Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : BC15 - BC18 Full Version

Association of Serum Beta-Trace Protein Levels in Patients with Chronic Kidney Disease: A Case-control Study

Published: December 1, 2022 | DOI:
Mohit Thalquotra, Gundeep Kaur Brar, Rajinderjit Singh Ahi

1. Student (Ph.D), Department of CIBR, Adesh University, Bathinda, Punjab, India. 2. Assistant Professor, Department of CIBR, Adesh University, Bathinda, Punjab, India. 3. Professor and Head, Department of Biochemistry, AIMSR, Adesh University, Bathinda, Punjab, India.

Correspondence Address :
Mohit Thalquotra,
Student (Ph.D), Department of CIBR, Adesh University, Bathinda, Punjab, India.


Introduction: Chronic Kidney Disease (CKD) is common disorder showing decreased Glomerular Filtration Rate (GFR) value (<60 mL/min/1.73 m2). Because of limitations of creatinine as a biomarker of GFR, new alternative biomarkers are being investigated, such as Beta-Trace Protein (BTP) is low molecular weight proteins that are filtered by the glomeruli. Serum BTP have been shown to be more helpful for estimating GFR.

Aim: To assess the role of Beta-Trace Protein (BTP) as a potential biomarker of Chronic Kidney Disease (CKD) in comparison to serum urea, serum creatinine, fasting blood sugar and Creatinine Clearance Rate (CCR).

Materials and Methods: This case-control study was conducted at Government Medical College, Rajouri, Jammu and Kashmir, India, from February 2021 to December 2021. Total 50 known patients of kidney diseases and 50 healthy individuals above the age of 18 years were enrolled in the study. Blood samples were collected from all individuals and serum BTP, serum urea level, serum creatinine level, fasting blood sugar were measured. Correlation of BTP with serum urea level, serum creatinine level, Fasting Blood Glucose (FBG) level, and CCR was calculated by Pearson Correlation test.

Results: In present study, 50 patients in case groups (33 male and 17 females) and 50 healthy controls (25 males and 25 females) were included. Among controls, the mean age of patients was 52.12±5.66 years and among cases 55.94±10.51 years. BTP level was increased two times (from 32.06±11.25 μg/mL to 66.36±27.80 μg/mL) in CKD patients than controls individuals. BTP level was positively correlated with serum urea level, serum creatinine level, and FBG level while negatively correlated with CCR.

Conclusion: The BTP may be a useful and reliable serum marker for identifying the magnitude of renal dysfunction in patients with CKD and may have its place beside serum creatinine as an alternative endogenous GFR marker.


Biomarker, Glomerular filteration rate, Renal dysfunction, Serum creatinine

The CKD is a progressive abnormality of kidney in either structural or functional form affecting greater than 10% of the population worldwide (1). It is more prevalent among geriatric age group along with other complications such as diabetes, obesity and coronary/vascular disease (1). Serum creatinine level has been used as basic biomarker for detection of CKD since years but it has many restrictions. The serum creatinine level is varied according to various factors such as age, gender, body weight etc., (2). Researcher suggested that determination of serum creatinine level is not accurate method to diagnose CKD, therefore there is need of alternate new biomarkers for early detection of CKD with accuracy as well as precision (3).

Various low molecular weight proteins in the range of 10-25 kDa have renal handling compatibility with the “ideal” GFR marker (4). In fact, they are cleared by the plasma through free glomerular filtration, subsequent complete tubular resorption, and degradation inside tubular cells. As a consequence, their serum concentrations increase progressively with the reduction of GFR. BTP also called lipocalin prostaglandin D2 synthase is a low molecular weight (23-29 KDa) glycoprotein. It is isolated from cerebrospinal fluid. It is present in very low concentration in blood (5),(6).

The BTP may be a promising biomarker. Because of BTP’s low molecular weight, it is expressed in almost all tissues involved in prostaglandin metabolism, such as the brain, retina, melanocytes, male reproductive organs, heart and kidney (7),(8),(9),(10). BTP is filtered freely in the kidneys and has very little tubular reabsorption and is excreted in the urine. Few researchers found that BTP serum levels correlate with GFR (11),(12),(13). Therefore, the present investigation was aimed to assess the role of BTP as a potential biomarker of CKD as previously GFR and CCR were considered as biomarkers for CKD. Also, to assess its relation to other biomarkers such as serum urea level, serum creatinine level, CCR, and FBG level.

Material and Methods

This case-control study was conducted at Government Medical College, Rajouri, Jammu and Kashmir, India, from February 2021 to December 2021. Study was approved by Ethics committee (IEC Reference no. AU/EC/FM/2021/187), Adesh University, Bathinda. Written informed consent was obtained from all the subjects prior to the study.

Inclusion criteria: Patients aged >18 years, with established diagnosis of CKD i.e., whose GFR levels were between 59-15 mL/min per 1.73 m2 were included. Healthy individuals aged >18 years were taken as control.

Exclusion criteria: Subjects with primary tubular diseases, Recent or concurrent administration of potentially nephrotoxic drugs, acute kidney injury, terminal kidney failure requiring dialysis were excluded from the study.

Fifty patients of known CKD were selected as cases from GMC Rajouri by convenient sampling. Fifty healthy individuals working in GMC Rajouri were selected as controls.

Study Procedure

The demographic data such as age, gender, height, weight, Body Mass Index (BMI), blood pressure was collected from all the study subjects. Under aseptic precautions, 5 mL of venous blood sample was collected after an overnight fasting of 12 hours from all subjects. After retraction of the clot, samples were centrifuged at 2000 rpm for 15 minutes for separation of serum. Serum was divided into two parts in aliquotes at -20°C for the estimation of BTP. The remaining serum was used for estimation of urea, and creatinine level. For estimation of glucose, separate blood sample was drawn in tube containing fluoride as gycolytic inhibitor and plasma sample was used.

Estimation of serum Beta-Trace Protein (BTP ) (Normal value 0.78-50 ng/mL): Determination of concentration of BTP in serum was measured by Enzyme Linked Immunosorbent Assay (ELISA). Enzyme immune assay kit was purchased from bio vendor Aviva System Biology Corporation. An antibody specific for PTGDS (Prostaglandin-Endoperoxide Synthase) had been precoated onto a well plate. To wells, test samples were incubated for 30 minutes. In the wells, biotinylated detector antibodies were added which were specific for PTGDS. The mixture was incubated and then washed. After that, Avidin peroxidase conjugate was added. After incubation, unbound conjugates were washed away. TMB substrate (3,3,5,5- tetramethylbenzidine) was added for enzymatic reaction through which blue coloured product was formed which produced yellow colour after addition of acidic stop solution. The intensity of yellow colour was measured at 450 nm (14).

Estimation of urea (Normal value 19-45 mg/dL): For determination of serum urea level, Urease-Glutamate Dehydrogenase (GLDH) method was used (15). All reagents (Urea standard, Tris buffer pH 8.5, a-ketogluterate GLDH, urease, and Nicotinamide Adenine Dinucleotide Hydrogen(NADH)) were purchased from sigma Aldrich. A 1 mL of working solution and 10 μL of standard/sample was mixed and incubated for 30 seconds and absorbance was measured at 340 mm (A1). Exactly after one minute, absorbance was measured at 340 nm for both standards and test (A2). Urea concentration was calculated by using following formula:

Urea concentration=Absorbance of sample (A1-A2)×Standard value

Absorbance of Standard (A1-A2)

Estimation of serum creatinine (Normal range-in male 0.7-1.3 mg/dL; in females- 0.6-1.1 mg/dL): Creatinine level was estimated by the Jaffe’s method, used with slight modifications (16). In 1 mL of sodium tungstate reagent, 1 mL sulfuric acid reagent, and 1 mL of distilled water was added. After mixing, 1 mL of serum sample was added. The mixture was centrifuged at 1500 rpm for 5 minutes. In the filtrate, picric acid reagent and NaOH sequentially to all tubes after all other materials have been added. After mixing, tubes were allowed to stand for 15 minutes at room temperature. Absorbance was measured at 510 nm. Creatinine value for test by using the concentration of the standard and its absorbance.

Determination of CCR: Creatinine clearance can be estimated using serum creatinine levels. The Cockcroft-Gault (C-G) formula uses a patient’s weight (kg) and gender to predict CrCl (mg/dL). The resulting CrCl is multiplied by 0.85 if the patient is female to correct for the lower CrCl in females. The C-G formula is dependent on age as its main predictor for CrCl. Below is the formula:

eCCr=(140-Age)×Mass (kg)×(0.85 if female)/72×{Serum Creatinine (mg/dL)} (17).

Estimation of plasma glucose (normal range- 74-100 mg/dL): For determination of glucose level in blood, Glucose oxidase-peroxidase (GOD-POD) method was used with end point analysis (18). Absorbance was measured at 505 nm. The intensity of the coloured complex was directly proportional to the concentration of glucose in samples.

Statistical Analysis

The statistical analysis was performed by using Statistical Package for Social Sciences (SPSS) version 26.0. Results were expressed as arithmetic mean and standard deviation (Mean±SD). Differences of continuous variables between the different group’s data were assessed by independent samples t-test. Pearson correlation was used to assess the correlation between parameters of interest. The level of significance was observed at p<0.001.


In control group, out of 50 healthy persons 25 were male and 25 female, while for cases, 33 male and 17 females were selected. Among controls, the mean age of patients was 52.12±5.66 years and among cases 55.94±10.51 years. Demographic features like height and BMI of controls were not comparable with cases (Table/Fig 1).

The FBG level was found to be significantly higher in cases (154.77±71.75 mg/dL) than healthy individuals (104.58±9.11). SBP and DBP were also found to be higher in case group as compared to control group. The difference between case and controls regarding FBS, SBP and DBP was found statistically significant (Table/Fig 2).

Results showed that creatinine and urea level in cases was found to be elevated than control. The variation was greater in females than males among case group. The levels of serum urea, Creatinine were significantly higher (p-value <0.001) in cases than control while CCR were significantly lowered (p-value <0.001) in patients with kidney impairment than control. The statistically significant difference (p-value <0.001) was found between control and case groups regarding BTP level, which indicated the increased level of BTP concentrations in case group as compared to controls (Table/Fig 3).

In patients with renal impairment, a strong positive correlation was found for serum creatinine and urea level with BTP (r value=0.99 for both). While BTP was negatively correlated with CCR (r=-0.98 for both). The correlation of BTP with serum urea level, serum creatinine level, CCR and FBG was found statistically significant (p-value <0.001) (Table/Fig 4),(Table/Fig 5),(Table/Fig 6),(Table/Fig 7),(Table/Fig 8).


Beta-trace protein may be a good biomarker for diagnosis of CKD. In the present study, it was found that serum level of beta-trace protein was significantly higher in case group of study than control group. Kidneys play important roles in body to perform various vital functions such as removal of excessive water and waste products from body, and regulation of acid-base balance of the blood. In CKD, kidneys are unable to perform its vital functions properly. CCR is considered as good indicators of any damage of kidneys (either structural or functional (19).

Now-a-days, CKD has become chronic health issues worldwide. CKD is considered as the twelfth most common cause of death. Its mortality rate is ~31.7% which is a serious health concern (20),(21). Side-effects associated with CKD can be reduced if it is diagnosed at early stage. So, in the present investigation, concentration of BTP in serum was aimed to find out its efficacy for early detection of renal dysfunction in patients of CKD.

Creatinine and urea are considered as good biomarkers to diagnose CKD (22),(23),(24). Results of the present study showed that in patients of CKD, serum level of urea and creatinine was elevated by approximately three times. However, the elevation in serum urea level and serum creatinine level was 218.05% and189.41%, respectively in males while in female groups this increment was found to be higher (234.54% and 223.45%, respectively). Thus, the elevation was higher in female patients than male. CCR was lowered in patients with renal impairment than control. These findings were in accordance to some previous findings which have concluded that the increased serum creatinine has a renal cause and consider a result of reduced CCR which is also related to increased serum urea concentration (25),(26),(27).

The FBG was also measured in all subjects involved in the study and results revealed that in patients with renal impairment values are higher than healthier persons. Results indicated the association of CKD with hyperglycaemia. Results clearly conclude that BTP was increased approximately two-folds (106.98 %) in patients with kidney impairment than healthy individuals. However, variation was higher in female groups (134.43%) than male groups (90.83%). These findings were in agreement with the study of Bishoy EA et al., (28). They have also reported that beta-trace protein have been elevated in patients with various renal diseases.

Findings of the current investigation also showed that concentration of BTP was positively correlated with serum urea level, serum creatinine level and FBG level while negatively correlated with CCR. These conclusions were in consistent with the previous studies, which stated that elevated beta-trace protein concentrations in CKD patients have significantly positive correlation with concentration of creatinine (29),(30). Hence BTP is good marker for early diagnosis of renal dysfunction in patients with CKD.


Due to limitations of present study, namely small sample size and heterogeneity of filters, additional systematic investigations are warranted to further elucidate the value of BTP as a diagnostic tool in patients on CKD.


The BTP level showed an elevation in serum of patients with renal impairment. BTP concentration in serum showed strong positive correlation with FBG, serum urea level, and serum creatinine level while it showed strong negative correlation with CCR. Present study suggests Serum BTP might me a potential biomarker for patients of CKD. However, some more studies are recommended in future for validation of the results.

Authors contribution: This study was conducted by MT under supervision of author RSA and the author GKB helped for designing the study.


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DOI and Others

DOI: 10.7860/JCDR/2022/59964.17284

Date of Submission: Aug 31, 2022
Date of Peer Review: Oct 07, 2022
Date of Acceptance: Nov 28, 2022
Date of Publishing: Dec 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Sep 24, 2022
• Manual Googling: Nov 21, 2022
• iThenticate Software: Nov 25, 2022 (15%)

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