Evaluation of iron status in anemic pre-dialysis chronic kidney disease patients.

Background: Data on iron status are generally less readily available in pre-dialysis chronic kidney disease (CKD) patients than in the hemodialysis population. In Nigeria, little is known about iron indices in patients with CKD. Aims: The aim of this study was to evaluate the iron status among anemic pre-dialysis patients with CKD. Patients and Methods: Using a cross-sectional study design, we evaluated serum ferritin and transferrin saturation (TSAT) among 63 pre-dialysis CKD patients with anemia attending our outpatient nephrology clinic. CKD was defined as a glomerular filtration rate less than 60 ml/min/1.73 m2 for 3 months or more, while anemia was defined as a hemoglobin concentration (Hb) less than 11 g/dl. Results: The mean age of the study participants was 52.5 ± 12.7 years and 33 (52.4%) of the patients were females. The most common causes of CKD were hypertension (44.4%) and diabetic nephropathy (30.6%). The mean Hb, mean serum ferritin, and mean TSAT were 9.2 ± 1.1 g/dl, 106.6 ± 72.7 ng/ml, and 24.3% ± 7.9%, respectively. There was no significant difference in median ferritin (91[interquartile range: 54-133] ng/ml versus 106 [interquartile range: 45-151; P=0.75) and mean TSAT (24.9 ± 7.2 % versus 23.8 ± 7.7 %; P=0.54) between male and female study participants; Half (50.8%) of the study participants had absolute iron deficiency (serum ferritin <100 ng/ml) and 6.3% had functional iron deficiency (ferritin >100 ng/ml and TSAT <20%). Conclusion: Iron deficiency is common among anemic adult Nigerian pre-dialysis CKD patients. Results of iron studies should guide therapy when correcting anemia in these patients.

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.

Effect of diabetes mellitus on glomerular filtration rate in an urban hospital diabetic population.

Glomerular filtration rate (GFR) as assessed by endogenous creatinine clearance was studied in 46 male and 38 female patients with diabetes mellitus (DM). Of these, 44 patients had uncomplicated DM (Group I) whilst 40 patients had complicated DM (Group II). There were 20 insulin-dependent diabetes mellitus (IDDM) patients in Group I and 5 in Group II, and 24 non-insulin dependent diabetes mellitus (NIDDM) patients in Group I and 35 in Group II. In Group I, 6 IDDM and 4 NIDDM patients had supranormal glomerular filtration rate (creatinine clearance 125 ml/min) and in Group II 1 IDDM and 6 NIDDM patients had supranormal GFR. The presence of diabetic complications and the mode of therapy of the diabetic state did not significantly affect the glomerular filtration rate. This concludes that glomerular hyperfiltration occurred in both IDDM and NIDDM Nigerian patients.

Acute renal failure at the Lagos University Teaching Hospital: a 10-year review.

The Dialysis Centre at the Lagos University Teaching Hospital was established in November 1981 as the first unit in West Africa to undertake chronic hemodialysis treatment. More than 500 patients have been managed in the center since then. Of these, 175 were cases of acute renal failure. The causes and outcome of these cases have been reviewed. There were 89 males (50.9%) and 86 females (49.1%). The majority, 111 (63.4%), were aged < 40 years. The main cause was sepsis, which occurred in 67 cases (38.3%). Gynecological and obstetric cases were 45 (25.7%), including 14 cases (8%) of pregnancy toxemia. Other causes were hemorrhage 18 (10.3%), obstructive uropathy 6 (3.4%), acute glomerulonephritis 8 (4.6%), and poisoning with "Holy Water" 6 (3.4%) and other nephrotoxins 9 (5.1%). Sixty-nine patients (39.4%) died in hospital, 92 (52.6%) recovered, and the fate of 14 (8%) was unknown as they were transferred from the hospital. Reasons for the high mortality included delayed hospitalization, selection of severe cases, and inability of patients to afford more than only one session of dialysis even though they needed more. It is hoped that as awareness of the value of dialysis increases and early treatment can be sought, the overall mortality will be reduced.