Pradeep Kumar Padhi

BACKGROUND There is paucity of data on prevalence of parasitic infections in patients of chronic kidney disease and in those undergoing haemodialysis. So, the present study was carried out with an aim to evaluate the prevalence of intestinal parasitic infections in patients of chronic kidney disease and those undergoing hemodialysis, and to correlate the prevalence of different parasitic infections in relation to severity of renal impairment in Chronic Kidney Disease (CKD) patients. MATERIALS AND METHODS This study was performed on 142 subjects suffering from Chronic Kidney Disease (CKD), defined as abnormalities of kidney structure or function, present for >3 months, with the implications for health, who satisfied the inclusion and exclusion criteria. The subjects in the study group (n=142) were divided into G3, G4, G5 category according to KDIGO, the number of subjects in each category being 33, 35, 74 respectively. G5 category subjects, for the purpose of the present study, were further subdivided into patients who were managed conservatively G5a (n=36) and patients who were undergoing haemodialysis G5b (n=38). The control group consisted of 30 healthy persons. Stool sample were collected in sterile, screw capped, plastic container from each patient and immediately transported to department of Microbiology. Jaffe’s alkaline picrate method was used for estimating serum creatinine which is based on the principle that creatinine gives red colour of picramic acid with alkaline solution of picric acid. Kinetic UV assay method was used for estimating blood urea. Examination of stool consisted of macroscopic and microscopic examination. RESULTS A total of 172 subjects of both sexes and >18 years of age were included in the present study. Of these, 30 healthy volunteers were included in the control group and 142 patients with different severity of CKD (according to KDIGO criteria) including 38 patients on haemodialysis were included in the study group. The subjects in the study group (n=142) were divided into G3, G4 and G5 groups according the KDIGO criteria. For the purpose of present study, the patients in G5 group were further classified into to two subgroups: patients on conservative management (G5a subgroup) and those on haemodialysis (G5b subgroup). Intestinal parasites were found in 21 (14.79%) of subjects in study group and 7(23.33%) in control group. The prevalence of intestinal parasites was more in higher categories of CKD, 1(3.03%), 4(11.43%) and 16(21.62%) in CKD categories G3, G4 and G5 respectively. The difference in the prevalence of intestinal parasitic infections in different categories of CKD was statistically significant (p=0.036). The prevalence of parasite was more in G5 as compared to G3 and G4 taken together, and the difference was statistically significant. (p=0.036). Intestinal parasites were found in 12 (31.5%) subjects in G5 category who were undergoing haemodialysis (G5b) as compared to 9(8.65%) subjects who were not undergoing haemodialysis (G3+G4+G5a). The difference was statistically significant (p=0.002). CONCLUSION Prevalence of intestinal parasitic infections is higher in advanced chronic kidney disease patients and those undergoing haemodialysis. Hookworm infections were found to be predominant parasitic infections in chronic kidney disease patients in the present study.