Impact of Anemia on The Quality of Life of Chronic Kidney Disease Patients: A Single Institution Experience.

BACKGROUND: Anemia is a common complication of chronic kidney disease (CKD) and has been shown to worsen as CKD advances. CKD negatively impacts patients' health-related quality of life. It is therefore necessary to determine the impact of anemia on the quality of life in patients with CKD. OBJECTIVES: We assessed the relationship between the severity of anemia and its impact on the quality of life of anemic CKD patients attending nephrology clinics. METHODOLOGY: A cross-sectional study of one hundred and sixty-three subjects which included 102 CKD patients with anemia and sixty-one CKD subjects without anemia, was done between April 2016 and January 2017. Karnofsky's structured questionnaire was used for the quality of life, while the packed cell volume was used to determine the severity of anemia. RESULTS: The prevalence of anemia among CKD subjects was 102(62.6%), and it significantly worsens as CKD advances, which ranged from 42.3% in stage 3 to 93% in stage 5 (p < 0.001). The mean physical performance score was significantly lower among anemic CKD subjects than among controls, which was 73.17 ± 12.95 and 84.59 ± 11.04 respectively (P < 0.001). Furthermore, the mean physical performance score decreases significantly with the advancing CKD among both study groups. CONCLUSION: This study showed that CKD patients with anemia had significant impairment in their physical ability than CKD patients without anemia.

CONTEXTE: L'anémie est une complication fréquente de la maladie rénale chronique (MRC) et a tendance à s'aggraver à mesure que la MRC progresse.La MRC a un impact négatif sur la qualité de vie liée à la santé des patients. Il est donc nécessaire de déterminer l'impact de l'anémie sur la qualité de vie des patients atteints de MRC. OBJECTIFS: Nous avons évalué la relation entre la gravité de l'anémie et son impact sur la qualité de vie des patients atteints de MRC anémiques fréquentant les cliniques de néphrologie. MÉTHODOLOGIE: Une étude transversale portant sur cent soixante-trois sujets, dont 102 patients atteints de MRC avec anémie et soixante et un sujets atteints de MRC sans anémie, a été réalisée entre avril 2016 et janvier 2017. Le questionnaire structuré de Karnofsky a été utilisé pour évaluer la qualité de vie, tandis que le volume globulaire a été utilisé pour déterminer la gravité de l'anémie. RÉSULTATS: La prévalence de l'anémie chez les sujets atteints de MRC était de 102 (62,6 %), et elle s'aggrave significativement à mesure que la MRC progresse, passant de 42,3 % au stade 3 à 93 % au stade 5 (p < 0,001). Le score moyen de performance physique était significativement plus bas chez les sujets atteints de MRC anémiques que chez les témoins, soit 73,17 ± 12,95 et 84,59 ± 11,04 respectivement (p < 0,001). De plus, le score moyen de performance physique diminue significativement avec la progression de la MRC dans les deux groupes d'étude. CONCLUSION: Cette étude a montré que les patients atteints de MRC avec anémie présentaient une altération significative de leur capacité physique par rapport aux patients atteints de MRC sans anémie. Mots-clés: MRC,Anémie, Qualité de vie (QdV), Hémoglobine (Hb).

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.

Nephritis as an initial diagnosis of lupus in Nigerian patients.

BACKGROUND: Systemic Lupus Erythematosus (SLE) is a multi-systemic autoimmune disease. Renal involvement is a common complication, causing considerable mortality and morbidity. SLE is rarely reported among black Africans, though recent reports from Nigeria indicate otherwise. Nephritis, though a common complication of SLE has rarely been reported as the initial diagnosis of lupus among black Africans. AIMS: The aim of our study is to highlight the clinical, laboratory and histological features in Nigerian patients presenting with features of nephritis and subsequent diagnosis of SLE. METHODS: This is a three year prospective study of patients with renal diseases, who were admitted to the rheumatology and nephrology units of the Lagos State University Teaching Hospital (LASUTH) Ikeja. Serology, biochemical, haematologic tests, kidney biopsy were done. RESULTS: Twelve patients were studied (F11; M1); mean age 30.4 years (SD ± 9.8); mean illness 8 weeks (SD ± 6.6). Six patients had a nephritic condition. Nine of the patients had baseline hypertension while 3 had a rapidly progressive nephritis. Two patients had baseline End Stage Renal Disease (ESRD). All had dipstick proteinuria 2+/3+, mean protein creatinine ratio 2.2 (SD ± 0.6), mean 24hr protein 2.8 gm (SD ± 2.7); more than 10 red blood cells/hpf haematuria (n-6), hyaline casts (n-5), granular casts (n-2), mean GFR 31.4 ml/ min (SD ± 21.3.), mean serum creatinine 6.9 mg/dl (SD ± 5.3); mean urea 138.8 mg/dl (SD ± 56.2). For the serology, Anti Nuclear Antibody (ANA) was positive in all the 12 subjects; positive anti dsDNA -10 patients; ENA - 10. Renal biopsy showed mostly WHO/ISSN classes III, IV and V. Treatment was with Euro Lupus regimen and rituximab/ cyclophosphamide. Four patients had dialysis. In terms of the outcome, there were 3 deaths while 9 patients were discharged. CONCLUSION: A high index of suspicion is needed to diagnose Lupus Nephritis in black Africans especially when their presentations do not fulfil the America College of Rheumatology (ACR) diagnostic criteria for SLE.

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.

Indices of kidney damage and cardiovascular disease risk factors in a semiurban community of iloye, South-west Nigeria.

Health screening exercises are important, as they enable early detection of diseases in individual subjects and also enable data collection, useful in estimating disease burden in the community. This paper describes the findings of a health screening exercise conducted in a semiurban population of Iloye, by the Rotary Club of Ota, Ogun State, Western Nigeria, as a part of its community-oriented services and projects. Three hundred and twenty six community members were screened during the exercise. There were 189 (57.97%) females and 137 (42.03%) males, with a mean age of 43.5 ± 14.88 yrs. Urinary abnormality and/or creatinine clearance less than 90 mls/min was detected in 147 (45.09%) participants. 99 (30.37%) participants had proteinuria, 16 (4.91%) had haematuria, and 5 (1.53%) participants had both haematuria and proteinuria. Eight (2.45%) participants had GFR less than 60 mls/min. Elevated blood pressure was found in 152 (46.63%), while 3 (0.9%) participants had diabetes, 71 (21.8%) were obese, 16 (4.9%) had hypercholesterolaemia, and 3 (0.9%) had hypertriglyceridaemia. Prevalence of both smoking and alcohol consumption was 6 (1.84%). It was concluded that the prevalence of indices of kidney damage and cardiovascular risk factors is high in Iloye community.

Clinical Characteristics of Human Immunodeficiency Virus (HIV) Seropositive Nigerian Patients Undergoing Dialysis

Renal failure is a common finding in human immunodeficiency virus infected patients; and it contributes significantly to their morbidity and mortality. Most dialysis centres in Nigeria currently do not accept HIV positive patients for dialysis therapy for many reasons. The prevailing high level of stigmatization of HIV positive patients and the lack of job security for infected staff are two major reasons for the non-acceptance of HIV infected patients for dialysis by these centres. Following a pathetic encounter with an HIV positive patient who required dialysis and the success of his treatment; our centre currently perform dialysis for HIV positive patients on routine basis. In this article; we present our clinical observations on the characteristics of HIV patients dialyzed in our unit between 1st January 2004 and 31st December 2004. A total of 142 patients dialyzed in our centre during this period. 24 (16.9) were HIV positive. Acute renal failure was significantly more common in the HIV positive patients. [14(31.8) of 44 patients who presented with acute renal failure. X2 = 8.95; p 0.05]. Aetiologically; septicaemia was the most common cause of acute renal failure [7(50) of 14 patients]. HIV associated nephropathy accounted for 8(80) out of 10 HIV positive patients dialyzed with chronic renal failure. Outcome of therapy was not significantly different when compared with the HIV negative patients. We conclude that renal function impairment is common in patients with HIV infection. Treatment outcomes are essentially similar to HIV seronegative patients. The main determining factor being the ability of the patient to finance dialysis therapy

Clinical characteristics of human Immunodefiency Virus (HIV) seropositive Nigerian patients undergoing dialysis

Renal failure is a common finding in human immunodeficiency virus infected patients; and it contributes significantly to their morbidity and mortality. Most dialysis centres in Nigeria currently do not accept HIV positive patients for dialysis therapy for many reasons. The prevailing high level of stigmatization of HIV positive patients and the lack of job security for infected staff are two major reasons for the non-acceptance of HIV infected patients for dialysis by these centres. Following a pathetic encounter with an HIV positive patient who required dialysis and the success of his treatment; our centre currently perform dialysis for HIV positive patients on routine basis. In this article; we present our clinical observations on the characteristics of HIV patients dialyzed in our unit between 1st January 2004 and 31st December 2004. A total of 142 patients dialyzed in our centre during this period. 24 (16.9) were HIV positive. Acute renal failure was significantly more common in the HIV positive patients. [14(31.8) of 44 patients who presented with acute renal failure. X2 = 8.95; p 0.05]. Aetiologically; septicaemia was the most common cause of acute renal failure [7(50) of 14 patients]. HIV associated nephropathy accounted for 8(80) out of 10 HIV positive patients dialyzed with chronic renal failure. Outcome of therapy was not significantly different when compared with the HIV negative patients. We conclude that renal function impairment is common in patients with HIV infection. Treatment outcomes are essentially similar to HIV seronegative patients. The main determining factor being the ability of the patient to finance dialysis therapy

Modified Allen's Test in radiocephalic arterio-venous fistula creation: how relevant?

The significance of the Modified Allen's Test has not been determined in Nigerians who need forearm arterio-venous fistulae. We sought to determine this in thirty-four patients who needed forearm arterio-venous fistulae for haemodialysis. Side-to-end radio-cephalic arterio-venous fistulae were successfully created on their forearms notwithstanding the result of Modified Allen's test. Modified Allen's test was negative in 12 (35.3% ) of the patients and side-to-end radio-cephalic fistulae were created on the forearm of all of them without any untoward effects. We concluded that preoperative Modified Allen's test is not necessary for side-to-end radio-cephalic arterio-venous fistulae of the forearm.

Arterial blood pressure in adult Nigerian sickle cell anaemia patients.

Sickle cell disease (SCD) is predominantly a problem of black community in whom a higher prevalence of hypertension has been reported. Despite these observations, a lower mean arterial blood pressure is observed to be common in homozygous sickle cell anaemia (SCA) patients, especially from outside Africa. In view of the well known diversity in both clinical and haematological presentations of SCD, we have evaluated the effects of sickled haemoglobin on blood pressure distribution in Nigerians with SCA. Arterial blood pressure was measured using mercury sphygmomanometer and the mean arterial pressure calculated in 64 adult Nigerians with SCA and 60 normal individuals. The mean age of SCA group was 22.14 +/- 4.90 years with a range of 18-57 years and in the controls was 27.18 +/- 8.06 years with a range of 18-54 years. The mean values of MAP 72.69 +/- 7.30 mmHg in SCA was significantly lower than 87.25 +/- 9.98 mmHg in the controls p < 0.007. The cause of this observed lower blood pressure in SCA is still speculative. We postulate that the differences in weight between SCA patients and normal individuals may contribute to this phenomenon. However, it is possible that nitric oxide (NO) or endothelial relaxing factor (EDRF) may also contribute to this lower blood pressure and the decrease in peripheral resistance in SCA.

Problem based medical education in the community: a student nutritional survey in Nigeria.

Students in their second year of medical studies perceived nutritional deficiency as a possible health problem in rural Nigeria and conducted a survey to investigate and compare the nutritional and health status of three distinct groups of children (Bokos in Babana, Bokos in Marami, Fulani). The nutritional status of the children in the three study populations differed and seasonal change affected the one to four year old children among the Fulani more than the other 2 groups. An attempt was made to explain the results on the basis of environmental and socioeconomic differences among the groups. This account, more than just elaborating on figures and more than making indisputable statements, aims at showing how medical students, from their earliest studies, can learn from an apparent health problem of the community, how they can be messengers of data relevant to picture the local epidemiology (practical aspect) and how their findings can be used as self instructive teaching--learning material (educational aspect).