Prevalence and factors associated with the severity of anaemia among patients on chronic haemodialysis in Lagos, Nigeria

Anaemia is a global public health problem with high mortality and morbidity. It is also a common consequence of chronic kidney disease (CKD). There is a paucity of data on the actual burden of anaemia among patients on chronic haemodialysis (CHD) in Lagos, Nigeria. Objectives: To determine the prevalence and factors associated with the severity of anaemia among Nigerian patients undergoing chronic haemodialysis. Methods: This was a retrospective analysis of adult patients with end-stage renal disease (ESRD) on maintenance haemodialysis at the Lagos State University Teaching Hospital, Ikeja, Lagos. The data extracted from the clinical case files included the bio-demographic and clinical parameters, including the treatment modalities. Results: A total of 92 patients comprising 69 (75%) males and 23 (25.0%) females with the overall mean age of 48.2±14.0 years were included. Hypertension was the commonest aetiology of CKD and the average duration of haemodialysis was 16.6 months. The commonest access route for haemodialysis was a central line while 96.7% and 81.5% received erythropoietin and intravenous iron sucrose respectively. Seventy-three (79.3%) patients have had intra-dialysis blood transfusions in the past. Mild, moderate, and severe anaemia were recorded in 17%, 67%, and 16% respectively. The use of erythropoietin, iron sucrose, and increased frequency of blood transfusions correlated with the severity of anaemia. Conclusion: Anaemia is highly prevalent among patients with CKD on chronic haemodialysis. Increased frequency of blood transfusions, inadequate utilization of erythropoietin, and iron sucrose administration are associated with anaemia severity.

Prevalence and associated factors for kidney dysfunction in hospitalized patients with COVID-19 pneumonia in Zambia

Abstract Background: A significant link has been reported between COVID-19 pneumonia, disease severity and development of kidney dysfunction. This study assessed the prevalence and correlated factors for kidney impairment in hospitalized patients with COVID-19 infection Methods: This nested retrospective study examined medical files of patients with confirmed COVID-19 pneumonia. The outcome variable was kidney dysfunction ( defined as functional renal indexes beyond the normal range) and associated factors. Multivariate logistic regression was employed to establish factors associated with renal dysfunction. Results: 179 patients were included in this nested study and the mean age was 58.3 years (SD 16.5) and 49.0% were female. The prevalence of renal dysfunction was 51.9% and 39.3% these patients renal had eGFR<60 mL/min/1.73m2 The proportion of kidney impairment was higher in males than females (59.3% vs.44.3 %), patients with underlying hypertension than normotensive (60.5% vs. 39.5 %) and those with chronic kidney disease (CKD) than those without (90% vs. 10%). After adjusting for age, male gender, critical COVID-19 disease, and raised white cell count, hypertension was an independent predictor of kidney impairment with a AOR 1.54 (95% CI [1.06-2.23],p=0.022). Presence of HIV or diabetes mellitus showed a non statistical significance with renal dysfunction. Conclusion: The study demonstrated a high prevalence of kidney dysfunction in hospitalized patients with COVID-19 pneumonia and presence of hypertension predicted nearly 2-fold development renal impairment.

Cardiovascular risk factors and renal impairment among young adults in a tertiary institution in Southwest Nigeria

Background: Specific research is sparse on renal dysfunction among homogenous group of young adults. This study estimated the prevalence of renal dysfunction among apparently healthy young adults and determine association (if any) between renal dysfunction and some cardiovascular risk factors. Methodology:Undergraduates (18-37 years) of a tertiary institution were studied on 2017 World Kidney Day. Their biodata, blood pressure, anthropometry, total cholesterol and estimated glomerular filtration rate were determined. Data was analyzed using SPSS version 20.0. Results:A total of 640 students were studied (M:F=1:3.8). Their mean age was 23.1±2.8 years. Thirty-three(5.2%) participants had renal dysfunction (eGFR < 60ml/min/1.73m2). The mean age of subjects with renaldysfunction (eGFR < 60ml/min/1.73m2) was significantly higher with an inverse association to renal function (p = 0.005). Two hundred and fifty-seven(40.2%) and 58 (9.1%) participants were pre-hypertensive and hypertensive respectively; overweight, abdominal obesity and hypercholesterolaemia were found among 12.2%, 14.2% and 8.1% of subjects respectively. The mean body mass index (p = 0.009) and serum total cholesterol (p = 0.003) were significantly higher among females. There was a higher prevalence of renal dysfunction among females even though this was not to the significant level (5.9 v 2.2%, p = 0.12). Conclusions:The prevalence of renal dysfunction among young adults is lower than current global estimates. The prevalence of cardiovascular risk factors for CKD were lower than that of older adults with no significant association to renal dysfunction. Increasing age was found to be significantly associated with reduced renal function.

Clinical and demographic profile of end stage kidney disease hemodialysis patients at University Teaching Hospital of Kigali

BACKGROUND: End stage kidney disease (ESKD) has become a major public health problem and is associated with considerable co-morbidity and mortality. In Rwanda, the extent and the distribution of ESKD have not been reported despite provision of dialysis services. This paper describes the clinical and demographic characteristics of ESKD patients in at a tertiary referral hospital in Rwanda. METHODS: This was a retrospective descriptive study of ESKD hemodialysis patients treated at a tertiary referral hospital from January 2014 to December 2017, start of hemodialysis services to date. Demographic and clinical data were obtained regarding all eligible patients treated. Descriptive statistics were reported using frequency and percent for categorical data; median and Interquartile range (IQR) for continuous data. Analysis of survivors versus non-survivors was performed using Chi-square test for categorical variables and Wilcoxon rank sum test for continuous, nonparametric variables. RESULTS: Over a three-year period, there were 64 patients with ESKD. Median age was 48 years (IQR: 35 to 57.5) and 42 (66%) were male. Edema (n=50, 78%) and anuria (n=40, 63%) were the most common presenting symptoms. Underlying comorbidities of ESKD included hypertension (n= 50, 78%), diabetes (n=24, 38%). Urea (n=52, 81%) and creatinine (n=57, 89%) were elevated in most patients. CONCLUSION: ESKD is a the leading cause of hemodialysis in young adults who would otherwise be contributing to the national development. It is a challenging to clearly establish etiologies as the majority present with more than one comorbidity. Hence healthcare providers should be proactive in prevention and prompt management of chronic kidney disease

The outcome of patients on hemodialysis at university teaching hospital of Kigali (CHUK) in a period of september 2014 to march 2017 - A retrospective study on patients with acute and chronic renal failure

Background: Kidney dysfunction is both a national and international problem. Its incidence is increasing in the general population, mostly due to the high prevalence of diabetes, hypertension and the long-term consequences of acute kidney injury. The incidence and prevalence of kidney dysfunction necessitating dialysis are unknown in Rwanda as studies are lacking.Methodology: This study describes the outcomes of the patients who received hemodialysis at CHUK. Data was retrospectively collected and statistically analyzed for 152 patients treated in the hemodialysis unit at CHUK between September 2014 and March 2017.Results: The results have shown that 51.3% and 48.7% of the population being studied were identified to have acute kidney injury and chronic kidney failure respectively. The main risk factors for hemodialysis treatment were hypertension (48%), diabetes mellitus (46.7%), eclampsia (13.2%), and volume deficit (15.8%). Hyperkalemia, pulmonary edema, encephalopathy, and other uremic symptoms were present in 39-43% of patients and were the most common indications for hemodialysis. Encephalopathy and poor oxygen saturation were independent risk factors for death. 20.6% could not afford the usual provision of three sessions of hemodialysis per week and therefore didn't receive dialysis as frequently as recommended. Forty-five patients (20.6%) could not afford the usual provision of three sessions of hemodialysis per week and received less frequent dialysis.Conclusion: There is high mortality in patients referred for hemodialysis in CHUK. Almost half of the patients have chronic renal failure and require permanent renal replacement therapy. Many patients limit therapy due to financial reasons

Obesity and kidney disease: hidden consequences of the epidemic

Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for chronic kidney disease. A high body mass index is one of the strongest risk factors for new-onset chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased bodyweight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing chronic kidney disease in the long term. The incidence of obesity-related glomerulopathy has increased tenfold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating a healthy lifestyle and health policy measures that makes preventive behaviours an affordable option

Chronic Kidney Disease Screening and Renoprotection in Type 2 Diabetes

Background: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. Methods: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. Results: Urinalysis was done in 49.1and serum creatinine in 50.3. No patient had glomerular filtration rate estimated. Seventy nine (67.6) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8) of these patients BP control was optimal in 29.1. Conclusion: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D

Pharmacological and Nonpharmacological Prevention of End-Stage Renal Disease

Slowing of the rate of deterioration in renal function in patients with chronic kidney disease (CKD) is feasible; but requires a combination of pharmacological and non pharmaco- logical interventions. Pharmacological interventions of proven efficacy are the following: a. Blood pressure control using angiotensin converting enzyme inhibitors and angioten- sin receptor blockers as the first line agents because these drugs have beneficial effects on glomerular haemodynamics and proteinuria in addition to their antihypertensive actions b. Strict blood glucose control in patients with diabetes mellitus c. Use of lipid-lowering agents (statins) d. Pharmacological control of hyperphosphataemia e. Prevention of anaemia with the use of erythropoietin and f. Pharmacological management of the underlying renal disease Non-pharmacological interventions are of equal importance and include maintenance of euvolaemia; prevention or prompt treatment of urinary tract obstruction and infection; hypercalcaemia and hypocalcaemia; and avoidance of nephroto- xins and smoking. The management of CKD is multifaceted and requires diligence and a team approach. Patients and their families should be active members of the team

Assessment of renal function in malaria patients in Minna, North Central Nigeria

Establishment of prevalence of malaria-associated renal impairment in Nigeria is important for proper prognosis and management of malaria and its associated complications. Using biuret method for protein estimation; alkaline picrate-slot method for creatinine and urea estimation; and flame photometry and titrimetric method for electrolytes estimation; selected kidney function parameters which included proteinuria; serum levels of urea; creatinine and electrolytes were determined in 169 malaria patients and in 58 individuals without malaria. Data obtained were analyzed using one-way analysis of variance to compare variation among malaria patients and individuals without malaria; Duncan multiple range test to compare variation among means; and correlation matrix to evaluate correlation between the parameters measured. Proteinuria in malaria cases differed significantly (p 0.05) from individuals without malaria; and a positive correlation existed between proteinuria and parasitaemia. There was no significant difference (p0.05) in the creatinine levels of malaria patients and those without malaria. It is concluded that there is a form of renal impairment associated with malaria infection in Minna irrespective of age and sex

Effect of hemodialysis on the hearing function of patients with chronic renal failure

Sensorineural hearing impairment (SHI) has been reported in chronic renal failure (CRF) patients with a prevalence of 20-40. The aetiopathogenetic mechanisms reported included osmotic alteration resulting in loss of hair cells and in some; complications of haemodialysis have been hypothesized. We have in the past reported 2 cases of CRF patients who developed acute SHL following hemodialysis. This is a report of investigation of the effect of hemodialysis on the hearing function of CRF patients using pure tone audiometry findings. Thirty-three CRF patients were recruited for Pure Tone Audiometry (PTA) at admission and after three sessions of hemodialysis. The pure tone audiometry was done with a computer audiometer BA 20 Kamplex in the sound - proof (acoustic) booth in the ENT clinic. The duration of illness; dosage of diuretics and blood pressure were also noted. Similar age and sex-matched control were selected among volunteers who were otherwise clinically healthy. The data was processed using the Statistical Package for the Social Sciences (SPSS Inc; Chicago; Illinois; USA). Thirty-three CRF patients treated with haemodialysis and 28 healthy controls completed the study; 34 males and 27 females; age range was 16 - 72 years; mean of 45.30 (SD16.20) for subjects and 49.7 for controls. Hearing loss was found in 22/34 (67) at recruitment and 27/34 (79) after 3 sessions of hemodialysis. There was a significant difference between the mean pre- and post-hemodialysis PTA values; P =0.0008. There was also a significant correlation between post - hemodialysis hearing threshold and (i) duration of illness (P = 0.00340) and (ii) creatinine levels of the patients (P=0.035). In conclusion; there was a significant depression in the hearing threshold of patients with CRF following three sessions of hemodialysis. This could be caused by changes induced by hemodialysis or effects of the duration and severity of disease

The effect of gum Arabic oral treatment on the iron and protein status in chronic renal failure patients under regular hemodialysis in Central Sudan

Objective To assess the effect of gum arabic (Acacia Senegal) oral treatment on the iron and protein status in chronic renal failure patients. Material and Methods Thirty-six chronic renal failure (CRF) patients (under regular hemodialysis); and 10 normal subjects participated in this study. The patients were randomly allocated into the following groups: Group A (n=12): CRF patients under low protein diet (LPD) (less than 40 gram/day); and gum arabic (50 g/day) treatment; Group B (n=14): CRF patients under LPD; gum arabic; iron (ferrous sulphate 200 mg/day) and folic acid (5 mg/day) treatment; Group C (control group; n=10): CRF patients under LPD; iron and folic acid treatment; Group D (n=10): normal volunteers who were kept on normal diet beside a daily dose of 50 gm gum arabic. Each of the above treatments was continued for three consecutive months. Predialysis blood samples were collected from each subject before treatment; and twice per month for three months. Hemoglobin (Hb); hematocrit; total protein; albumin; globulin and 24-hour urine volume as well as serum iron; total iron-binding capacity (TIBC);transferrin saturation; packed cell volume (PCV) and; mean corpuscular hemoglobin concentration (MCHC) were determined. Results Following administration of gum arabic oral treatment for three months; serum iron increased by 5.85and 4.81for groups A and B; respectively. These increases were significantly different from the baseline (P0.05); and control group C (P0.01). TIBC was significantly decreased in group A (4.44) and in group B (4.31) as compared with the baseline and control group C (P0.05). Transferrin saturation was significantly increased by 7.77; and 9.59for groups A and B; respectively; compared with the baseline (P0.05) and control group C (P0.01). Hb; PCV; MCHC; serum total protein; albumin and globulin; and 24-hour urine volume showed no statistically significant differences from the baseline and control groups. Conclusion The improvement in iron status due to oral administration of gum arabic could reduce the need for oral iron prescription

Proposition d'un régime calculé en proteines, en sodium et en potassium pour l'Ivoirien insuffisant renal

Le but de ce travail est de proposer un regime calcule en proteines, sodium et potassium, adapté aux habitudes de l'Ivoirien pour les insuffisants renaux éligibles ou non a la dialyse ou en phase aigue

Profil hématologique d'un groupe d'insuffisants rénaux chroniques à Yaoundé

31 insuffisants renaux chroniques; 10 hemodialyes et 6 malades sous dialyse peritoneale ambulatoire continue ont ete etudies sur le plan hematologique. La plupart des malades presentent une anemie normocytaire normochrome avec une baisse marquee de l'hematocrite. Le temps de saignement est allonge chez les insuffisants renaux chroniques terminaux et les dialyses. Le taux de globules blancs; le taux de plaquettes; le taux de prothrombine; le temps de coagulation ainsi que le taux de fer serique sont normaux dans la majorite des cas