Letters to Editor

Peritoneal dialysis in Peru Sir, Due to the improved quality‑of‑life and the increased survival, it is important to consider the implementation of peritoneal dialysis (PD) in the developing countries. To do this, government policy needs to support the use of PD over hemodialysis (HD). The governments of Hong Kong and Thailand promoted the PD economically as a result the PD prevalence there exceeds 80%.[1] In Latin America, the case of Mexico is worth noting, where 25% of the end‑stage chronic kidney disease patients use PD.[2] An important reason to choose PD is the favorable cost‑efficiency over HD.[1,3] Although, it is important to highlight the importance of dialysis programs, they should have a multidisciplinary team of health professionals with adequate budgetary resources and advanced technology.[4]

etc.[6] PD is not developed because the health personnel do not have enough training. It is demonstrated that having suitably trained personnel has a major impact on PD care. Moreover, it has been described that there is a decrease on peritonitis incidence secondary to PD when there is an advanced nursing experience.[7] All these limitations could be resolved if we focus the health system resources. Finally, apart from all the benefits that a PD gives to the patients, it is described as a measure for health spending control.[8] PD is widely beneficial to any country and it should be used as the first option in renal replacement therapy. Therefore, it is necessary to implement a new health policy, with health promotion and prevention at each stage of the kidney disease. With this strategy, we shall be able to make a more efficient use of all our economic resources. E. Vélez-Segovia1,2, L. Salazar-Huayna1,2, E. Alva-Bravo1,3

Peru is a South American country with a total population of about was 30 million. The social health insurance (Essalud), which covers a quarter of the total Peruvian population, had approximately 8607 on dialysis treatment, of which 86% used HD and 14% PD in 2011.[6] Nearly, 60% of the Peruvian on dialysis treatment are treated in high complexity national hospitals. In relation to regarding the performance versus treatment executed in HD, the major healthcare networks in the country exceeded their operational capacity by 40%. This excess is due to increasing demand for dialysis and the low percentage of PD that is offered in high complexity national hospitals, where only 4‑6% of patients on renal replacement therapy use PD. It should also be noted that the highest percentages of PD are outside of the capital (Lima), the majority of them are in rural places, where the lack of HD units has forced promotion of PD, obtaining favorable results.[5] The main limitations of PD in Peru are the lack of human resources, insufficient amount of hospitals rooms and lack of training. First, it is necessary to have a sufficient number of health‑care personnel, especially to attend the diverse tasks that PD service involve as training programs, home visits, emergency care, etc., Second, the rooms allocated to the PD are often not well maintained, increasing risks to the patient’s health. It is necessary that those rooms have good lighting, ventilation, comfort,

Indian Journal of Nephrology

School of Medicine, Universidad Peruana de Ciencias Aplicadas, 2 Sociedad Científica de Estudiantes de Medicina UPC, 3 Deparment of Nephrology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru 1

Address for correspondence: Dr. E. A. Vélez‑Segovia, Los Corales 574, Balconcillo, La Victoria, Lima, Peru E‑mail: [email protected]

References 1.

Finkelstein  FO, Abu‑Aisha  H, Najafi  I, Lo  WK, Abraham  G, Pecoits‑Filho R, et al. Peritoneal dialysis in the developing world: Recommendations from a symposium at the ISPD meeting 2008. Perit Dial Int 2009;29:618‑22. 2. Pecoits‑Filho R, Abensur H, Cueto‑Manzano AM, Dominguez J, Divino Filho JC, Fernandez‑Cean J, et al. Overview of peritoneal dialysis in Latin America. Perit Dial Int 2007;27:316‑21. 3. Sennfält K, Magnusson  M, Carlsson  P. Comparison of hemodialysis and peritoneal dialysis – A cost‑utility analysis. Perit Dial Int 2002;22:39‑47. 4. Méndez‑Durán A. Diez años de experiencia en diálisis en un Servicio de Nefrología el sector público de México. Dial Transplant 2012;7:1‑5. 5. Centro Nacional de Salud Renal. Reporte estadístico del Centro Nacional de Dialisis diciembre 2011. Lima: Essalud; 2011. 6. Martínez‑Vega  A, Alberto‑Bazán M, Morales‑de la Cruz  M. Factores favorables para la realización de la Diálisis Peritoneal Continua Ambulatoria en el hogar. Rev CONAMED 2010;15:140‑6. 7. Yang Z, Xu R, Zhuo M, Dong J. Advanced nursing experience is beneficial for lowering the peritonitis rate in patients on peritoneal dialysis. Perit Dial Int 2012;32:60‑6. 8. de Francisco AL. Sustainability and equity of renal replacement therapy in Spain. Nefrologia 2011;31:241‑6.

January 2014 / Vol 24 / Issue 1

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Letters to Editor Address for correspondence: Dr. Rashmi Patnayak, Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati ‑ 517 507, Andhra Pradesh, India. E‑mail: [email protected]

Access this article online Quick Response Code:

Website: www.indianjnephrol.org DOI: 10.4103/0971-4065.125140

Reference 1.

Utility of left-over renal tissue for light microscopy after immunofluorescence Sir, We read the article “retrieval of kidney tissue for light microscopy (LM) from frozen tissue processed for immunofluorescence (IF): A simple procedure to avoid repeat kidney biopsies” by Tyagi et al., with the interest. [1] In our institute, we also usually receive two cores of renal tissue, one in buffered formalin for LM and the other in normal saline for IF. Usually, we process both the tissue simultaneously. We have received adequate renal tissue, most of the time. But occasionally, there are cases where we have faced a similar situation as described by the authors, where glomeruli were present in IF sections, but absent in LM sections. In those instances, we have processed the left over frozen tissue originally sent for IF by fixing it with formalin for 2 hours. In our experience, we also have observed that crescents are easily diagnosed in the processed left over frozen IF tissue, thereby helping in arriving at the diagnosis and avoiding the necessity of repeat renal biopsy. So, in our opinion, in cases where renal biopsy is inadequate in LM sections, the left over frozen tissue can be processed to look for glomeruli, before asking for repeat renal biopsy.

Acknowledgment The authors wish to thank senior technicians Mrs. Ushanandini and Mr. Ramana for their help.

R. Patnayak, A. Jena1, A. K. Chowhan, N. Rukmangadha, V. S. Kumar2 Departments of Pathology, 1Surgical Oncology, and 2Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India 68

January 2014 / Vol 24 / Issue 1

Tyagi  I, Majumdar  K, Kamra  S, Batra  VV. Retrieval of kidney tissue for light microscopy from frozen tissue processed for immunofluorescence: A simple procedure to avoid repeat kidney biopsies. Indian J Nephrol 2013;23:206‑10.

Access this article online Quick Response Code:

Website: www.indianjnephrol.org DOI: 10.4103/0971-4065.125141

Prevalence and risk factors of renal artery stenosis in South Asian patients with type 2 diabetes using renal angiography Sir, Renal artery stenosis (RAS) is associated with increased risk of refractory hypertension and progression of kidney disease, but may be difficult to distinguish from diabetic nephropathy in patients with type 2 diabetes (T2DM) due to nearly similar clinical and biochemical features. The prevalence of RAS was evaluated in a cohort of South Asian patients with T2DM undergoing angiography for investigation of coronary artery disease and to identify clinical characteristics. Patients with known vasculitis, RAS, serum creatinine level >3.3 mg/dl or on renal replacement therapy were excluded. Coronary artery lesions of  ≥50% narrowing of the luminal diameter were classified as significant. RAS was defined as ≥50% narrowing of the luminal diameter. There were 249 South Asian patients with T2DM (mean age 58 ± 9 years, 167 [67.1%] males). The mean duration of T2DM was 10 ± 7 years; 79 (32%) patients were on Indian Journal of Nephrology

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