Examining Socioeconomic Status of Patients with Chronic Kidney Disease Attending Renal Clinic in Southeast Nigeria: A Single Centre Experience.

BACKGROUND: There are few reports on socioeconomic status (SES) of patients with chronic kidney disease (CKD) in Nigeria and indeed Africa, South of the Sahara. Identifying SES as an important factor for disability in people with CKD would provide a means for early identification of those at risk and, possible intervention. OBJECTIVE: To determine the SES of CKD patients attending renal clinic in the University of Nigeria Teaching Hospital. METHODS: Cross-sectional descriptive design was adopted using pretested questionnaire to elicit data on SES (age, place of residence, household asset ownership, source of drinking water; source of cooking energy; and type of toilet facility) from one hundred and forty-five (145) CKD patients attending renal clinic in the University of Nigeria Teaching Hospital. Principal component analysis was used to classify the SES into five quintiles. RESULTS: Majority of the respondents (patients) in stages 4 and 5 CKD, constituting 17.2% and 39.3% respectively were from the lower SES. There was significant correlation between SES and age of the patients; place of residence; hypertension history; ownership of some household assets; source of drinking water; source of cooking energy; and type of toilet facility. CONCLUSION: This study demonstrated that many of our patients were from the lower SES. It is recommended that both governmental and non-governmental agencies should help these patients with some form of health insurance to alleviate their healthcare cost burden.

Predictors of autonomic dysfunction among predialysis chronic kidney disease patients in Nigeria.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem with increasing incidence and mortality in Africa. Autonomic dysfunction (AD) has been implicated as a major contributor to the disease morbidity and mortality, but little is known about the predictors of this dysfunction in African populations. Understanding the predictors of this condition is necessary for early detection and management of CKDs. Objectives: This study was designed to determine the predictors of AD in CKD patients in Nigeria. MATERIALS AND METHODS: It was a cross-sectional study of CKD patients at University of Nigeria Teaching Hospital, Enugu, Nigeria. The CKD patients with AD were compared with those without AD and a normal control group. Autonomic function was assessed through noninvasive cardiovascular tests: measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing, HRR to Valsalva maneuvre, and HRR to respiration. Data on symptoms of CKD and AD were obtained using a validated questionnaire. RESULTS: The mean age of the CKD patients was 41.3 ± 1.5 (range: 21-69) years. Early hospital presentation is associated with significantly less risk of the development of AD (P < 0.001). Dizziness, nocturnal diarrhea, and impotence are the major markers/predictors of AD in CKD patients (P < 0.05). CONCLUSION: AD is common among predialysis CKD patients in Nigeria, and best predicted by the presence of postural dizziness, nocturnal diarrhea, and impotence in men. Physicians should, therefore, be on the lookout for these features for prompt and adequate management of cases.

Medical Causes of Death in a Teaching Hospital in South-Eastern Nigeria: A 16 Year Review

Background: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region. Objective: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital; Ituku/Ozalla; Enugu; South-East Nigeria from 1995 to 2010. Materials and Methods: Data were collected retrospectively from January 1995 to December 2010. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago; IL; USA) version 17.0 was used. Simple descriptive statistics were done. Student's t-test was used to compare means of continuous variables; while Chi-square test was used to test significance of differences between two proportions. Results: The mortality rate was 22.8 (6250/27;514) admissions. The male to female ratio was 1.7:1. Infections (20.2) were the most common cause of death. However; chronic kidney disease was the single most common disease entity causing death (12.3). Other important causes of death in order of prevalence were cerebrovascular accident (10.5); acquired immune deficiency syndrome and tuberculosis either alone or as co-infection (10.3); heart failure (8.8); chronic liver disease (7.0); septicemia (6.5); respiratory failure (5.3); diabetes mellitus (4.6); cardiac arrhythmias (2.9); and primary liver cell carcinoma (2.7). There were few deaths from tetanus; malaria; typhoid fever; and coronary artery disease. Conclusion: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases

Medical causes of death in a teaching hospital in South-Eastern Nigeria: A 16 year review.

BACKGROUND: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region. OBJECTIVE: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, South-East Nigeria from 1995 to 2010. MATERIALS AND METHODS: Data were collected retrospectively from January 1995 to December 2010. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) version 17.0 was used. Simple descriptive statistics were done. Student's t-test was used to compare means of continuous variables, while Chi-square test was used to test significance of differences between two proportions. RESULTS: The mortality rate was 22.8% (6250/27,514) admissions. The male to female ratio was 1.7:1. Infections (20.2%) were the most common cause of death. However, chronic kidney disease was the single most common disease entity causing death (12.3%). Other important causes of death in order of prevalence were cerebrovascular accident (10.5%), acquired immune deficiency syndrome and tuberculosis either alone or as co-infection (10.3%), heart failure (8.8%), chronic liver disease (7.0%), septicemia (6.5%), respiratory failure (5.3%), diabetes mellitus (4.6%), cardiac arrhythmias (2.9%), and primary liver cell carcinoma (2.7%). There were few deaths from tetanus, malaria, typhoid fever, and coronary artery disease. CONCLUSION: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases.

Seizure disorder among chronic kidney disease patients in Enugu, South East Nigeria.

BACKGROUND: Seizures are the commonest neurological condition presenting in Africa. The pattern of non- epileptic seizures in systemic diseases including chronic kidney disease is unknown in South East Nigeria. OBJECTIVES: This study examined the pattern of seizures in chronic kidney disease patients in Enugu, South East Nigeria. METHODS: This was a retrospective study of chronic kidney disease patients who presented to the University of Nigeria Teaching Hospital Enugu (UNTH) from January 2007 December 2008. Data from subjects who satisfied the inclusion criteria were reviewed and analysed using Statistical Package for the Social Sciences version 13.5. Ethical clearance was obtained from the UNTH Ethics Committee. RESULTS: There were 145 patients, 95 males and 50 females. Mean age was 35 years. Only 5 patients (3,4%) had seizures (mostly generalized tonic-clonic) associated with severe hypertension. None had hypocalcaemia. Three patients (60%) received dialysis with benefit while 2 patients (40%) died before dialysis could be done. CONCLUSION: Seizures are infrequent in chronic kidney disease patients in Enugu; are commoner in males and those with severe disease. Dialysis improved survival in those with seizures. Larger multicentre studies are needed to further elucidate the spectrum of Nigeria.

Pattern of cancer deaths in the medical wards of a teaching hospital in South East Nigeria.

BACKGROUND: Cancers are emerging public health problems in developing countries like Nigeria. The epidemiological shift and aging population make cancers a challenge. OBJECTIVE: We set out to describe the pattern of death due to cancer in our medical ward. The hospital is one of the premier hospitals covering the South East zone of Nigeria. MATERIALS AND METHODS: We retrospectively reviewed the case notes and death certificates of all who died of cancer in our adult medical wards for 16 years (January 1995 to December 2010). STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL) version 17.0 was used. RESULTS: Twenty seven thousand, five hundred and fourteen patients were admitted into the medical wards. Six thousand, two hundred and fifty died. Out of the 6250 deaths, cancers accounted for 7.6%. Male to Female ratio was 2.4:1. The mean age at death was 43.7 ± 17.4 years. The mean age at death in both sexes was similar (42.9 ± 17.5 for men and 45.7 ± 17.0 years for women), P = 0.109. Primary liver cell carcinoma was the most common cause of death among men (40.8%), while cancer of hematopoietic organ was the most common in women (48.7%). The overall fatality rate was 1.7% (477/27 514) of medical admissions. Younger and middle age groups were most commonly affected in both sexes. CONCLUSION: Since the most productive age groups were affected, governments in developing countries should as a matter of urgency put in place adequate cancer preventive and curative services.

Left ventricular diastolic function in a predialysis patient population.

BACKGROUND: Diastolic dysfunction is common in chronic kidney disease (CKD) accounting for 40%-66% of cardiovascular complications. OBJECTIVE: To determine the prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in adult Nigerians with CKD at presentation and to compare findings with those of hypertensive patients with normal renal function. METHODS: Eighty-six consecutive patients with CKD were studied, comprising 43 hypertensives and 43 age- and sex-matched healthy subjects as controls. Clinical, laboratory, and echocardiographic variables were measured. RESULTS: Left ventricular diastolic dysfunction was present in 62.8% of CKD patients, 79.1% of hypertensive patients and 25.6% of normal controls (p<0.001). There was a positive correlation between left ventricular diastolic function (LVDF) and systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), severity of SBP, severity of DBP in CKD patients but not in hypertensive patients. There was a negative correlation between LVDF and age in CKD patients and hypertensive patients. Linear multiple regression analysis showed age as the only predictor of LVDD. CONCLUSION: There is a high prevalence of diastolic dysfunction in CKD patients at first presentation to a nephrologist in Nigeria.

Left ventricular systolic function in a Nigerian pre-dialysis patient population with chronic kidney disease.

AIMS AND OBJECTIVES: This study evaluates left ventricularsystolic function (LVSF) and factors affecting it in CKD patients at first presentation, using two dimensional echocardiography. PATIENTS AND METHODS: One hundred consecutive patients with CKD who were presenting to the medical outpatient and renal clinics of university of Nigeria teaching hospital, Enugu for the first time, who satisfied the study criteria were screened. Eighty six patients completed the study. Forty-eight sex matched hypertensive patients with normal renal function and forty-six age and sex matched subjects (with normal blood pressure and renal function) were selected as controls. Clinical and laboratory parameters and echocardiographic indices were measured. RESULTS: Left ventricular systolic dysfunction (LVSD) was present in 13 (15.1%) of CKD patients and 4 (8.3%) of hypertensive patients (p < 0.001). The mean fractional shortening in CKD patients (35.1 +/- 10.4%) was significantly lower than the hypertensive patients (40.1 +/- 9.8), p = 0.008. Positive correlation was found between fractional shortening (FS) and estimated glomerular filtration rate, haemoglobin level, CKD stage, diastolic blood pressure, serum albumin and systolic blood pressure.(r = 0.281, P < 0.001; r = 0.277, p < 0.001; r = 0.270, p = < 0.001; r = 0.237; P = 0.001; r = 0.230, p = 0.002; and r = 0.199, p = 0.007) respectively. Left ventricular mass index and mean arterial blood pressure, correlated negatively with LV systolic function (r = -0.315, P < 0.001; and r = -0.223, P Stepwise multiple regression analysis showed that of all the factors that correlated with LVSF. CONCLUSION: This study has shown that LVSF is impaired in a significant number of our CKD patients at presentation.

Left Ventricular Diastolic Function in a Predialysis Patient Population

BACKGROUND: Diastolic dysfunction is common in chronic kidney disease (CKD) accounting for 40-66of cardiovascular complications. OBJECTIVE: To determine the prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in adult Nigerians with CKD at presentation and to compare findings with those of hypertensive patients with normal renal function. METHODS: Eighty-six consecutive patients with CKD were studied; comprising 43 hypertensives and 43 age- and sexmatched healthy subjects as controls. Clinical; laboratory; and echocardiographic variables were measured. RESULTS: Left ventricular diastolic dysfunction was present in 62.8of CKD patients; 79.1of hypertensive patients and 25.6of normal controls (p 0.001. There was a positive correlation between left ventricular diastolic function (LVDF) and systolic blood pressure (SBP); diastolic blood pressure (DBP); mean arterial pressure (MAP); severity of SBP; severity of DBP in CKD patients but not in hypertensive patients. There was a negative correlation between LVDF and age in CKD patients and hypertensive patients. Linear multiple regression analysis showed age as the only predictor of LVDD. CONCLUSION: There is a high prevalence of diastolic dysfunction in CKD patients at first presentation to a nephrologist in Nigeria

Case fatality among hypertension-related admissions in Enugu, Nigeria.

OBJECTIVE: To determine the case fatality rate and ultimate causes of death among patients with hypertension-related conditions admitted to an urban tertiary hospital, METHOD: A five-year review of hypertension-related admissions into the medical wards of the University of Nigeria Teaching Hospital, Enugu, between 1995 and 1999, was undertaken. RESULTS: 7220 patients were admitted into the medical wards during the period under review. Of these, 445 (6.2%) were due to hypertension-related causes. Of the later, 285 (64%) were males while 160 (36%) were females. One hundred and ninety one of the hypertension-related admissions died, giving a case fatality of 42.9%. The mean age at death was 54.8+/-15.8 years (53.5+/-15.9 years for males; 57.2+/-15.4 years for females, t=2.47, df=189, p=0.117). Sixty six percent of these were males while thirty four percent were females. Eighty six (45%) of the deaths occurred during acute hypertensive crises such as cerebrovascular accidents, hypertensive encephalopathy, and acute renal failure. Other important complications leading to death were congestive cardiac failure, accounting for thirty three cases (17.3%); and chronic renal failure 32 (16.8%). In twenty one (11%) hypertension-related admissions, the causes of death were not documented. CONCLUSION: Hypertension, with its related complications, constitute a major cause of morbidity and mortality in our medical wards. The case fatality rate is very high and often mostly avoidable complications were responsible. There is need to further study the determinants of these avoidable causes of death.

Left ventricular hypertrophy in renal failure a review.

Renal failure is becoming increasingly common in our enironment. Advances in management like availability of dialysis and transplantation is prolonging the live of patients. As a consequence complication are increasingly being encountered. Cardiovascular complication is one of the commonest; and left ventricular hypertrophy is one of the major cardiovascular complications of end stage renal failure. It is an independent predictor of survival in patients with chronic renal failure and is present in a large number of patients entering maintenance haemodialysis. This review summarizes the occurrences of left ventricular hypertrophy, its pathomechhanism, clinical significance, evaluation and interventional strategies. This information is useful to us as we grapple with this problem.