Albuminuria and Reduced Estimated Glomerular Filtration Rate among First-degree Relatives of Patients with Chronic Kidney Disease in Lagos, Southwest Nigeria.

Screening of individuals at increased risk of developing chronic kidney disease (CKD) has been advocated by several guidelines. Among individuals at increased risk are first-degree relatives (FDRs) of patients with CKD. There is a paucity of data on the prevalence and risk of CKD in FDRs of patients with CKD in sub-Saharan African population. This study aimed to screen FDRs of patients with CKD for albuminuria and reduced estimated glomerular filtration rate (eGFR). A cross-sectional survey of 230 FDRs of patients with CKD and 230 individuals without family history of CKD was conducted. Urinary albumin: creatinine ratio (ACR) was determined from an early morning spot urine. Glomerular filtration rate was estimated from serum creatinine. Reduced eGFR was defined as eGFR <60 ml/min/1.73 m2 and albuminuria defined as ACR ≥30 mg/g. A higher prevalence of albuminuria was found in the FDRs compared to the controls (37.0% vs. 22.2%; P < 0.01). Reduced eGFR was more prevalent among the FDRs compared with the controls (5.7% vs. 1.7%, P < 0.03). Hypertension (odds ratio [OR], 2.9) and reduced eGFR (OR, 9.1) were independent predictors of albuminuria while increasing age (OR, 6.7) and proteinuria (OR, 10.7) predicted reduced eGFR in FDRs. The odds of developing renal dysfunction were increased 2-fold in the FDRs of patients with CKD, OR 2.3, 95% confidence interval, 1.29-3.17. We concluded that albuminuria and reduced eGFR are more prevalent among the FDRs of patient with CKD and they are twice as likely to develop kidney dysfunction as healthy controls.

Do the Benefits of Transplant Tourism Amongst Nigerian Patients Outweigh the Risks? A Single-Center Experience.

BACKGROUND: Transplant tourism (TT) is the term used to describe travel outside one's country of abode for the sole purpose of obtaining organ transplantation services. OBJECTIVE: This study describes the characteristics and outcomes of kidney transplant tourists who were followed up in our institution. METHODS: A retrospective study was conducted on patients who underwent kidney transplantation outside the country and were followed up in our institution from 2007 to 2015. RESULTS: 26 patients were followed up; 19 (73%) were males. The mean±SD age of patients was 40.5±10.3 years. The majority (n=20) of the transplantations were carried out in India. Living-unrelated transplants were most common (54%). Complications encountered were infections in 11 (42%) patients, new-onset diabetes after transplantation in 9 (35%), chronic allograft nephropathy in 8 (31%), biopsy-proven acute rejections in 3 (12%), and primary non-function in 2 (8%). 1-year graft survival was 81% and 1-year patient survival was 85%. CONCLUSION: Kidney transplant tourism is still common among Nigerian patients with end-stage renal disease. Short-term graft and patient survival rates were poorer than values recommended for living kidney transplants. We therefore advise that TT should be discouraged in Nigeria, given the availability of transplantation services in the country, and also in line with international efforts to curb the practice.

Acute kidney injury in Lagos: Pattern, outcomes, and predictors of in-hospital mortality.

CONTEXT: The pattern of acute kidney injury (AKI) differs significantly between developed and developing countries. AIMS: The aim of th study was to determine the pattern and clinical outcomes of AKI in Lagos, Southwest Nigeria. SETTINGS AND DESIGN: A retrospective review of hospital records of all patients with a diagnosis of AKI over a 20-month period. SUBJECTS AND METHODS: Records of 54 patients were reviewed. Information retrieved included, bio-data, etiology of AKI, results of laboratory investigations, and patient outcomes. STATISTICAL ANALYSIS USED: Continuous data are presented as means while categorical data are presented as proportions. The Student's t-test was used to compare means while Chi-square test was used to compare percentages. Logistic regression analysis was used to determine the factors that predicted in-hospital mortality. RESULTS: Twenty-seven (50%) of the patients were male. The mean age of the study population was 39.7 years ± 16.3 years. Sepsis was the etiology of AKI in 52.1% of cases. Overall, in-hospital mortality was 29.6%. Patients who died had a shorter mean duration of hospital stay (9.2 days vs. 33.9 days [P < 0.01]), lower mean serum bicarbonate (19.5 mmol/L vs. 22.9 mmmol/L [P = 0.02]), were more likely to be admitted unconscious (82.4% vs. 17.6% [P = 0.01]) and to have been admitted to the Intensive Care Unit (37.5% vs. 7.9% [P = 0.01]). In addition, when dialysis was indicated, patients who did not have dialysis were more likely to die (58.3% vs. 41.7% [P = 0.02]). CONCLUSIONS: The pattern of AKI in this study is similar to that from other developing countries. In-hospital mortality remains high although most of the causes are preventable.

Needle-stick injury among health care workers in hemodialysis units in Nigeria: a multi-center study.

BACKGROUND: Needle-stick and sharps injuries carry the risk of infection and are occupational hazards for all health care professionals involved in clinical care. OBJECTIVE: To determine the frequency and factors contributing to needle-stick injury (NSI) among health care workers of dialysis units in Lagos, Nigeria. METHODS: Data were obtained by anonymous, self-reporting questionnaire from staff of 4 hemodialysis units between October and December 2011. Information on demographics, job category and duration, details of NSI in the past, kind of activity and procedure under which the NSI occurred, if injury was reported, vaccination status of staff, and post-exposure treatment received were obtained. RESULTS: The study population included 38 (37.3%) doctors, 42 nurses (41.2%), 14 (13.7%) dialysis technicians and 8 (7.8%) ancillary staff. There were 39 (38.2%) males. The mean±SD age of the study population was 34.4±8.3 years. 25 (24.5%) staff had suffered NSI in the last 12 months and 41 (40.2%) in their entire working career. The most common activity leading to NSI was recapping of needles (45%), improper disposal of needles (30%), and venous cannulation and setting of drips (27.5%). NSI was significantly (p=0.016) higher among those with work experience between 6 and 10 years than others. Hollow bore needles were responsible for 82.9% of the NSIs. Only 15 (37%) respondents reported their NSI to their unit head or designated officer in order to get medical advice. CONCLUSION: In Lagos, Nigeria, NSI is common among hemodialysis staff and is under-reported. Many NSIs can be prevented by adhering to the practice of universal precautions as well as education of staff on such precautionary methods.

Pattern of intradialytic complications at the Lagos University Teaching Hospital.

BACKGROUND: The safety of haemodialysis (HD) procedure has improved greatly over the years but, the procedure is not without risks; complications still occur during dialysis. In this study, we report on the pattern of intradialytic complications seen over a one year period at the dialysis centre of the Lagos University Teaching Hospital Lagos (LUTH), Nigeria. METHOD: We reviewed the dialysis and hospital records of consecutive patients with chronic kidney disease (CKD) who received haemodialysis treatment in the dialysis centre during the period between January and December 2010. Data comprised patients' demographics, aetiology of kidney failure and complications encountered during the HD treatment sessions. RESULTS: The study involved 201 patients with CKD; there were 113 (56.2%) males, the mean age was 47.5 +/- 15.7years. There were 140 (69.7%) new patients and 61 (30.3%) old patients. The most common aetiology of CKD was hypertension (42.8%) followed by glomerulonephritis (15.9%). A total of 1010 haemodialysis sessions were recorded with complications occurring in 36.2% of the HD sessions. The most frequently encountered complication was hypertension which occurred in 15.2% of HD sessions followed by hypotension 8.5%. Hypotension occurred more frequently during first HD session (18.4%) compared with subsequent sessions (6.1%) X2 = p < 0.001. Patients who experienced hypertension had significantly higher pre-dialysis systolic blood pressure (BP) values (mean 168 +/- 28.6mmHg vs 149.3 +/- 20.1mmHg) and pre-dialysis diastolic BP (100.6 +/- 18mmHg vs 90.3 +/- 11.4mmHg) compared with those who did not p <0.001. CONCLUSION: Hypertension was the most frequently encountered complication. Hypotension was still commonly encountered especially during first HD treatments. Clinicians must make concerted to optimise blood pressure in patients undergoing haemodialysis therapy.

Factors influencing non-compliance with anti-hypertensive drug therapy in Nigerians.

BACKGROUND: Non-compliance with antihypertensive drug therapy can have a negative impact on cardiovascular outcome. The objective of this study was to determine compliance rate with anti-hypertensive therapy and factors affecting compliance among patients attending a Nigerian tertiary hospital. METHODS: A cross sectional study was conducted on 225 black hypertensive patients attending a tertiary clinic in Lagos, Nigeria. Demographic data, current anti-hypertensive therapy, compliance with prescribed therapy, factors affecting compliance and BP were documented via an investigator administered questionnaire and open-ended interviews. RESULTS: In this study, 77(34.2%) of the hypertensive patients were non-compliant. Blood pressure control was significantly better among compliant patients (45.9%) than in non-compliant patients (27.3%) (x(2) = 7.35 p=0.007). Gender, age, number of drugs used, educational level and presence of co-morbidities did not affect compliance. The major reasons for non-compliance were miscellaneous factors (60%) related to both patient's attitudes and beliefs (reflecting ignorance),and consultation failure on the part of clinicians. Lack of finances and side effects of medications accounted for 23.8% and 16.2% of non-compliances respectively. CONCLUSION: Although lack of finances is the single most self reported reason, miscellaneous factors related to patients' attitudes and belief contribute frequently. Incorporating patient education and counselling in routine follow-up may improve compliance, BP control, and ultimately impact positively on cardiovascular outcome.

Hepatitis B and C virus infection in Nigerian patients with HIV/AIDS.

OBJECTIVES: This study was designed to assess the prevalence of HBV and HCV infection in HIV patients and evaluate the risk of infection compared with HIV negative control subjects. METHOD: This is a prospective case control study in which 240 HIV/AIDS patients and age and sex matched controls were evaluated. The diagnosis of HIV infection was based on a positive HIV screening test using Capillus test kits (Trinity Biotech PLC, Ireland) and confirmed using Western blot assay. HBsAg and anti-HCV were assayed by commercially available chromatographic immunoassay (SD BIOLINE). RESULTS: Eleven (9.2%) of the 120 HIV/AIDS patients and 8 (7%) of the 120 control subjects were positive for the HBsAg (OR=1, p=0.27). HBeAg was detected in 3 of the 11 (27.3%) subjects with HIV/HBV co infections. HIV positive patients were 7 times more likely to have HCV infection than control patients (5.8% compared with 0.8%, OR=7.3, p= 0.03). CONCLUSION: The lack of a strong association between HBV and HIV infection may be related to different exposure routes in this population where HBV infection is highly endemic and childhood infection almost universal. In this African population, HIV infection may be a super-infection of HBV infections contracted in childhood. This high HCV/HIV co-infection rate is consistent with the shared parenteral and sexual routes of transmission.

Lipid peroxidation and erythrocyte fragility in poorly controlled type 2 diabetes mellitus.

BACKGROUND: Type 2 Diabetes mellitus has been recently found to have evidence of raised inflammatory markers. The chronic inflammation correlates strongly with cardiovascular morbidity markers such as coronary artery disease, stroke and peripheral arterial disease. The chronic inflammation has been linked to the generation of free radicals. The evidence is however inconclusive. Thus there is increased interest in determining the oxidative status of persons with diabetes. OBJECTIVES: This study was carried out to determine if the plasma oxidative stress status is high in diabetics (especially those that are poorly controlled) and to determine the effect on erythrocyte stability. METHODS: Plasma levels of thiobarbituric acid reacting substances (TBARS), an index of lipid peroxidation, and erythrocyte osmotic stability were determined. These were compared between poorly controlled type 2 diabetics and nondiabetic individuals. RESULTS: The plasma level of TBARS were significantly higher in the plasma of the diabetics: 0.90 +/- 0.09 micromol malondialdehyde (MDA) equivalent L(-1) vs 0.57 +/- 0.02 micromol MDA equivalent L(-1) for control subjects (p=0.002). The diabetic erythrocytes also showed significantly higher fragility: 3.99 +/- 0.37% haemolysis vs 2.11 +/- 0.27% haemolysis for controls (p=0.0004). CONCLUSION: Our data shows the occurrence of significantly higher oxidative stress level and osmotic fragility of erythrocytes in the cohort of persons with poorly controlled diabetes mellitus.

Attitude to Psychiatric Referral: A study of Primary Care Physicians.

To evaluate the attitudes of primary care physicians to psychiatric referral using a structured questionnaire. Cross-sectional survey of the attitude of 126 (105m, 2lf) consenting doctors working in randomly selected health institutions offering primary care services in Lagos using a structured questionnaire was conducted. Non-recognition of the extent of psychiatric morbidity among patients, stigma, effect of psychiatric referral on self-esteem of patients, not being sure of how rewarding such referral could be, and difficulty in securing psychiatric services seem to affect the referral decisions of most physicians. Equal proportions of physicians (44.4%) agree or disagree with the statement "doctors need to be very careful in referring patients to psychiatrists". Addressing doctors attitudinal dispositions may be a useful step in the design of intervention measures aimed at improving the outcome of psychiatric morbidity presenting in primary care.