Cardiovascular Risk Factor Burden and Association With CKD in Ghana and Nigeria.

Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD); however, the burden of cardiovascular risk factors in patients with CKD in Africa is not well characterized. We determined the prevalence of selected cardiovascular risk factors, and association with CKD in the Human Heredity for Health in Africa Kidney Disease Research Network study. Methods: We recruited patients with and without CKD in Ghana and Nigeria. CKD was defined as estimated glomerular filtration rate of <60 ml/min per 1.73 m2 and/or albuminuria as albumin-to-creatinine ratio <3.0 mg/mmol (<30 mg/g) for ≥3 months. We assessed self-reported (physician-diagnosis and/or use of medication) hypertension, diabetes, and elevated cholesterol; and self-reported smoking as cardiovascular risk factors. Association between the risk factors and CKD was determined by multivariate logistic regression. Results: We enrolled 8396 participants (cases with CKD, 3956), with 56% females. The mean age (45.5 ± 15.1 years) did not differ between patients and control group. The prevalence of hypertension (59%), diabetes (20%), and elevated cholesterol (9.9%), was higher in CKD patients than in the control participants (P < 0.001). Prevalence of risk factors was higher in Ghana than in Nigeria. Hypertension (adjusted odds ratio [aOR] = 1.69 [1.43-2.01, P < 0.001]), elevated cholesterol (aOR = 2.0 [1.39-2.86, P < 0.001]), age >50 years, and body mass index (BMI) <18.5 kg/m2 were independently associated with CKD. The association of diabetes and smoking with CKD was modified by other risk factors. Conclusion: Cardiovascular risk factors are prevalent in middle-aged adult patients with CKD in Ghana and Nigeria, with higher proportions in Ghana than in Nigeria. Hypertension, elevated cholesterol, and underweight were independently associated with CKD.

Prevalence of chronic kidney disease and risk factors in North-Central Nigeria: a population-based survey.

BACKGROUND: Chronic kidney disease (CKD) is a growing challenge in low- and middle-income countries, particularly in sub-Saharan Africa. There is insufficient population-based data on CKD in Nigeria that is required to estimate its true burden, and to design prevention and management strategies. The study aims to determine the prevalence of CKD and its risk factors in Nigeria. METHODS: We studied 8 urban communities in Kwara State, North-Central zone of Nigeria. Blood pressure, fasting blood sugar, urinalysis, weight, height, waist circumference and hip circumference were obtained. Albuminuria and kidney length were measured by ultrasound while estimated glomerular filtration rate (eGFR) was derived from serum creatinine, using chronic disease epidemiology collaboration (CKD-EPI) equation. Associations of risk factors with CKD were determined by multivariate logistic regression and expressed as adjusted odds ratio (aOR) with corresponding 95% confidence intervals. RESULTS: One thousand three hundred and fifty-three adults ≥18 years (44% males) with mean age of 44.3 ± 14.4 years, were screened. Mean kidney lengths were: right, 93.5 ± 7.0 cm and left, 93.4 ± 7.5 cm. The age-adjusted prevalence of hypertension was 24%; diabetes 4%; obesity 8.7%; albuminuria of > 30 mg/L 7%; and dipstick proteinuria 13%. The age-adjusted prevalence of CKD by estimated GFR < 60 ml/min/1.73m2 and/or Proteinuria was 12%. Diabetes (aOR 6.41, 95%CI = 3.50-11.73, P = 0.001), obesity (aOR 1.50, 95%CI = 1.10-2.05, P = 0.011), proteinuria (aOR 2.07, 95%CI = 1.05-4.08, P = 0.035); female sex (aOR 1.67, 95%CI = 1.47-1.89, P = 0.001); and age (aOR 1.89, 95%CI = 1.13-3.17, P = 0.015) were the identified predictors of CKD. CONCLUSIONS: CKD and its risk factors are prevalent among middle-aged urban populations in North-Central Nigeria. It is common among women, fueled by diabetes, ageing, obesity, and albuminuria. These data add to existing regional studies of burden of CKD that may serve as template for a national prevention framework for CKD in Nigeria. One of the limitations of the study is that the participants were voluntary community dwellers and as such not representative for the community. The sample may thus have been subjected to selection bias possibly resulting in overestimation of CKD risk factors.

Usefulness of renal length and volume by ultrasound in determining severity of chronic kidney disease.

To determine the correlation of renal ultrasonic parameters and degree of kidney function among chronic kidney disease patients seen at the Nephrology unit of the University of Ilorin Teaching Hospital (UITH) Ilorin, we studied 322 patients. The results were analyzed with specific reference to socio-demography and correlating renal length and volume with estimated glomerular filtration rate. The male to female ratio was 2:1, with an age range from 20 to 80 years and mean age of 45.06 (±13.0) years. The serum creatinine levels ranged from 201 to 1205 µmol/L, with a mean of 388 ± 168 µmol/L, while the estimated glomerular filtration rate (eGFR) ranged from 3.77 to 44.32 mL/min, with a mean of 18.2 ± 7.19 mL/min. The right and left renal lengths ranged from 6.9 to 13.0 cm, with a mean of 9.11 ± 1.06, and 6.5-13.4 cm, with a mean of 9.23 ± 1.07 cm, respectively. The mean volumes of the right and left kidneys were 98.6 ± 41.9 cm 3 and 105 ± 46.2 cm 3 , respectively. The Pearson correlation of the right and left kidneys length to eGFR were -0.197 and -0.137 respectively, while that of the right and left kidney volume to eGFR were -0.122 and -0.043, respectively. Our study showed that there is a positive correlation between ultrasonic renal measurements and degree of kidney function.

Prevalence of non-communicable diseases and its awareness among inhabitants of Sokoto metropolis: outcome of a screening program for hypertension, obesity, diabetes mellitus and overt proteinuria.

INTRODUCTION: Developing countries confront double jeopardy of prevalent infectious disease and increasing Non-Communicable Diseases (NCD) with imminent projected epidemic proportions. Nigeria has witnessed tremendous socio-economic changes and rural to urban migration culminating in emergence of NCD. The impact of these diseases on the lives of people is enormous when measured in terms of outcomes. We initiated a screening program among inhabitants of Sokoto metropolis in an attempt to unravel the prevalence and pattern of NCD. METHODS: This is a descriptive cross sectional study involving 535 participants who were randomlyselected during World Kidney Day Screening in Sokoto. Health promotion talk was organized for the participants before commencing the screening. We took anthropometric measurements and calculated body mass index (BMI) and waist/hip ratio for all individuals. We also checked blood pressure and blood glucose levels and performed urinalysis for all participants. RESULTS: There were 535 participants including 332 males and 203 females with a mean age of 37 ± 17 years. Overweight, obesity and morbid obesity were found in 12.3%, 6.7% and 0.9% of participants respectively. About 11% had waist/hip ratio greater than 1. The prevalence of pre-hypertension and hypertension was 8.5% and 30.2% respectively. Elevated random blood glucose levels were found in 6% of participants while 17.9% had at least 1+ of proteinuria in urinalysis. CONCLUSION: Non-communicable diseases are common in our environment and the level of awareness is low. Regular health education and screening programs are necessary in order to reduce the menace.

Prevalence and pattern of cystic kidney diseases in Ilorin, Nigeria.

Cystic kidney disease is an important cause of chronic renal failure. Since the utilization of imaging techniques in the diagnosis of diseases has become widespread, cystic kidney disease is now being increasingly diagnosed. This study is designed to determine the prevalence and pattern of cystic kidney disease at the Nephrology Unit of University of Ilorin Teaching Hospital (UITH), Ilorin. All consecutive adult patients seen in the Nephrology Unit of UITH during a ten-year period (January 1999-December 2008) were studied for the presence of cystic kidney disease. The results were analyzed with specific reference to age, gender, annual incidence, type of cystic disease, location of cyst, mode of presentation, complications and prognosis. A total of 67 out of 436 renal patients (15.4%) studied had cystic kidney disease. A progressive annual increase in the number of cases was noticed. The age-range was 20-83 years with a mean of 47.4 +/- 16.2 years and the peak incidence was in the third and sixth decades with male to female ratio of 1.3:1. The types of cystic kidney disease identified in the study were: 26 simple cysts (38.8%), 35 polycystic kidney disease (53.3%) and six multicystic kidney disease (8.9%). The most common mode of presentation was abdominal pain followed by hypertension, urinary tract infection, chronic renal failure and palpable abdominal mass, in decreasing order. Our study indicates that cystic kidney disease is not an uncommon problem among our renal patients and the incidence is on the increase. Although, routine screening of family members with cystic kidney disease still remains a contentious issue because the knowledge may evoke anxiety in terms of employment and insurance, screening of symptomatic cases or those that develop hypertension, hematuria and proteinuria is strongly recommended.