Sreepada Subhramanyam - Academia.edu (original) (raw)

Papers by Sreepada Subhramanyam

Indian Journal of Peritoneal dialysis, Apr 5, 2007

The pathogenic mechanisms resulting in encapsulating peritoneal sclerosis(EPS) in a chronic perit... more The pathogenic mechanisms resulting in encapsulating peritoneal sclerosis(EPS) in a chronic peritoneal dialysis patient is still not resolved. The peculiar and incompletely explained geographic preponderance in certain countries, conflicting reports of efficacy or failure of different therapeutic approaches to the disease, sporadic occurrence of EPS in patients who are already on immunosuppressive medications especially sirolimus, which supposedly are effective in treating KPS, indicates that there are multiple poorly understood mechanisms involved in the pathogenesis. Our case highlights the same.

Indian Journal of Peritoneal dialysis, Aug 1, 2016

Severe hyponatremia and renal failure requiring renal replacement therapy pose a therapeutic chal... more Severe hyponatremia and renal failure requiring renal replacement therapy pose a therapeutic challenge. Hemodialysis to correct volume overload, azotemia, and abnormal electrolyte levels will result in rapid correction of serum sodium concentration and place the patient at risk for osmotic demyelination syndrome. We present a patient with acute kidney injury and severe hypotonic hyponatremia (serum sodium<115 mEq/L) who was treated successfully with Automated Peritoneal Dialysis(APD).Previous experiences of using continuous venovenous hemofiltration successfully have been documented,,where sodium correction rate is regulated by intricate single pool sodium kinetic modelling, but there are no reports of peritoneal dialysis in these situations. In our case, bedside Tenchoff catheter placement and cycler PD used. We found that APD can be a cost effective safe, accurate and easy alternate treatment in combined hyponatremia and renal failure requiring dialysis.

Contributions To Nephrology, Dec 12, 2016

South Asian countries have a population of 1.7 billion and are classified as low-middle to poor i... more South Asian countries have a population of 1.7 billion and are classified as low-middle to poor income nations. Their health care systems cannot presently meet the growing need for renal replacement therapy (RRT), provided as haemodialysis or peritoneal dialysis (PD). Most patients cannot afford the treatment and quickly default. Furthermore, most of the population is located in rural areas, where there are few treatment centres; therefore, there is a huge gap between those treated and those in need. PD can bridge this gap and can serve as a first line of therapy if it becomes more affordable. Government reimbursement schemes, the Once-in-a-Lifetime Payment Scheme, and PD insurance all provide strong impetus to dialysis programmes. Local manufacturing of PD fluid has also reduced the cost of therapy to some extent. PD may be preferable for patients with cardiovascular morbidity and it also obviates the risk of transmission of blood-borne diseases such as HIV, hepatitis B, and hepatitis C. In our own centre, automated PD is being used as initial RRT for acute kidney injury with good results. In prospective transplant recipients, PD has been found to decrease the risk of posttransplant graft dysfunction. Key Messages: Remote PD and home visits by PD clinical coordinators have brought faraway patients and their nephrologists closer with the use of technology. For these reasons, the current pressing need is to bring PD to the forefront of RRT in resource-poor countries in South Asia to enable universal treatment of patients with renal disease.

Indian Journal of Peritoneal dialysis, 2007

Indian Journal of Transplantation, 2021

Background: Tacrolimus exposure is estimated by trough levels (C0). Recent studies suggest that C... more Background: Tacrolimus exposure is estimated by trough levels (C0). Recent studies suggest that C0 may not accurately reflect the area under the curve (AUC) and may not correlate with clinical events like acute rejection (AR) and nephrotoxicity. Materials and Methods: In an open, prospective, single-center study, 29 consecutive recipients of renal transplantation underwent C0 along with 2-h (C2), 4-h (C4), and 6-h (C6) estimation of blood tacrolimus levels by enzyme-linked immunosorbent assay, 72 h after initiation with tacrolimus or after a change in its dosage. AUC was estimated by trapezoidal method. C0, C2, C4, and C6 levels were correlated with the AUC. Results: Thirty-six AUC estimations were made over a 2-year period. The best correlate was C6. Correlation coefficients were C0 – 0.868, C2 – 0.788, C4 – 0.839, and C6 – 0.904. C6 values accounted for 79% of the variability of the AUC. Six patients experienced AR, with 5 having C0 within the target range. C6 values correlated best with AUC in these patients (C0 – 0.970, C2 – 0.833, C4 – 0.942, and C6 – 0.970). This was statistically significant. Three patients developed tacrolimus toxicity. In these patients, the correlation coefficients were C0 – 0.551, C2 – 0.556, C4 – 0.77, and C6 – 0.941. By regression analysis, we developed predictive equations. The equation AUC = 12.126 + 2.81 × C0 + 2.92 × C6 best predicted the AUC. Conclusions: Overall C6 levels were more predictive of the AUC, accurately predicting AR and nephrotoxicity. Incorporating C6 may improve tacrolimus therapeutic drug monitoring.

Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2007

In a peritoneal dialysis (PD) program, an efficient and well-structured home visit schedule is im... more In a peritoneal dialysis (PD) program, an efficient and well-structured home visit schedule is imperative for ensuring patient compliance, adherence to proper exchange technique, nutrition status monitoring and intervention, and early detection of evolving medical co-morbid problems so as to prevent further complications. Regular home-visit follow-up of the PD patient directly affects technique survival and quality of life. The clinical coordinator is ideally placed to be the direct link between the PD center and patients in their domiciliary surroundings. This professional plays a crucial role in the success of a PD program.

Indian Journal of Nephrology, 2020

© 2020 Indian Journal of Nephrology | Published by Wolters Kluwer Medknow Sir, Guillain-Barre syn... more © 2020 Indian Journal of Nephrology | Published by Wolters Kluwer Medknow Sir, Guillain-Barre syndrome (GBS) is an acute ascending form of polyradiculoneuropathy characterized by symmetrical flaccid areflexic motor paralysis with/without sensory disturbances. GBS is extremely rare after solid organ transplantation (SOT), probably because of their immunocompromised state.[1] GBS presenting after an ABO-incompatible (ABOi) transplant and during pregnancy has never been reported in past among SOT recipients. We herein report a case of GBS diagnosed during pregnancy in an ABOi renal transplant (RT) recipient who recovered completely with timely management.

Indian Journal of Transplantation, 2019

Guillain–Barre syndrome (GBS) is an extremely rare complication after solid organ transplantation... more Guillain–Barre syndrome (GBS) is an extremely rare complication after solid organ transplantation (SOT) and its clinical course can be more severe in them. Most of the cases of GBS in SOT have been associated with Cytomegalovirus infection. GBS presenting after an ABO-incompatible (ABOi) transplant and during pregnancy has never been reported in the past among SOT recipients. We report a case of a 27-year-old female ABOi renal transplant recipient who presented with acute flaccid paralysis all four limbs during the second trimester of pregnancy, diagnosed to have GBS. Pregnancy and vaccination might have played a role in precipitating GBS in our patient. She was treated with plasma exchange and experienced GBS treatment-related fluctuations but finally recovered completely without any adverse pregnancy outcome.

Blood purification, 2018

Initiating renal replacement therapy in late referred patients with central venous catheter (CVC)... more Initiating renal replacement therapy in late referred patients with central venous catheter (CVC) hemodialysis (HD) causes serious complications. In urgent start peritoneal dialysis, initiating peritoneal dialysis (PD) within 14 days of catheter insertion still needs HD with CVC. We initiated Emergent start PD (ESPD) with Automated PD (APD) at our center within 48 h from the time of presentation. A prospective, case-controlled, intention-to-treat study with 56 patients was conducted between March 2016 and August 2017. Group A (24 patients) underwent conventional PD 14 days after catheter insertion. Group B (32 patients), underwent ESPD with APD. Exit site leak (ESL), catheter blockage, and peritonitis at 90 days were primary outcomes. Technique survival was secondary outcome. Baseline characteristics were similar with 3 episodes of ESLs (9.4%) in the study group and none in the control group (p = 0.123). Catheter blockage (16.7%-Group A, 25%-Group B) and peritonitis (none vs. 9.4% i...

Indian Journal of Peritoneal dialysis, 2016

Contributions to nephrology, 2017

Hong Kong Journal of Nephrology, 2014

Indian Journal of Transplantation, 2011

Basic kidney diseases were CGN(60.20%), CIN(15.31%), DN(8.16%), PKD(2.04%) and others(14.29%). Th... more Basic kidney diseases were CGN(60.20%), CIN(15.31%), DN(8.16%), PKD(2.04%) and others(14.29%). They were followed up for a median 75.5 patient-months. Mortality occurred in 25 (25.51%) patients (M:F-20:5). Causes of death were Sepsis/infection (36%), coronary artery disease (28%), CVA (8%), failed graft (4%) and unknown (24%). DWGF was 88% of total death and contributed to 78.57% of total graft loss. Overall patient survival was 90.8%, 80.2%, 65.6% and 59.1% at 1, 5, 10 and 15 years, respectively(Kaplan-Meier analysis). When the group with mortality was compared to the group with those still alive, there were significant differences in recipient age (median 40 vs 31, p=0.007), pre-transplantation hypertension(HTN) (100% vs 65.75%, p<0.001), posttransplant infection(76% vs 42.47%, p=0.005), coronary artery disease(28% vs 1.37%, p<0.001), and serum creatinine at last follow up (median 2.3 vs 1.56, p=0.003). Conclusion: Along with infection, CAD is an important cause of death at all times during the first 15 years following renal transplantation even in non-diabetic recipients. Death with functioning graft is very alarming.

Contributions to nephrology, 2009

Peritoneal dialysis (PD) is acknowledged worldwide as a well-accepted form of renal replacement t... more Peritoneal dialysis (PD) is acknowledged worldwide as a well-accepted form of renal replacement therapy (RRT) for end-stage renal disease (ESRD). Ideally, PD should be the preferred modality of RRT for ESRD in developing countries due to its many inherent advantages. Some of these are cost savings (especially if PD fluids are manufactured locally or in a neighboring country), superior rehabilitation and quality of life (QOL), home-based therapy even in rural settings, avoidance of hospital based treatment and the need for expensive machinery, and freedom from serious infections (hepatitis B and C). However, this is not the ground reality, due to certain preconceived notions of the health care givers and governmental agencies in these countries. With an inexplicable stagnation or decline of PD numbers in the developed world, the future of PD will depend on its popularization in Latin America and in Asia especially countries such as China and India, with a combined population of 2.5 b...

Contributions to nephrology, 2012

Anemia is a significant cause of morbidity and lowers the quality of life of patients suffering f... more Anemia is a significant cause of morbidity and lowers the quality of life of patients suffering from chronic kidney disease (CKD). Iron deficiency is the most important cause of erythropoietin (EPO) hyporesponsiveness in CKD. EPO administration significantly increases the costs of CKD management. It follows that paramount importance must be given to enhancing responsiveness to EPO thereby ensuring that the patient derives maximum benefit. Intravenous iron (IVI) administration has been used for decades to replenish body iron stores. Multiple preparations of Iron are available in the market. However, IVI administration is fraught with dangers like adverse drug reactions, susceptibility to infection, and, as recently postulated, direct cellular toxicity. Traditional approaches to IVI administration have focused on multiple administrations of lower doses for fear of adverse reactions. However, recent studies have demonstrated that higher doses can be safely administered in a single infu...