Effect of Chronic Kidney Disease on Olfactory Function: A Case-Control Study.

BACKGROUND: Olfactory function of patients with chronic kidney disease (CKD) has been found to be defective, and patients are often unaware of it. This predisposes them to malnutrition with consequence on health recovery and quality of life. AIM: To assess the olfactory function and determine the pattern of olfactory dysfunction in patients with CKD attending the University College Hospital, Ibadan. MATERIALS AND METHODS: This was a prospective, hospital-based case-control study of adult patients with CKD. The control group were age- and sex-matched individuals without CKD. Olfactory threshold (OT), odor discrimination (OD), and odor identification (OI) tests were carried out in participants using the "Sniffin Sticks." RESULTS: There were 100 patients with CKD and 100 healthy controls, age ranges between 19 to 86 years (mean ± SD = 46.3 ± 13.9 years) and 20 to 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (P = .57). The mean olfactory scores were significantly lower among the cases than control, OI 11.2 ± 2.3 and 13.1 ± 1.2 (P < .001), OD 8.5 ± 2.4 and 10.9 ± 1.5 (P < .001), OT 6.4 ± 2.5 and 9.6 ± 1.9 (P < .001), and threshold discrimination and identification 26.0 ± 5.7 and 33.6 ± 3.3 (P < .001), respectively. Prevalent olfactory dysfunction among patients with CKD was 77% (hyposmia 72%, anosmia 5%), and the control was 16% (all hyposmia; P < .001). CONCLUSION: There was high prevalence of olfactory dysfunction among patients with CKD, and the affectation is more at the central olfactory pathway.

Association of Diabetes Mellitus with Coronavirus Disease 2019 Severity: A Retrospective Study from a Center in South Western Nigeria.

BACKGROUND AND OBJECTIVES: Coronavirus Disease 2019 (COVID-19) is a novel viral infection, now a pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Diabetes mellitus (DM) has been associated with severe COVID-19 and poor glycaemic control is reportedly the link between these conditions. This study aimed to determine the association between DM and the severity of COVID-19. METHODS: This was a retrospective study involving 86 patients with COVID-19 admitted to a tertiary hospital in South-Western Nigeria. Socio-demographic, clinical and laboratory data were extracted from their medical records. Ethical approval was obtained and descriptive and inferential statistics computed. RESULTS: The mean age of the patients was 61 ± 16.1 years and 61.6% were males. Fever was noted in 67.4% of patients and, similarly, 67.4% of the patients had an SpO2<94% in ambient air when admitted. Thirty-six percent (36%) of the study patients had DM. Amongst patients with DM and those without DM, 72.2% and 62%, respectively, had severe or critical COVID-19 (p=0.323). Patients with DM were older than those without DM (65.8 years vs 57.3 years; p=0.015). The frequency of oxygen desaturation, respiratory failure, acute kidney injury (AKI) and multi-organ failure were significantly higher in COVID-19 patients with DM (p=0.037, 0.043, 0.004 and 0.016, respectively). Mortality was higher in COVID-19 patients with DM but this was not statistically significant (p=0.214). The odds of a patient with diabetes and COVID-19 developing respiratory failure and acute kidney injury were 1.395 (95%CI 1.154-6.913) and 1.125 (95%CI 1.025-1.621), respectively. CONCLUSION: Diabetes mellitus was recorded in older patients with COVID-19 and associated with suboptimal oxygen saturation at presentation, respiratory failure, and acute kidney injury. There was no association found between DM and COVID-19 severity and mortality.

CONTEXTE ET OBJECTIFS: La maladie de coronavirus 2019 (COVID-19) est une nouvelle infection virale, aujourd'hui pandémique, causée par le coronavirus-2 du syndrome respiratoire aigu sévère (SARS-CoV-2). Le diabète sucré (DM) a été associé à une COVID-19 sévère et un mauvais contrôle glycémique serait le lien entre ces deux pathologies. Cette étude vise à déterminer l'association entre le DM et la sévérité du COVID-19. MÉTHODES: Il s'agit d'une étude rétrospective portant sur 86 patients atteints de COVID-19 admis dans un hôpital tertiaire du sud-ouest du Nigeria. Les données sociodémographiques, cliniques et de laboratoire ont été extraites de leurs dossiers médicaux. Une approbation éthique a été obtenue et des statistiques descriptives et inférentielles ont été calculées. RÉSULTATS: L'âge moyen des patients était de 61 ± 16,1 ans et 61,6% étaient des hommes. De la fièvre a été notée chez 67,4 % des patients et de même, 67,4 % des patients avaient une SpO2<94 % à l'air ambiant lors de leur admission. Trente-six pour cent (36 %) des patients de l'étude étaient atteints de diabète. Parmi les patients atteints de DM et ceux qui ne l'étaient pas, 72,2 % et 62 % respectivement présentaient un COVID-19 sévère ou critique (p=0,323). Les patients atteints de DM étaient plus âgés que ceux sans DM (65,8 vs 57,3 ; p=0,015). La fréquence de la désaturation en oxygène, de l'insuffisance respiratoire, de l'insuffisance rénale aiguë (IRA) et de la défaillance multi-organique était significativement plus élevée chez les patients atteints de diabète de type 1 (p=0,037, 0,043, 0,004 et 0,016 respectivement). La mortalité était plus élevée chez les patients diabétiques de COVID-19, mais cela n'était pas statistiquement significatif (p=0,214). Les probabilités qu'un patient diabétique et COVID-19 développe une insuffisance respiratoire et une lésion rénale aiguë étaient de 1,395 (95%CI 1,154-6,913) et 1,125 (95%CI 1,025-1,621). CONCLUSION: Le diabète sucré a été enregistré chez les patients âgés atteints de COVID-19 et associé à une saturation en oxygène sous-optimale à la présentation, à une insuffisance respiratoire et à des lésions rénales aiguës. Aucune association n'a été trouvée entre le DM et la sévérité du COVID-19 et la mortalité. Mots clés: COVID-19 ; Diabète Mellitus ; SRAS- CoV-2.

Comparative analysis of fibroblast growth Factor-23 as a correlate of cardiovascular disease among individuals with chronic kidney disease, hypertensives, and healthy controls.

Background: Chronic kidney disease (CKD) is a global growing public health epidemic with attending morbidity and huge financial cost. Cardiovascular disease (CVD), a major complication of CKD, contributes to its excessive mortality rate. The aetio-pathogenesis of the excess burden of CVD in CKD is a feature yet to be unravelled. Fibroblast growth factor-23 (FGF-23) has been implicated as a risk factor for CVD among patients with CKD. However, most of these studies were predominantly among the Caucasian population. Aim: This study aims to determine the correlation between FGF-23 and CVD among Nigerians with CKD. Patients and Methods: A cross-sectional comparative study composed of three groups: participants with CKD, hypertensives without CKD, and healthy individuals, represented as group 1, 2, and 3, respectively. Information obtained included demographic data and occurrence of risk factors for CVD. Cardiovascular risks were assessed by echocardiography and all the participants had kidney function tests done with plasma FGF-23. Results: The study sample size consisted of 135 participants. The mean (SD) age for participants with CKD and controls were 50.2 (12.7), 54.3 (15.5), and 40.2 (14.1) years, respectively. The median [interquartile range (IQR)] of plasma FGF-23 for participants with CKD 210 (139-304) RU/ml, and controls 124 (86-170) RU/ml, and 71 (38 - 89) RU/ml P < 0.001. Most participants with CKD had left ventricular hypertrophy (LVH) (80.0%), compared to the controls; 28.9% and 6.7% P < 0.001. Similarly, majority of participants with CKD had elevated plasma FGF-23 with LVH (85.7%) compared to controls 55.6% and 11.5%, whereas for aortic valve calcification with elevated plasma FGF-23 among CKD and controls were 53.6% (P = 0.29), 37.0% (P = 0.03), and 19.2% (P = 0.06), respectively. Conclusion: Individuals with CKD had frequencies of elevated plasma FGF-23, LVH, and cardiac valve calcification, which are surrogates of cardiovascular events.

Effect of Chronic Kidney Disease on Taste Function: A Case Control Study among Nigerian.

Taste dysfunction has been associated with chronic kidney disease (CKD) especially end stage kidney disease (ESKD) and also implicated as one of the predisposing factors for the prevalent malnutrition, muscle wasting and impaired quality of life among patients with CKD. To assess the taste function and determine the pattern of taste dysfunction in patients with CKD attending the University College Hospital, Ibadan. This was a cross sectional, hospital-based case-control study of adult patients with CKD. The control group were age and sex matched without CKD. Interviewer-assisted questionnaires were administered on all participants to obtain clinical information concerning demographics, clinical data on kidney disease and taste dysfunction. The four basic taste modalities namely; sweet, sour, bitter and salt taste senses of the participants were tested with validated "taste strips". There were 100 patients with CKD and 100 healthy controls, age ranges between 19 and 86 years (mean ± SD = 46.3 ± 13.9 years) and 20 and 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (p = 0.57). Hypogeusia was found in 27.0% of CKD patients with specific taste modalities dysfunction for salt, sour, sweet and bitter taste of 13.0, 24.0, 13.0 and 17.0%, respectively. The controls only had specific taste modalities dysfunction for salt, sour and bitter taste of 1.0% for each of the taste modalities. The mean total taste scores in the cases and controls were - 9.8 ± 3.2 and 13.4 ± 1.5 (p = 0.001), respectively. The mean taste scores were significantly lower among the cases than controls, salt taste-2.82 ± 1.1 and 3.7 ± 0.7 (p = 0.001), sour taste - 2.2 ± 1.0 and 3.2 ± 0.7 (p = 0.001), sweet taste-, 2.9 ± 1.8 and 3.8 ± 0.5 (p = 0.001), bitter taste - 1.9 ± 1.2 and 2.8 ± 0.9 (p = 0.001). Taste dysfunction is prevalent among patients with CKD and the affectation involves all taste modalities.

Impact of Impaired Kidney Function on Outcomes of Nigerians with COVID-9 Infection: Report of Two Cases from the University College Hospital, Ibadan.

COVID-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak.

L'infection au COVID-19 affecte principalement les voies respiratoires système; cependant, d'autres systèmes et organes sont également affectés. Les reins font partie des organes les plus fréquemment touchés par SRAS-CoV-2 et cela a été rapporté comme étant un prédicteur de gravité accrue, besoin de soins intensifs (USI),l'admission, et la mort. Nous avons présenté deux cas de COVID-19 associés avec des comorbidités qui incluent le diabète sucré, systémique hypertension et le rénale affaibli. La relation des comorbidités multiples en particulier le rénale affaibli fonction des résultats de l'infection au COVID-19 et de la défis de l'offre de dialyse aux patients atteints de COVID-19 une infection avec insuffisance rénale a été discutée. Les deux cas présentés ont également mis en évidence l'état de préparation à la gestion du COVID-19 et de ses divers complications et comorbidités, en particulier insuffisance rénale dans un hôpital tertiaire au Nigéria au début du COVID-19 épidémie. Mots clés: lésion rénale aiguë, maladie rénale chronique, comorbidité, COVID-19.

Exposure to Agrochemicals and Markers of Kidney Damage among Farmers in Rural Communities in Southwestern Nigeria.

BACKGROUND: Chronic kidney disease of unknown origin (CKDu) is assuming an epidemic proportion, especially in farming communities worldwide. We explored the relationship between CKD markers and agrochemical exposure among rural farmers in South Western Nigeria. METHODS: We studied selected farming communities in Southwestern Nigeria where the use of agrochemicals was widespread. A pre-tested questionnaire was administered to participants. Anthropometric data, information on use of agro-chemicals; urine and blood samples were obtained. Informed consent was obtained from participants. The study was approved by the Institutional Ethics committee and complied with 1975 Helsinki declaration, as revised in 2000. RESULTS: A total of 438 farmers made up of 202 males (46.1%) and 236 females (53.9%) were studied. The mean microalbuminuria was 30.2 ±11.7 mg/dl. Majority of the farmers had CKD stage 2(42.0%) and CKD stage 3 (37.7%). The type of farming engaged in had a positive, but not significant, correlation with eGFR (r=0.012, p=0.832). There was positive correlation between type of farming and GFR category (r=0.24, p=0.000). Frequency of use of hexachlorocyclohexane had a positive and significant correlation with eGFR (r=0.111, p=0.045). Annual crop farming had a correlation with UACR (r=0.149, p=0.024). CONCLUSION: Annual crop farming had a positive correlation with UACR, eGFR and GFR category. The prolonged use of agrochemicals on an annual basis can cause kidney damage.

Self-reported Sleep Disorder and Ambulatory Blood Pressure Phenotypes in Patients with or without Chronic Kidney Disease: Findings from Ibadan CRECKID Study.

BACKGROUND: Sleep disordered breathing has been closely linked to pathogenesis, poor control of hypertension, and progression of chronic kidney disease (CKD). Though hypertension and CKD are highly prevalent in Nigeria, the effects of sleep disorders on CKD and hypertension phenotypes have not been widely studied. This study investigated the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS: Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP =140mmHg and/or DBP =90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2Equation and CKD was defined as eGFR<60ml/min/1.73m . RESULTS: A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; p<0.0001. CONCLUSION: This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.

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.

Salivary Electrolytes, Total Protein and Immunoglobulin A in Patients with Chronic Kidney Disease: A Case Control Study.

The objectives of this study were to compare levels salivary electrolytes, total protein and immunoglobulin A(IgA) in patients with chronic kidney disease (CKD) and healthy individuals; and to determine the relationship between thesalivary and blood levels of these factors between the two groups. Ninety-eight participants consisting of 48 patients withCKD and 50 healthy individuals (age and gender matched) were included. Whole saliva and blood samples were collectedand analyzed for concentrations of electrolytes (K+, Na+, Ca2+, Cl-, and HCO32-), total protein and IgA. Data were analyzedusing Independent-Samples t-test and Pearson correlation test. Concentrations of salivary K+, Ca2+, Cl-, and total proteinwere higher; while concentrations of salivary Na+, HCO32- were lower in patients with CKD compared with healthyindividuals. There was no difference in the salivary IgA levels in patients with CKD compared with healthy individuals.Salivary calcium level showed linear correlation with the plasma calcium level while salivary chloride level showed negativecorrelation with plasma chloride level among patients with CKD. These findings indicate that saliva and plasma from patientswith CKD are characterized by higher potassium, chloride, and lower sodium concentrations than their levels in healthyindividuals; thus, suggesting a possible increased adrenal-cortical activity in patients with CKD.

Acute kidney injury in Lagos: Pattern, outcomes, and predictors of in-hospital mortality.

CONTEXT: The pattern of acute kidney injury (AKI) differs significantly between developed and developing countries. AIMS: The aim of th study was to determine the pattern and clinical outcomes of AKI in Lagos, Southwest Nigeria. SETTINGS AND DESIGN: A retrospective review of hospital records of all patients with a diagnosis of AKI over a 20-month period. SUBJECTS AND METHODS: Records of 54 patients were reviewed. Information retrieved included, bio-data, etiology of AKI, results of laboratory investigations, and patient outcomes. STATISTICAL ANALYSIS USED: Continuous data are presented as means while categorical data are presented as proportions. The Student's t-test was used to compare means while Chi-square test was used to compare percentages. Logistic regression analysis was used to determine the factors that predicted in-hospital mortality. RESULTS: Twenty-seven (50%) of the patients were male. The mean age of the study population was 39.7 years ± 16.3 years. Sepsis was the etiology of AKI in 52.1% of cases. Overall, in-hospital mortality was 29.6%. Patients who died had a shorter mean duration of hospital stay (9.2 days vs. 33.9 days [P < 0.01]), lower mean serum bicarbonate (19.5 mmol/L vs. 22.9 mmmol/L [P = 0.02]), were more likely to be admitted unconscious (82.4% vs. 17.6% [P = 0.01]) and to have been admitted to the Intensive Care Unit (37.5% vs. 7.9% [P = 0.01]). In addition, when dialysis was indicated, patients who did not have dialysis were more likely to die (58.3% vs. 41.7% [P = 0.02]). CONCLUSIONS: The pattern of AKI in this study is similar to that from other developing countries. In-hospital mortality remains high although most of the causes are preventable.