Gender Disparity in Survival amongst End-Stage Renal Disease Patients on Haemodialysis.

BACKGROUND: Gender inequality in access and outcome of health care utilisation has been a major concern worldwide. We evaluated some demographic and clinical characteristics as well as compared the mortality rate between men and women with end-stage renal disease on haemodialysis (HD), to find out if gender has any influence on mortality. METHODS: This was a single centre retrospective study. All adult incident and prevalent haemodialysis patients with end-stage renal disease (ESRD) seen between July 2007 and June 2019 were enrolled in the study. Data collected included age, sex, hepatitis B and C viral status, vascular access at the commencement of haemodialysis, duration on haemodialysis, number of dialysis sessions ever conducted and outcome of haemodialysis. The outcome was stratified as alive, dead, or lost to follow up. The primary outcome measure was all-cause mortality. The IBM SPSS Statistical software version 23 was used to analyse the data. Kaplan Meier survival curve was used to compare all-cause mortality between men and women. RESULTS: This study included 995 HD patients of whom 704 (70.8%) were males. Mean age was 44.7 + 16.3 years. At the end of the study period, 878 (88.2%) patients died. The mortality rates for men and women did not significantly differ with a cumulative median survival of 17 and 16 days respectively (Log-rank = 0.85, p = 0.358). Hepatitis B seropositivity was significantly associated with increased mortality (Hazard Ratio (HR) = 1.2; 95% CI 1.025 - 1.526). CONCLUSIONS: Despite the perceived poor access to modern healthcare services by women in Northern Nigeria, there is no gender disparity in crude mortality in patients with end-stage renal disease on haemodialysis.

Hemodialysis among pregnancy related acute kidney injury patients: A single center experience in North-Western Nigeria.

Pregnancy related acute kidney injury (PRAKI) patients that underwent hemodialysis (HD) between May 2007 and April 2015 were studied with specific reference to clinical features, laboratory values, duration of pregnancy at the diagnosis of acute kidney injury and outcome. It involved 38 patients aged between 15 and 30 years. The main clinical features were fever, edema and oliguria. The leading etiological factors included ante/postpartum hemorrhage, septic abortion, and toxemia of pregnancy. The majority of cases occurred during the third trimester. PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. HD improved patient survival in our study.

Factors influencing hemodialysis and outcome in severe acute renal failure from Ilorin, Nigeria.

The epidemiology of acute renal failure (ARF) varies between nations and even within the same country because of differences in diagnostic criteria, causes, mode of presentation, and cost of therapy. To determine the factors influencing hemodialysis and outcome of severe ARF in Ilorin, Nigeria, we studied ARF patients on hemodialysis in our center between January 1989 and December 2009. There were 138 (58 males and 80 females) patients with age range between 18 and 69 years and a mean of 29.4 ± 11.9 years. Major etiologies of ARF included septicemia, acute glomerulonephritis, septic abortion, herbal remedies, post-partum bleeding, and gastroenteritis. The mean duration of illness and waiting time before dialysis was 11.7 ± 8.14 days and 3.28 ± 1.86 days, respectively. The mean number of dialysis was 2.24 ± 1.13 sessions and 89% of the patients received a maximum of three sessions before recovery. Hypotension, twitching of muscles, and back pains were common intradialysis complications. The factors that influenced hemodialysis and outcome were late presentation, severity of ARF, and financial constraints. The etiological agents are preventable and treatable conditions. The short duration of hospital stay, waiting time before dialysis, and total duration of illness influenced the outcome positively. We strongly recommend early referral of patients with severe ARF to nephrologists for proper management in a bid to reduce mortality from this disease.

Electrocardiographic abnormalities among dialysis naïve chronic kidney disease patients in Ilorin Nigeria.

BACKGROUND: Chronic kidney disease (CKD) has an increased risk of not only end-stage renal disease (ESRD), but majority of moderate CKD patients do die from cardiovascular disease (CVD) before reaching ESRD. The prognosis of these patients is very poor in most developing countries because of late presentation, inadequate diagnostic facilities, and inability to pay for treatment. Knowledge about CVD in CKD is crucial because of unpredictable progressive nature of the disease and increased risk of premature death from cardiovascular events. We sought to determine prevalence and pattern of electrocardiographic abnormalities in dialysis naïve CKD patients. MATERIALS AND METHODS: This is a 10-year prospective cross-sectional study carried out at the University of Ilorin Teaching Hospital, Ilorin. Patients were recruited from the nephrology clinic and renal wards and all who met diagnostic criteria for stages 4 and 5 CKD were included. All had their standard 12-lead electrocardiogram (ECG) recorded and various findings were critically studied and interpreted independently by two consultant physician including a cardiologist. Data analysis was done using SPSS version 16. RESULTS: Overall, 86% of the patients had at least one form of ECG abnormality, with hypertension (HTN) and anemia being the main contributory factors. These include left ventricular hypertrophy (LVH) (27.6%), left atrial enlargement (LAE) (21.6%), combination of LVH and LAE (17.2%), and ventricular premature contractions (6%). Etiology of CKD appears to have influence on ECG changes as prevalence of LVH and LAE were high among hypertensive renal disease, chronic glomerulonephritis (CGN), and diabetic nephropathy patients. CONCLUSION: LVH and LAE were very common ECG abnormalities in our dialysis naïve CKD patients. HTN, CGN, anemia, late presentation, and male gender appear to be the main risk factors for the ECG abnormalities. There is need for gender-specific intervention strategies directed at early detection and treatment of HTN, anemia, and underlying kidney disease, especially in resource poor nations where the burden of CKD is assuming epidemic proportion.

Electrocardiographic Abnormalities among Dialysis Naive Chronic Kidney Disease Patients in Ilorin Nigeria

Background: Chronic kidney disease (CKD) has an increased risk of not only end-stage renal disease (ESRD); but majority of moderate CKD patients do die from cardiovascular disease (CVD) before reaching ESRD. The prognosis of these patients is very poor in most developing countries because of late presentation; inadequate diagnostic facilities; and inability to pay for treatment. Knowledge about CVD in CKD is crucial because of unpredictable progressive nature of the disease and increased risk of premature death from cardiovascular events. We sought to determine prevalence and pattern of electrocardiographic abnormalities in dialysis naive CKD patients. Materials and Methods: This is a 10-year prospective cross-sectional study carried out at the University of Ilorin Teaching Hospital; Ilorin. Patients were recruited from the nephrology clinic and renal wards and all who met diagnostic criteria for stages 4 and 5 CKD were included. All had their standard 12-lead electrocardiogram (ECG) recorded and various findings were critically studied and interpreted independently by two consultant physician including a cardiologist. Data analysis was done using SPSS version 16. Results: Overall; 86of the patients had at least one form of ECG abnormality; with hypertension (HTN) and anemia being the main contributory factors. These include left ventricular hypertrophy (LVH) (27.6); left atrial enlargement (LAE) (21.6); combination of LVH and LAE (17.2); and ventricular premature contractions (6). Etiology of CKD appears to have influence on ECG changes as prevalence of LVH and LAE were high among hypertensive renal disease; chronic glomerulonephritis (CGN); and diabetic nephropathy patients. Conclusion: LVH and LAE were very common ECG abnormalities in our dialysis naive CKD patients. HTN; CGN; anemia; late presentation; and male gender appear to be the main risk factors for the ECG abnormalities. There is need for gender-specific intervention strategies directed at early detection and treatment of HTN; anemia; and underlying kidney disease; especially in resource poor nations where the burden of CKD is assuming epidemic proportion

Factors Influencing Attitude Towards Kidney Donation for Transplantation in Ilorin

Background: Chronic renal failure (CRF) is a major cause of premature death and morbidity in Nigeria. Majority of patients with end stage renal disease (ESRD) are in the productive age bracket. Haemodialysis is the most commonly available mode of renal replacement therapy. The quality of life of the few that can afford the cost of haemodialysis is poor when compared to the transplanted patients. A survey is carried out to assess factors affecting attitudes towards kidney donation in Ilorin; Nigeria. Methods: A total of 600 self administered; semi-structured questionnaires were distributed amongst asymptomatic adults (aged 17years) with a response rate of 88. Data analysis was done using statistical package for social studies (SPSS) version 14. Results: There were 282 males (53.4) and 246 females (46.6) with age range of 17-65years and a mean of 34.76+14.9. Two hundred and ninety two (55) were willing to donate a kidney (165 males; 127 females). Majority of the willing donors (86) were between 30 and 50 years of age. Though educational level positively influenced the knowledge about the kidney failure; it did not influence willingness to donation of a kidney. There was religion related gender disparity in the willingness to donate a kidney as more male Christians and Muslims were willing to donation than their females. Conclusions: The main constraints to kidney donation were fear of surgical pains; belief in life after death and uncertainty of donor outcome. This calls for awareness programmes on the safety of kidney donation for transplantation