Late referral and associated factors among chronic kidney disease outpatients in Southern Nigeria.

Background: Chronic kidney disease (CKD) is a recognized noncommunicable disease that contributes to the global disease burden. Studies on late referral (LR) of CKD patients to the nephrologist have reported incidence rates of 22%-58% according to the definition of LR used. CKD patients who present late to the nephrologist tend to have poorer outcomes with increased morbidity and mortality. Aim: The aim of the study is to determine the prevalence of LR and associated factors among CKD outpatients. Materials and Methods: A cross-sectional observational study, in which CKD patients attending the renal outpatient clinic of two tertiary hospitals over a period of 6 months, were recruited. LR was defined as commencement of renal replacement therapy within 3 months after the first presentation to a nephrologist. Results: A total of 181 participants were recruited during the period of study; 114 were men. One hundred and twelve participants (61.8%) had stage 5 CKD, of which 97 had commenced maintenance hemodialysis. The prevalence of LR was 44.8% (81/181) (95% confidence interval: 37.4%-51.9%). Lack of funds was the most frequent reason given by participants who delayed after formal referral to a nephrologist. Being a known diabetic was associated with LR. Age, gender, level of education, occupation, being a known hypertensive, or known diabetic were not significant predictors of LR. Conclusion: Prevalence of LR is high. Education of medical practitioners, patients, and the general public on early symptoms and physical signs of kidney disease is required. Initiation of all-encompassing health insurance scheme is necessary to solve the problem of lack of funds for medical consultation and treatment.

RésuméContexte: La maladie rénale chronique (MRC) est une maladie non transmissible reconnue qui contribue au fardeau mondial de la maladie. Études sur référence tardive (LR) des patients atteints de néphropathie chronique chez le néphrologue ont signalé des taux d'incidence de 22% à 58% selon la définition de la LR utilisée. Les patients atteints d'IRC qui se présentent tardivement chez le néphrologue ont tendance à avoir de moins bons résultats avec une morbidité et une mortalité accrues. But: Le but de L'étude vise à déterminer la prévalence de la LR et des facteurs associés chez les patients ambulatoires atteints de néphropathie chronique. Matériels et méthodes: Une coupe transversale étude observationnelle, dans laquelle les patients atteints de néphropathie chronique fréquentant la clinique de néphrologie rénale de deux hôpitaux tertiaires sur une période de 6 mois, recruté. La LR était définie comme le début de la thérapie de remplacement rénal dans les 3 mois suivant la première présentation à un néphrologue. Résultats: Un total de 181 participants ont été recrutés pendant la période d'étude. 114 étaient des hommes. Cent douze participants (61,8%) ont eu stade 5 CKD, dont 97 avaient commencé une hémodialyse de maintenance. La prévalence de la LR était de 44,8% (81/181) (intervalle de confiance à 95%: 37,4% à 51,9%). Le manque de fonds est la raison la plus fréquemment invoquée par les participants qui ont tardé après avoir été officiellement dirigés vers un néphrologue. Étant un diabétique connu était associé à la LR. L'âge, le sexe, le niveau d'éducation, la profession, être un hypertendu connu ou un diabétique connu étaient prédicteurs non significatifs de la LR. Conclusion: La prévalence de la LR est élevée. Education des médecins, des patients et du grand public sur les premiers symptômes et les signes physiques de la maladie rénale est nécessaire. L'initiation d'un régime d'assurance maladie global est nécessaire pour résoudre le problème du manque de fonds pour la consultation et le traitement médicaux.

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. FUNDING: Self-funded.

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

Knowledge of acute kidney injury among nurses in two government hospitals in Ondo City, Southwest Nigeria.

Adequate knowledge of acute kidney injury (AKI) among all health-care providers is essential for early diagnosis and management to reduce the associated burden. This study determined the knowledge of AKI among nurses in two government hospitals in Ondo City, Southwest Nigeria. This cross-sectional descriptive study was carried out in two government hospitals in Ondo City using a self-administered pretested questionnaire that assessed knowledge of AKI and associated factors. A total of 156 respondents participated in the study. Majority were between 20 and 40 years of age and were females. Ninety-nine (63.5%) had ≤10 years of nursing experience. A total of 106 (67.5%) respondents had received formal lectures on AKI in the past. Only 12 (7.7%) respondents had good knowledge of AKI, 98 (62.8%) had fair knowledge, and the remaining 46 (29.5%) had poor knowledge of AKI. There was a significant association between the knowledge of AKI and having received previous AKI lectures (P = 0.03), but knowledge was not associated with the years of nursing experience (P = 0.37). There was a significant association between having received previous AKI lecture and knowledge of AKI. We, therefore, recommend regular in-service training on AKI for practicing nurses.

Knowledge of Kidney Donation Among Care Givers in Two Tertiary Hospitals in Southwest Nigeria.

One of the major challenges of kidney transplantation is shortage of kidney donors. Care givers (CGs) are potential kidney donors, but the majority of them are unwilling to donate due to inadequate knowledge on kidney donation. This study evaluated the knowledge of kidney donation and its determinants among CGs in two tertiary hospitals in Southwest Nigeria. This was a cross-sectional study that was carried out in the Kidney Care Centre (KCC), Ondo and Babcock University Teaching Hospital (BUTH), Ilishan-Remo using a self-administered pretested questionnaire that assessed knowledge of kidney donation and its determinants. Pvalue of <0.05 was taken as significant. A total of 244 respondents participated in the study. The majority were below 40 years, married, and female. The proportion of respondents with adequate knowledge of kidney donation was 63.4%. More respondents from BUTH compared to KCC had adequate knowledge of kidney donation (80% vs. 46.7%, P ≤ 0.001). Similarly, the mean knowledge score was higher in respondents from BUTH (P ≤ 0.001). Factors that determined knowledge of kidney donation were female gender (AOR: 3.43, 95% CI: 1.25-9.40, P = 0.02) and social class (AOR: 1.22, 95% CI: 0.50-2.95, P ≤ 0.001). There was positive correlation between knowledge of kidney donation among the respondents from both hospitals and their willingness to donate kidneys (r = 0.439, P ≤ 0.001). Knowledge of kidney donation was better among BUTH's respondents. Gender and social class were predictors of knowledge of kidney donation. Improving knowledge of kidney donation may improve willingness to donate among the public.

Chronic kidney disease in Nigeria: Late presentation is still the norm.

BACKGROUND: Chronic kidney disease (CKD) has become a public health problem in Nigeria. Efforts are being geared toward early diagnosis and prevention of CKD. This study involved the evaluation of the referral pattern and mode of presentation of CKD patients at first contact in a tertiary health institution. PATIENTS AND METHODS: Patients' records over an 18 month period were retrieved and the following information extracted: Sociodemographic data, referral hospital, mode of presentation, etiology of CKD, packed cell volume, blood pressure, and estimated glomerular filtration rate (GFR) at first presentation. RESULTS: There were 202 CKD patients with a male: female ratio of 1.7:1 and a mean age of 48.15 ± 16.69 years. The median estimated GFR of the patients at presentation was 3.17 ml/min/1.73 m(2). The common etiologies of CKD were chronic glomerulonephritis, hypertension, diabetes mellitus, obstructive nephropathy in 69 (34.2%), 47 (23.3%), 38 (18.8%), and 21 (10.4%) respectively. Among these patients, 111 (55%) and 98 (48.6%) had moderate to severe hypertension and anemia, respectively, 173 (85.6%) presented in CKD Stage 5, 101 (50%) required urgent hemodialysis whereas 123 (60.9%) required in-hospital admission. Only (18) 9% of these CKD patients presented by self-referral while (103) 51% were referred from secondary and private health facilities. CONCLUSION: Most Nigerian CKD patients still present very late to nephrologists implying that the present preventive strategies have not yielded desired results. Early diagnosis and referral of CKD patients could be better achieved through regular education of the public and retraining of health workers especially those in primary and secondary health institutions.