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.

Heavy metal exposure and renal impairment: A systematic review of observational studies

Background: Environmental exposure to toxins has been strongly implicated in its multi-faceted etiology of chronic kidney disease, a serious public health problem affecting individuals, families, and communities. There is a need to synthesize available studies on the effect of heavy metal exposure on renal function, considering the rising global burden of kidney disease. The objective of this study is to determine the association between exposure to heavy metals and renal disease. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review. A comprehensive independent search, title, abstract, and full-text screening of available literature on Google Scholar, PubMed, and OAREScience was done between March 2021 and May 2021. The criteria for study inclusion were full-text articles published in English language in the last 20 years (2001-2020), and observational primary human studies reporting the association between heavy metal exposure and renal disease. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies. Results: A total of 552 studies were identified following the search from the different databases. A total of 13 studies were finally included in the review. Heavy metals implicated in the studies include cadmium, lead, mercury, and arsenic, with ten studies showing environmental exposure as the primary source. Ten (10) studies showed an association between heavy metal exposure and renal impairment (p<0.05) while only 3 studies reported no association. Conclusion: Environmental monitoring is needed to stem the tide of heavy metal exposure in view of the growing burden of chronic kidney disease.

Assessment of electrolytes, markers of glycaemic control and renal dysfunction among adult Nigerians recently diagnosed with type 2 diabetes mellitus

Background: Diabetes mellitus is a chronic and progressive endocrine disorder that may result in macro and microvascular complications. Objective: This study assessed some biochemical analytes in Nigerians who were recently (≤ 6 months) diagnosed with Type 2 diabetes mellitus (T2DM). Methods: 160 T2DM and 90 non-diabetic control participated in this study. Blood samples were collected and analyzed for Heart-type fatty acid-binding protein (HFABP), high sensitivity C-reactive protein (hs-CRP), electrolytes, lipid and renal profile parameters, glycated haemoglobin (HBA1C) and fasting blood glucose (FBG), using standard guidelines. Result: The body mass index (BMI) of the T2DM volunteers was higher than control (P <0.001). The lipid profile, potassium, glucose, HBA1C, urea and creatinine values were elevated (P <0.001) while estimated glomerular filtration rate (eGFR) was lower (P<0.05) in diabetes. The median HFABP and hs-CRP were raised (P <0.05) in T2DM. Positive associations existed between FBG and urea (P <0.001), Creatinine and HBAIC (P <0.001). A logistic regression analysis, shows that an increased BMI, HBA1C, FBG, Cholesterol, urea and creatinine were associated with higher odds (p<0.001) of cardiovascular and renal complications. Conclusion: Elevated hs-CRP, glycated haemoglobin, urea and creatinine among T2DM increase the odds of cardiovascular and renal insults in this population

Functional iron status of chronic kidney disease patients at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

Background: Functional iron deficiency has been found to be a common cause of poor response to erythropoiesis stimulating agents in anaemic patients with chronic kidney disease (CKD). Objectives: Assess the functional iron status of patients with chronic kidney disease. Methods: This was a hospital based cross sectional study. The study subjects were chronic kidney disease patients with age and sex matched healthy controls. Full blood count, serum ferritin, soluble transferring receptor, C-reactive protein, serum iron and total iron binding capacity were measured in the patients and healthy controls. Data was analyzed with statistical package for the social sciences software version 22.0. And the level of statistical significance was set at p. value < 0.05. Results: The mean ± SD of the age of patient with CKD was 55.0 + 15.4 years, while that of controls was 52.7 + 13.6 years. The mean serum ferritin, serum iron, TIBC and CRP were significantly higher in patients compared with controls (p<0.001, 0.023, <0.001 and 0.001) respectively. Functional iron deficiency was seen in 19.5% of patients with CKD. Conclusion: The predominant form of iron deficiency in our study was functional iron deficiency

Insuffisance rénale chronique: aspects épidémiologique, diagnostique, thérapeutique et évolutif au CHU de Bouaké de 2016 à 2020 / Epidemiological aspects, diagnosis features and therapeutic outcome of chronic kidney disease at the Teaching Hospital of Bouake from 2016 to 2020

Le profil épidémiologique de l'insuffisance rénale chronique (IRC) varie d'un pays à un autre et d'une région à une autre dans un même pays. L'objectif de la présente étude était de décrire les cas d'IRC observés dans la ville de Bouaké. Méthodes : il s'agissait d'une étude rétrospective réalisée dans le service de Médecine Interne du CHU de Bouaké durant la période allant du 1er Janvier 2016 au 31 Décembre 2020. L'IRC était définie par un DFG inférieur à 60 ml/minute évoluant depuis plus de trois mois et/ou une atrophie rénale. Résultats : nous avons recensé 150 cas donnant une prévalence hospitalière de 3,6%. L'âge moyen était de 38,8±10 ans avec une prédominance masculine. Les antécédents étaient dominés par l'automédication traditionnelle et l'hypertension artérielle dans 68% des cas chacun. Dans 91% des cas, l'IRC était classée grade 5. Les étiologies étaient dominées par l'hypertension artérielle (34%). Le traitement symptomatique était la transfusion dans 73% et l'usage des antihypertenseurs dans 73%. Le traitement de suppléance était indiqué dans 91% et réalisé dans 3%. La mortalité était de 25%. Les facteurs associés à la survenue du décès étaient une altération de l'état général, une hypercréatininémie, une hyperphosphorémie, des reins atrophiés et le recours à la transfusion sanguine. Conclusion: l'IRC était diagnostiquée à un stade sévère. La principale cause était l'hypertension artérielle. La mortalité demeure élevée, faute d'accès au traitement de suppléance. L'accent doit être mis sur la prévention de l'IRC au cours des pathologies à risque.

Background: The epidemiological profile of chronic kidney disease (CKD) varies from country to country and from region to region within, even in the same country. The objective of this study was to describe the cases of CKD found in the city of Bouake (Ivory Coast). Methods: We proceeded to a retrospective study carried out in the Internal Medicine department of the Bouake University Hospital from January 1, 2016 till December 31, 2020. CKD was defined by a GFR (Glomerular Filtration Rate) at less than 60 ml/ minute and small kidneys. Results: In all , we identified 150 cases corresponding to 3.6% as hospital prevalence . The mean age was 38 .8 ± 10 years with a male predominance. The history was dominated by traditional self-medication and high blood pressure (HBP) for respectively 68% of cases. In 91% of cases , the CKD was classified as grade 5. The etiologies were dominated by HBP (34%). The care was a symptomatic one using transfusion in 73% and antihypertensive medication was prescribed for 73% of the patients. The substitution treatment was indicated in 91% of cases and carried out in 3%. The rate of mortality was 25 % and factors associated with death were a deterioration of the general condition, increased of blood level of creatininemia, hyperphosphatemia, small size of kidneys and the use of blood transfusion. Conclusion: CKD was diagnosed at a severe stage. The main cause was high blood pressure. Mortality remains high due to lack of access to replacement therapy . Emphasis should be placed on the prevention of CKD in high-risk pathologies

La dénutrition chez un groupe de patients atteints d'insuffisance rénale chronique : étude prospective

Introduction : La dénutrition est fréquente chez les patients en insuffisance rénale chronique. Elle affecte 35% des patients au début de la dialyse et représente une des causes de morbi-mortalité. L'objectif de ce travail est de déterminer la fréquence de la dénutrition chez des patients à différents stades d'Insuffisance rénale chronique Matériels et méthodes : Une étude longitudinale descriptive portant sur 162 patients en insuffisance rénale chronique à différents stades (2, 3,4, 5 et 5D) a été réalisée au service de Néphrologie du CHU Nafissa Hamoud à Alger. Nous avons étudié les paramètres nutritionnels biologiques et anthropométriques chez les patients en IRC à différents stades. Résultats : L'âge moyen des patients est de 56,5±17 ans avec un sex-ratio de 1,43. Les taux de l'indice de masse corporelle, de l'albumine et de la pré-albumine moyens sont respectivement : (21,98 ± 0,28), (37,84g/l ± 0,47) et (302, 93 mg/l ± 5,4). Les trois paramètres diminuent significativement (p<0,05) avec la dégradation de la fonction rénale (du stade 2 vers le stade 5D). Les patients les plus dénutris se retrouvent aux stades 5 et 5D. La dénutrition est plus importante chez les patients avec IRC grave et chez les hémodialysés. Conclusion : L'insuffisance rénale chronique représente un véritable problème de santé publique. La dénutrition est l'une des causes de morbi-mortalité chez ces patients surtout après l'épuration extra rénale notamment l'hémodialyse, ce qui nous incite à nous intéresser au statut nutritionnel des patients en IRC

La parathyroïdectomie dans le traitement de l'hyperparathyroïdie secondaire chez les dialysés chroniques

Introduction: L'hyperparathyroïdie secondaire est une complication grave de l'insuffisance rénale chronique, ayant un impact négatif sur la morbi-mortalité. La parathyroïdectomie trouve toute son indication en cas d'échec du traitement médical. Le but de cette étude était de partager notre expérience dans la prise en charge de l'hyperparathyroïdie secondaire et de présenter les caractéristiques démographiques, biochimiques, cliniques et thérapeutiques des patients opérés dans notre service. Matériels et Méthodes : Etude d'une série de cas consécutifs opérés entre janvier 2002 et décembre 2013. Etaient inclus tous les patients ayant présenté une hyperparathyroïdie secondaire prouvée biologiquement et remplissant les critères d'opérabilité. Résultats : La série était composée de 69 patients (35 femmes, 34 hommes). La moyenne d'âge était de 37,7 ±13 ans. Le tableau clinique était dominé par les signes osseux et cutanés. En préopératoire, la valeur moyenne de la PTH était de 1727 ± 1380,10 pg/mL et celle de la calcémie de 2,39 ± 0,28 mmol/L. Sur le plan chirurgical, la parathyroïdectomie était subtotale chez 60 patients (87%) et totale chez 9 patients (13%) dont 7 avec auto transplantation et 2 sans autotransplantation. En post opératoire, la valeur de la PTH avait baissé significativement par rapport à la valeur préopératoire (p<0,01). Conclusion : Les résultats de cette étude suggèrent que la parathyroïdectomie entre les mains d'experts est un moyen efficace pour réduire la sécrétion de PTH avec une faible morbi-mortalité dans le cadre de l'hyperparathyroïdie secondaire réfractaire au traitement médical

Gender disparity in risk factors for chronic kidney disease in a rural community in Southern Nigeria

Background: The evidence for gender disparity in prevalence of CKD is conflicting; while some studies report male preponderance, others have report female preponderance or no difference. Reasons for gender disparities in CKD prevalence may be related to differences in the occurrence of risk factors across the gender, amongst other factors. This study was to determine gender disparities in the risk factors for CKD. Method: This study is based on data from a community based cross-sectional study carried out in Ogbona, a rural community in Southern Nigeria. The WHO STEPS for surveillance of chronic diseases risk factors and chronic disease-specific morbidity and mortality questionnaire was adapted for this study. Four hundred and seventy-six participants were selected from 142 housing units in the community using multi-stage cluster sampling. Clinical examinations and laboratory investigations including serum creatinine, and urinalysis were performed. Results: Majority of participants were females (66.2%). CKD was commoner in females compared to males (14.3% vs. 12.7%, P= 0.06). More females than males had high body fat percentages (65.7% vs. 40.9%, P=<0.0001), high waist-hip ratio (99.7% vs 73.3%, P=<0.0001) and central obesity (43.1% and 4.3% P=<0.0001). More males compared to females used alcohol (56% vs. 9.2%, P=<0.0001), were overweight (42.2% vs 28.9%, P=0.004), and had proteinuria (6.2% vs 2.5%, P=0.054). The odds of females having central obesity are 16.7 times the odds of males having central obesity; similarly, the odds of females having high BF are 2.7 times the odds of males having high BF. Females had 122-fold the odds of men having high WHR. The odds of drinking alcohol are 92% less compared to males. There were no statistically significant gender differences regarding hypertension, diabetes mellitus, and use of nephrotoxins (NSAIDS, skin lightening agents, herbal medications). No female smoked cigarettes. Conclusion: This study shows that there is no statistically significant gender difference as regards prevalence of CKD, however several risk factors of CKD show gender disparity. The odds for central obesity, high WHR, high body fat percentages are significantly greater in females; while smoking, alcohol use, and over weightness, are commoner in males. There were no statistically significant gender differences regarding hypertension, diabetes mellitus, and use of nephrotoxins (NSAIDS, skin lightening agents, herbal medications)

Relationship between serum level of ionized calcium, magnesium, phosphate, vitamin D and parathyroid hormone with stages of CKD

Background: Chronic kidney disease is defined as either damage or a decreased Glomerular Filtration Rate of less than 60ml/min/1.73m2 for 3 or more months. There is destruction of renal mass with irreversible sclerosis and loss of nephron leading to a progressive decline in GFR.Secondary hyperparathyroidism hyperphosphataemia, hypocalcaemia and vitamin-D deficiency are common complications of CKD. Objective: To determine relationship between serum level of ionised calcium, magnesium, phosphate, vitamin-D and parathyroid hormone with stages of CKD. Method: This study was conducted at ABUTH Zaria. 125 consecutive adult patients in various stages of CKD who presented were enrolled and 125 apparently healthy matched for sex and age controls were also recruited. Results: 9% of patients were in stage-1, 16% in stage-2, 22% in stage-3, 12% in stage-4 and 41% in stage-5. Serum ionised calcium, vitamin-D and eCrCl showed a progressive decline as the stage of CKD advances, while serum phosphate, creatinine and iPTH showed a progressive increase as the stage of CKD advances. Changes in serum magnesium showed a slight change with advancing stages of CKD. The difference in mean serum levels of calcium, phosphorus, vitamin-D, parathyroid hormone, creatinine and eCrCl with different stages of CKD were statistically significant. eCrCl correlated negatively with phosphate and iPTH while serum creatinine correlated negatively with calcium and positively with phosphate and iPTH. Conclusion: Majority of CKD patients were in late stage. Correlation of analytes with stages was more in late stages and biochemical derangements occurred in late, rather than early stages of CKD

Prevalence and factors associated with chronic kidney disease among medical inpatients at the Kenyatta National Hospital, Kenya, 2018: a cross-sectional study

Introduction: the burden of chronic kidney disease (CKD) is increasing worldwide. Few studies in low and low-middle income countries have estimated the prevalence of CKD. We aimed to estimate prevalence and factors associated with CKD among medical inpatients at the largest referral hospital in Kenya.Methods: we conducted a cross-sectional study among medical inpatients at the Kenyatta National Hospital. We used systematic random sampling and collected demographic information, behavioural risk factors, medical history, underlying conditions, laboratory and imaging workup using a structured questionnaire. We estimated glomerular filtration rate (GFR) in ml/min/1.73m2 classified into 5 stages; G1 (≥ 90), G2 (60-89), G3a (45-59), G3b (30-44), G4 (15-29) and G5 (<15, or treated by dialysis/renal transplant). Ethical approval was obtained from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (KNH-UoN ERC), approval number P510/09/2017. We estimated prevalence of CKD and used logistic regression to determine factors independently associated with CKD diagnosis.Results: we interviewed 306 inpatients; median age 40.0 years (IQR 24.0), 162 (52.9%) were male, 155 (50.7%) rural residents. CKD prevalence was 118 patients (38.6%, 95% CI 33.3-44.1); median age 42.5 years (IQR 28.0), 74 (62.7%) were male, 64 (54.2%) rural residents. Respondents with CKD were older than those without (difference 4.4 years, 95% CI 3.7-8.4 years, P = 0.032). Fifty-six (47.5%) of the patients had either stage G1 or G2, 17 (14.4%) had end-stage renal disease; 64 (54.2%) had haemoglobin below 10g/dl while 33 (28.0%) had sodium levels below 135 mmol/l. ); history of unexplained anaemia (aOR 1.80, 95% CI 1.02-3.19), proteinuria (aOR 5.16, 95% CI 2.09-12.74), hematuria (aOR 7.68, 95% CI 2.37-24.86); hypertension (aOR 2.71, 95% CI 1.53-4.80) and herbal medications use (aOR 1.97, 95% CI 1.07-3.64) were independently associated with CKD.Conclusion: burden of CKD was high among this inpatient population. Haematuria and proteinuria can aid CKD diagnosis. Public awareness on health hazards of herbal medication use is necessary

Factors contributing to primary caregiver delay in presenting children with chronic kidney disease for medical care in Ghana

Background: Conforming to the 2016 World Kidney Day focus on raising awareness of the early detection of kidney diseases in children, we report on factors that contribute to primary caregiver delay in presenting their children with chronic kidney disease (CKD) for medical care in Kumasi, Ghana.Aim: The objective of the study was to explore and describe the factors that contribute to primary caregiver delay in presenting children with CKD for medical care in Kumasi, Ghana.Setting: The study was conducted in the Paediatric Renal Unit in Kumasi, Ghana.Methods: A qualitative study was conducted in January 2017. Semi-structured interviews were used to collect data from a convenience sample of 10 primary caregivers whose children were admitted for CKD, but were not too ill. The primary caregivers had to respond to the research question: What factors contribute to your delay in presenting your child with CKD for medical care? Thematic data analysis and the ecological model of Schneider (2017) were used to organise the findings.Results: Four themes and related subthemes, including intrapersonal-related factors, interpersonal-related factors, community-related factors and infrastructural factors were identified as those that contribute to delay in presenting children with CKD for medical care.Conclusion: The findings show that primary prevention strategies for CKD in children should not only focus on personal-related factors but also cut across all levels of the socio-ecological model in order for them to be effective

Burden, psychological well-being and quality of life of caregivers of end stage renal disease patients

BACKGROUND: Caregivers of chronic kidney disease (CKD) patients play an important role in the management of the patients. Their psychological needs are often overlooked and unmet by the managing team. This study assessed the psychosocial well-being and quality of life (QoL) of caregivers of CKD patients in two hospitals in Southern Nigeria. METHODS: Burden of caregiving, QoL, depression, and anxiety were assessed using standardized instruments; modified Zarit questionnaire, modified SF-12 questionnaire and Hospital Anxiety and Depression Scale (HADS) respectively among caregivers of CKD patients on maintenance haemodialysis and controls. RESULTS: Fifty-seven caregivers of CKD patients and aged and sex-matched controls participated in the study. Anxiety was significantly higher in caregivers compared to control (31.6% vs 5.3%, p = 0.004). Also, depression was significantly higher in caregivers (31.6% vs 3.5%, p= <0.001). Twenty-eight (49.1%) of the caregivers had mild to moderate burden and 19 (33.3%) had a high burden. The mean Zarit burden score was higher in female caregivers compared to male caregivers (18.30±8.11 vs 14.83±6.70, p = 0.09). The mean depression score was higher in female caregivers compared to male caregivers (8.58±3.83 vs 6.75±3.80, p= 0.08). There was significant positive correlation between Zarit burden and hospital anxiety score (r = 0.539, p= < 0.001) and depression score (r = 0.472, p = 0.005). CONCLUSION: Depression, anxiety and burden were common among caregivers of CKD patients especially females compared to controls. Supportive interventions for these caregivers should be included in treatment guidelines in order to improve overall patients' outcome

Hearing impairment among chronic kidney disease patients on haemodialysis at a tertiary hospital in Ghana

Background: Chronic kidney disease is a major public health challenge, globally. Inadequate excretion of metabolic waste products by the kidneys results in circulation of these toxic materials in the body. This can cause damage to tissues and organ systems including the auditory system which can lead to hearing loss. Aim: The study was aimed at determining the prevalence, degrees and types of hearing impairment among Chronic kidney disease patients on haemodialysis in Ghana. Methods: A case-control study involving 50 Chronic Kidney disease patients and 50 age and gender-matched control group was carried out at the Korle Bu Teaching Hospital (KBTH). A structured questionnaire was administered to obtain basic socio-demographic data and case history of the participants. Audiological assessment was performed using a test battery comprising otoscopy, tympanometry and pure tone audiometry in a soundproof booth. Results: Higher hearing thresholds were recorded across all the frequencies tested among the case group than the control group (p < 0.05) in both ears. Only sensorineural hearing loss was identified among the cases. The prevalence of hearing loss was 32% among the case group and 12% among the control group. No significant association was observed between hearing loss and duration of Chronic kidney disease (p = 0.16), gender of Chronic kidney disease patient and hearing loss (p = 0.88), and duration of Chronic kidney disease and degree of hearing loss (p=0.31).Conclusion: Our study showed that Chronic Kidney disease patients on haemodialysis are at higher risk of experiencing hearing loss

Chronic kidney disease for the primary care clinician

An epidemic of chronic kidney disease (CKD) is being experienced in South Africa. This is driven by a heavy burden of infections, non-communicable diseases, pregnancy-related diseases and injuries. The serious long-term complications of CKD include end-stage renal disease, heart disease and stroke. Competing priorities such as the high burden of HIV, tuberculosis and other infections, unemployment and poverty result in serious constraints to providing comprehensive renal care, especially in the public healthcare sector. The prevention and early detection of CKD by primary care practitioners is therefore of utmost importance. Annual screening is recommended for patients at high risk of developing CKD. This involves checking blood pressure, urine dipstick testing for albuminuria or proteinuria and estimating the glomerular filtration rate from serum creatinine concentrations. In patients with established CKD, renoprotective measures are indicated to arrest or slow down the loss of renal function. These patients are at high risk of cardiovascular disease and close attention should be paid to optimally managing their risk factors

An analysis of the direct cost of renal dialysis provided through a public-private partnership at a tertiary hospital in Limpopo Province, South Africa

Background. Chronic kidney disease (CKD) is increasingly recognised as an important cause of morbidity and mortality in South Africa (SA). Although the cost of dialysis is well documented in developed countries, little is known about this cost in sub-Saharan Africa. Objectives. To review the costs of providing peritoneal dialysis (PD) and haemodialysis (HD) at the Pietersburg renal dialysis public-private partnership (PPP) unit in Limpopo Province, SA. Methods. A retrospective review of the cost of inputs required for HD and PD was conducted from a provider's perspective, covering the period 2007 - 2012. A top-down approach was used to estimate the average annual cost per patient on HD and PD. Results. During the 6-year period under review, the number of patients on dialysis increased from 77 in 2007 to 182 in 2012. More than 60% of the patients were on HD. The average annual cost per patient was estimated to be ZAR212 286 (USD25 888) and ZAR255 076 (USD31 106) for HD and PD, respectively, in 2012. Personnel cost, PD supplies, HD supplies, the outsourcing fee and pharmaceutical supplies were the main cost drivers. PD proved to be more expensive than HD, despite the use of locally manufactured fluids. Conclusions. The study highlights the exceptionally high cost of dialysis treatment. Dialysis should be made more accessible by implementing measures to address the main cost drivers. Moreover, a comprehensive approach that includes prevention of CKD at primary healthcare level, an organ donation programme and an effective kidney transplant programme is urgently required in Limpopo. Further research is required to evaluate the cost-effectiveness of the PPP approach

Grossesse au cours de l'hémodialyse chronique : à propos d'un cas

Pendant très longtemps la grossesse chez l'hémodialysée chronique était considérée comme médicalement contre indiquée, à cause des nombreuses complications materno fœtales qu'elles pouvaient engendrer. Sa prise en charge est aussi lourde pour les équipes médicales (néphrologue, obstétricien et néonatologie) que pour la patiente elle-même. Nous rapportons ici un cas de grossesse chez une dialysée observe à la clinique madeleine de Dakar au Sénégal. Cette grossesse est la première décrite avec une naissance d'un enfant vivant ayant un poids de naissance normal sans anomalie malformative grâce au suivi pluridisciplinaire (néphrologue, obstétricien et néonatologie), l'intensification des soins de dialyse, la correction de l'anémie, la maitrise de la pression artérielles et l'amélioration de l'état nutritionnel de la mer

Risk factors for chronic kidney disease among in­school adolescents in Ibadan, Southwest, Nigeria

Background: Chronic kidney disease (CKD) a common noncommunicable diseases associated with high morbidity and mortality.Epidemiology of CKD in Sub­Saharan Africa suggests high burden of CKD with early onset. The adolescent age group has been reported to be at increased risk of kidney disease arising from prevalent risky behaviors and obesity. The in­school adolescents constitute a large group of at­risk individuals that are easily accessible for screening. Objective: This study aimed to determine the prevalence of kidney CKD and its risk factors among in-school adolescents. Materials and Methods: This was a cross­sectional study of 420in­school adolescents in Ibadan, Southwest Local Government Area, Ibadan, Nigeria. A pretested questionnaire was administered to the participants selected using multistage clustered sampling technique. Anthropometric and blood pressure measurements were taken,urine samples were collected for dipstick urinalysis, while 80 participants provided blood for serum creatinine and estimated glomerular filtration rate (eGFR). Results: A total of 420 in­school adolescents participated in the study, the mean age was 14.0 ± 2.3 years and 57.4% were female. The mean body mass index, mid­upper arm circumference (MUAC), and median eGFR were 19.9 ± 3.7 kg/m2, 20.8 c ± 3.7 cm, 96.1 (36.6­156) ml/min/1.73 m2, respectively. The common risk factors for CKD were herbal consumption (59.2%),abnormal MUAC (47.1%), and truncal obesity (28.3%). Proteinuria, hematuria, and CKD were observed in 10%, 16%, and 21.3% of the participants, respectively. Excess body weight (odds ratio [OR], 5.03), abnormal MUAC (OR, 4.11), hypertension (OR, 2.51),and family history of kidney disease (OR, 1.58) were independently associated with CKD. Conclusions: CKD and its risk factors were common among in­school adolescents and the occurrence of CKD was associated with excess body weight, abnormal MUAC,hypertension, and family history of kidney disease

Traditional red cell indices are not suggestive of iron deficiency in children with chronic kidney disease

Background. Iron deficiency (ID) contributes significantly to the chronic anaemia seen in chronic kidney disease (CKD). The use of traditional red cell indices such as mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and red cell distribution width (RCDW) in screening for ID has been recommended, because they are inexpensive and widely available, especially in low-income settings.Objectives. To determine the prevalence of anaemia and ID, and the role of traditional red cell indices in screening for ID in children with CKD.Methods. A sample of 130 children (aged 5 - 18 years) with various stages of CKD was recruited. Blood samples were taken and assessed for traditional red cell indices (MCV, MCH, MCHC and RCDW), serum haemoglobin, creatinine, C-reactive protein, iron, transferrin,transferrin saturation (TSAT) and ferritin.Results. The mean (standard deviation) age was 10.7 (3.6) years, with a male-to-female ratio of 1.8:1. There was a high prevalence (32%) of anaemia among the patients. The median TSAT and ferritin were 19 (range 13 - 26)% and 50 (28 - 102) ng/mL, respectively. The prevalence of ID and ID with anaemia (IDA) was 43% and 11%, respectively. The majority of the patients (110/130; 85%) were iron deplete, and serum ferritin and RCDW were found to be independent predictors for anaemia, ID and IDA. There was no significant difference in the traditional red cell indices in iron-deplete and iron-replete patients.Conclusion. The routine use of traditional red cell indices alone in screening for ID in children with CKD should be discouraged

Adaptation posologique de la metformine chez le sujet insuffisant rénal chronique

L'insuffisance rénale chronique est une maladie grave et fréquente qui est d'autant plus élevée chez les patients diabétiques et notamment de type 2 parmi lesquels la moitié souffre d'une insuffisance rénale chronique (IRC) définie par un débit de filtration glomérulaire (DFG) inférieur à 60 ml/mi /1.73 m2 et/ou une microalbuminurie ≥ 30 mg/g. La metformine étant le traitement de première intention, son adaptation posologique à la fonction rénale est primordiale. Afin de définir un outil fiable pour les prescripteurs,nous avons évalué les recommandations des résumés des caractéristiques produit (RCP) de 46 spécialités et celles de 3 sociétés savantes internationales. Les RCP de 3 spécialités émettent des recommandations claires, 2 ne sont pas précisent et 41 recommandent une adaptation à la fonction rénale des patients âgés. Les sociétés savantes recommandent une utilisation de la metformine jusqu'à une valeur de DFG de 30 ml/min. Cette étude a montré que les RCP étaient peu fiables et que les prescripteurs devaient davantage se baser sur des recommandations d'experts validées. Un des rôles du pharmacien hospitalier est de diffuser les recommandations et d'aider le prescripteur dans le choix du meilleur traitement adapté à la fonction rénale des patients

Awareness and attitude to deceased kidney donation among health-care workers in Sokoto, Nigeria

Background: Access to renal replacement therapy by the increasing population of patients with end-stage kidney disease across Sub-Saharan Africa, including Nigeria, has become a major public health challenge. Although deceased kidney donation constitutes a viable source, its uptake by patients is contingent on its acceptance by health-care workers. Objectives: The aim of this study is to assess the awareness and attitude to deceased kidney donation among health-care workers in Sokoto, Nigeria. Materials and Methods: A cross-sectional study was conducted among 470 staff of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria (attending a 1-week seminar), selected by universal sampling. Data were collected with a set of pretested, self-administered, and semi-structured questionnaire. Results: The mean age of the respondents was 34.1 ± 7.8 years, and most of them (77.7%) were aged <40 years. Majority of respondents were males (60.6%), married (76.5%), and Moslems (73.5%). While almost all the respondents (98.1%) were aware of deceased kidney donation, only about half (51.9%) were willing to accept deceased kidney donation. Furthermore, 43.4% were willing to give consent to donate deceased relative's kidney, and 26.1% were willing to carry an organ donation card. Predictors of willingness to accept deceased kidney donation were male sex, being a medical doctor or laboratory scientist and being a Moslem (Odds ratio >2, P < 0.05). The major disincentives reported were fear that it may not work (42%) and fear of disease transmission (37.0%). Conclusion: Periodic education of health-care workers on effectiveness and safety of deceased kidney donation is crucial to promoting its acceptance among them