcomes and decision-making in nephrology care.

Background: Patients with end-stage kidney disease (ESKD) often experience significant symptom burden and reduced quality of life (QoL). This study compared these outcomes between hemodialysis (HD) and non-dialysis (ND) ESKD patients in India. Methods: A six-month cross-sectional study was conducted among 247 patients with ESKD aged ≥ 18 years, following Institutional Ethics Committee approval (IEC-214/2021). Symptom burden and QoL were assessed using the Edmonton Symptom Assessment System–Revised: Renal and EuroQol 5-Dimension 5-Level instruments. Results: HD patients reported a higher symptom burden than ND patients (81.3% vs. 65.8%), with fatigue being the most common symptom. They also had greater mobility impairment (63% vs. 45%) and lower EQ-5D-5L utility scores (0.69 ± 0.32 vs. 0.79 ± 0.27), indicating poorer QoL. Older age and lower education were associated with higher symptom burden, while poorer QoL was associated with older age, widowhood, lower education, and longer dialysis vintage (p < 0.05). Symptom burden was moderately correlated with poorer QoL (r = 0.60, p < 0.01). Conclusions: HD patients experience a greater symptom burden and poorer QoL than ND-ESKD patients. Routine symptom assessment and targeted symptom management may improve patient-centered outcomes.

Background: Chronic kidney disease-associated pruritus (CKD-aP) is characterised as pruritus in individuals with advanced chronic kidney disease (CKD) without a discernible alternative etiology. This study assessed the prevalence, severity, and effects of CKD-aP on sleep and health-related quality of life (HRQoL) among end-stage kidney disease patients (ESKD) undergoing maintenance hemodialysis (MHD) in an Indian cohort. Methods: This cross-sectional, single-centre study included adults with renal failure undergoing MHD for ≥3 months. The primary outcome was CKD-aP prevalence and its relationship with demographic, clinical, and laboratory variables. Secondary outcomes included CKD-aP severity, characteristics, HRQoL, and sleep quality scores. Statistical analysis was conducted using SPSS v21, with a significance level of p < 0.05. Results: The 12-item Pruritus Severity Scale found mild CKD-aP to be the most common (37% of patients). The 5-D Itch Scale found that patients with moderate-to-severe CKD-aP had longer daily itching (52.9%) with a nonsignificant change over time (p = 0.18), and the back (77.9%) was the most affected site. The Dermatology Life Quality Index revealed that 75.5% of patients had HRQoL impairment. The Skindex-16 found that moderate-to-severe CKD-aP was linked to a greater symptom burden and emotional distress. The Pittsburgh Sleep Quality Index found poorer sleep quality as CKD-aP worsened. Conclusions: CKD-aP is common in patients undergoing hemodialysis and negatively impacts quality of life, emphasizing the need for routine assessment and targeted management.