Blood pressure variation and its correlates among patients undergoing hemodialysis for renal failure in Benin City, Nigeria.

BACKGROUND: Blood pressure (BP) variation is commonly encountered during hemodialysis (HD) procedure. Both intradialysis hypotension and hypertension have implications for outcome of treatment and overall morbidity and mortality of the patients. METHODOLOGY: A retrospective study was carried out in the dialysis unit of a tertiary health institution in Benin City among patients who had HD for acute kidney injury (AKI) or chronic kidney disease (CKD) over a 3-year period. Data retrieved included age, gender, type of kidney disease, cause of kidney disease, systolic BP at onset of dialysis and at end of dialysis, and diastolic BP (DBP) at onset of and at end of dialysis. RESULTS: Complete data were available for 217 patients. One hundred and seven patients (49.3%) had no significant change in BP; 30.9% had intradialytic hypertension (IDHT) while 19.8% had intradialytic hypotension (IDH). IDH was more prevalent among patients with diabetic kidney disease while IDHT was more common among patients with hypertensive nephropathy (P = 0.002). Female patients had higher mean BP parameters compared to male patients pre- and post-dialysis, but only changes in DBP were statistically significant (P = 0.029). Patients with CKD had higher mean BP parameters pre- and post-dialysis compared to patients with acute AKI and the differences were statistically significant. CONCLUSION: Females had higher mean BP parameters than males. Patients with CKD had higher mean BP parameters compared with AKI patients. IDHT is a significant problem among patients on HD in our center. Measures to curtail this trend should be instituted with the goal of reducing morbidity and mortality.

Serum C-reactive protein levels in pre-dialysis chronic kidney disease patientsin southern Nigeria.

BACKGROUND: Cardiovascular disease is the major cause of hospitalization and mortality in chronic kidney disease (CKD). C-reactive protein (CRP) is a marker of cardiovascular disease and predictor of mortality in CKD patients. CKD patients with elevated CRP should be identified early with institution of measures to treat cardiovascular risk factors in order to reduce attendant mortality. AIMS: Determination of serum CRP levels in CKD patients and associated factors. METHODS: This was a case-control study involving 80 consecutive CKD patients and 40 control subjects without CKD. Data obtained from participants included demographics, body mass index (BMI), and aetiology of CKD. Serum CRP levels, albumin, creatinine and lipid profile were determined. Cases and controls were compared. P values <0.05 were taken as significant. RESULTS: The mean age of the CKD subjects was 49.09±16.85 years. The median CRP value was significantly higher in the CKD group compared to controls (p=<0.001). Low, average and high cardiovascular event risk according to CRP values were present in 51(63.8%), 13(16.2%) and 16(20%) of the CKD patients respectively. Cardiovascular event risk was significantly higher in CKD subjects (p=<0.001). Serum creatinine, BMI, triglyceride and atherogenic index of plasma correlated positively with CRP. Estimated glomerular filtration rate (eGFR), high density lipoprotein-cholesterol and albumin correlated negatively with CRP. Elevated serum CRP was significantly predicted by low eGFR and high BMI on multivariate analysis. CONCLUSION: Chronic kidney disease patients have increased cardiovascular event risk. Interventions aimed at reducing weight and treating dyslipidaemia should be instituted early in order to reduce this risk.

Hyperuricemia in predialysis chronic kidney disease patients in Southern Nigeria

Background: Cardiovascular disease (CVD) is the leading cause of hospitalization and death in chronic kidney disease(CKD) patients. Hyperuricemia has emerged as one of the nontraditional cardiovascular risk factors. Studies have shown that hyperuricemia plays a major role in the development of CVD and rapid progression of CKD to end-stage renal disease. Objective: The aim was to determine the prevalence and pattern of hyperuricemia in predialysis CKD patients attending a teaching hospital in Southern Nigeria. Methodology: One hundred and twenty consecutive predialysis CKD patients and 40 control subjects with normal renal function were recruited over 2 years. Data obtained from participants included demographics, body mass index, blood pressure reading, and etiology of CKD. Blood sampling was done for the determination of serum uric acid, creatinine, and fasting serum lipids. P < 0.05 were taken as significant. Results: The mean age of the CKD subjects was 48.8 ± 16.6 years with a male:female ratio of 1.7:1. The prevalence of hyperuricemia in the CKD subjects was 47.5% and this was significantly higher than 15% observed in the control group (P ≤ 0.001). The prevalence of hyperuricemia was highest in CKD stage 3b. Hyperuricemia was more prevalent in younger predialysis CKD subjects and those with hypertensive nephropathy. There was no significant association between hyperuricemia, obesity, gender and dyslipidemia in this study. Conclusion: Hyperuricemia is highly prevalent in young predialysis CKD patients even in the early stages. Measures to reduce hyperuricemia should be put in place especially lifestyle and dietary modification

Assessment of some cardiovascular risk factors in predialysis chronic kidney disease patients in Southern Nigeria.

BACKGROUND: Cardiovascular risk factors are responsible for cardiovascular disease and rapid progression of chronic kidney disease (CKD) to end-stage renal disease. Prompt evaluation, modification, and treatment of these factors in predialysis patients will reduce morbidity and mortality. This study assessed some cardiovascular risk factors in predialysis CKD patients in a tertiary hospital in Southern Nigeria. PATIENTS AND METHODS: This was a case-control study that involved 76 consecutive predialysis CKD patients and 38 age-and sex-matched controls without CKD over 1 year period. Both groups were assessed for cardiovascular risk factors, and comparisons were made. A P value of <0.05 was taken as significant. RESULTS: The mean ages of the CKD versus control group were 48.00 ± 15.28 versus 45.34 ± 15.35 years. The male:female ratio was 1.7:1 for both groups. The common etiologies of CKD in this study were hypertension 30 (39.5%), diabetes mellitus 23 (30.3%), and chronic glomerulonephritis 19 (25%). There were 38 (50%) in CKD stage 3, 31 (40.8%) in CKD stage 4, and 7 (9.2%) in CKD stage 5. The common cardiovascular risk factors found in the CKD versus control were hypertension (96.1% vs. 42.1%), anemia (96.1% vs. 23.7%), left ventricular hypertrophy (77.6% vs. 23.7%), dyslipidemia (67.1% vs. 39.5%), hypocalcemia (60.1% vs. 18.5%), hyperphosphatemia (63.2% vs. 0%), and hyperuricemia (57.9% vs. 15.8%). These risk factors were significantly higher in CKD group. Hyperphosphatemia and hypoalbuminemia significantly increased across CKD stages 3-5. Anemia was significantly more common in males whereas dyslipidemia was more common in female CKD patients. CONCLUSION: Cardiovascular risk factors were highly prevalent in predialysis CKD subjects even in early stages. Hypoalbuminemia and hyperphosphatemia significantly increased across the CKD stages 3-5 whereas anemia and dyslipidemia showed significant gender differences. Cardiovascular risk factors should be treated early in predialysis CKD patients.