Perspectives of relatives of patients with end-stage kidney disease on kidney sources, commercial kidney donation, and barriers to living kidney donation in Nigeria: a qualitative study.

BACKGROUND: Kidney transplantation is the best mode of kidney replacement therapy. However, the shortage of organ donations has been a major challenge globally. Relatives of patients with end-stage kidney disease (ESKD) are potential kidney donors. We explored their perspectives about kidney donation, kidney commercialisation, and barriers to kidney donation. METHODS: In-depth interviews were conducted among 28 relatives of ESKD patients across the six geopolitical zones and Federal Capital Territory of Nigeria. The interview focused on potential sources of kidney donors, kidney commercialisation and barriers to kidney donation. ATLAS.ti version 9.0.22.0 was used for data analysis. RESULTS: Mean age of the study participants was 41.57 ± 14.55 years; 54% were females, 60.7% were married, 93% had tertiary education and 75% were first degree relatives of ESKD patients. There were 7 themes and 28 subthemes generated in this study. The potential sources of kidney donors identified by the study participants included commercial, hospital, family and non-family member donors. While some opined that a family member is the best choice as a kidney donor, others preferred a commercial donor. The majority of those interviewed do not believe that it is wrong to purchase a kidney, and would be willing to do so. Identified factors that promote kidney commercialisation were unwillingness of a family member to donate, having the financial capacity to purchase a kidney, non-fitness of family members to donate. Identified barriers to kidney donation were age, poor health status, polygamy, perceived poor expertise of the medical team, perceived risk of the procedure, parental influence and religious beliefs. CONCLUSIONS: The majority of participants lacked correct information about kidney donation. Implementation of educational program policies and laws regulating and reinforcing ethical principles of kidney donation and transplantation should be ensured.

Clinical Characteristics and Outcomes of Hemodialysis in a New Center in Northern Nigeria.

BACKGROUND: Hemodialysis is the most common renal replacement therapy (RRT) modality in Africa and few countries enjoy reimbursement from the government to fund it. Africa contributes <10% of the total RRT patients worldwide this is mainly due to high cost. AIMS AND OBJECTIVES: We aimed to review the clinical characteristics and outcomes of patients requiring hemodialysis in our center over a 7 years period, to highlight the enormous challenges encountered. MATERIALS AND METHODS: This is a retrospective study of patients aged 15 years and above that was seen between April 2010 and March 2017 at the Hemodialysis unit of Abubakar Tafawa Balewa University Teaching Hospital. Information was extracted from the patient's case folders and dialysis charts. RESULTS: In total, 226 patients had hemodialysis over the period, 124 (54.9%) were male and 102 (49.1%) were female. Sixty-one (27%) patients had acute kidney injury (AKI), 143 (63.3%) had chronic kidney disease (CKD), whereas 22 (9.7%) had acute-on-CKD. A total of 2215 sessions of hemodialysis were done in the period, of which 782 (35.3%) were for AKI and 469 (21.2%) for acute on CKD. A total of 138 (60.6%) patients were discharged and 58 deaths were recorded. CONCLUSION: Although there is rapid proliferation of hemodialysis facilities in the country, many patients could not afford adequate hemodialysis. Inadequate dialysis due to finances was the main cause of death in these category of patients.

Prevalence and pattern of chronic kidney disease-mineral bone disorders among hemodialysis patients in kano, northwest nigeria.

Introduction: Mineral and bone disorders (MBD) are among the important complications of chronic kidney disease (CKD) including end-stage renal disease. In addition to the higher rate of all-cause and cardiovascular-related mortality, MBD is also a cause of significant morbidity in CKD patients. Materials and Methods: This is a cross-sectional study of all consenting patients on hemodialysis at Aminu Kano Teaching Hospital, between December 2011 and June 2012. With the aid of an interviewer-administered questionnaire, the demographic profile and clinical features of the patients were obtained. After a general physical examination, blood sample was taken for the determination of calcium, phosphate, intact parathyroid hormone, 25 hydroxy (25[OH]) Vitamin D3, packed cell volume, serum creatinine, and potassium. Results: Forty-eight patients on maintenance hemodialysis were recruited for the study, 39 (81.3%) were male and 9 (18.8%) were female. The age range was 40-59 years, with a mean of 45.96 ± 13.7 years. Chronic glomerulonephritis was the predominant cause of CKD (25%). Hyperphosphatemia was noted in 19 (39.5%) of the patients, whereas 22 (46%) had hypocalcemia. In 26 (54.1%) of the patients, the calcium-phosphate product was >4.55 mmol2/L2. We found that 58% of the patients had CKD-MBD, of which 15 (31%) had secondary hyperparathyroidism, whereas 13 (27%) had features suggestive of adynamic bone disease. None of the patient had normal serum 25(OH) Vitamin D3(mean: 43.79 ± 21 ng/ml). Conclusion: CKD-MBD is common among patients on hemodialysis in our center. Screening for CKD-MBD and appropriate use of phosphate binder and Vitamin D when indicated are highly recommended.

RésuméIntroduction: Les maladies minérales et osseuses comptent parmi les complications importantes de la néphropathie chronique, notamment: phase terminale de la maladie rénale. Outre le taux plus élevé de mortalité toutes causes confondues et liée à la cardiopathie, la MBD est également une cause de morbidité chez les patients atteints d'IRC. Matériels et Méthodes: Ceci est une étude transversale de tous les patients consentants sous hémodialyse à Aminu Hôpital universitaire de Kano, entre décembre 2011 et juin 2012. À l'aide d'un questionnaire administré par un intervieweur, le le profil et les caractéristiques cliniques des patients ont été obtenus. Après un examen physique général, un échantillon de sang a été prélevé pour la determination de calcium, de phosphate, d'hormone parathyroïde intacte, de 25 hydroxy (25 [OH]) vitamine D3, de volume de globules rouges, de créatinine sérique et de potassium. Résultats: Quarante-huit patients sous hémodialyse d'entretien ont été recrutés pour l'étude, 39 (81,3%) étaient des hommes et 9 (18,8%) des femmes. La tranche d'âge était comprise entre 40 et 59 ans, avec une moyenne de 45,96 ± 13,7 ans. La glomérulonéphrite chronique était la principale cause de néphropathie chronique (25%). Une hyperphosphatémie a été notée chez 19 (39,5%) des patients, alors que 22 (46%) présentaient une hypocalcémie. Dans 26 (54,1%) des patients, le le produit de phosphate de calcium était> 4,55 mmol2 / L2. Nous avons constaté que 58% des patients étaient atteints de MRC, dont 15 (31%) avaient une atteinte secondaire. hyperparathyroïdie, alors que 13 (27%) présentaient des signes évocateurs d'une maladie osseuse adynamique. Aucun patient ne présentait un taux sérique normal de 25 (OH) Vitamine D3 (moyenne: 43,79 ± 21 ng / ml). Conclusion: La MPC est fréquente chez les patients hémodialysés de notre centre. Dépistage de CKD-MBD et l'utilisation appropriée du liant de phosphate et de la vitamine D lorsque cela est indiqué sont fortement recommandés.

Prevalence and pattern of chronic kidney disease-mineral bone disorders among hemodialysis patients in kano, northwest Nigeria

Introduction: Mineral and bone disorders (MBD) are among the important complications of chronic kidney disease (CKD) including end-stage renal disease. In addition to the higher rate of all-cause and cardiovascular-related mortality, MBD is also a cause of significant morbidity in CKD patients. Materials and Methods: This is a cross-sectional study of all consenting patients on hemodialysis at Aminu Kano Teaching Hospital, between December 2011 and June 2012. With the aid of an interviewer-administered questionnaire, the demographic profile and clinical features of the patients were obtained. After a general physical examination, blood sample was taken for the determination of calcium, phosphate, intact parathyroid hormone, 25 hydroxy (25[OH]) Vitamin D3, packed cell volume, serum creatinine, and potassium. Results: Forty-eight patients on maintenance hemodialysis were recruited for the study, 39 (81.3%) were male and 9 (18.8%) were female. The age range was 40­59 years, with a mean of 45.96 ± 13.7 years. Chronic glomerulonephritis was the predominant cause of CKD (25%). Hyperphosphatemia was noted in 19 (39.5%) of the patients, whereas 22 (46%) had hypocalcemia. In 26 (54.1%) of the patients, the calcium-phosphate product was >4.55 mmol2/L2. We found that 58% of the patients had CKD-MBD, of which 15 (31%) had secondary hyperparathyroidism, whereas 13 (27%) had features suggestive of adynamic bone disease. None of the patient had normal serum 25(OH) Vitamin D3(mean: 43.79 ± 21 ng/ml). Conclusion: CKD-MBD is common among patients on hemodialysis in our center. Screening for CKD-MBD and appropriate use of phosphate binder and Vitamin D when indicated are highly recommended