Burden of chronic kidney disease: an international perspective.

CKD is associated with increased cardiovascular mortality and a loss of disability-adjusted life years. Diseases of the genitourinary system were responsible for 928,000 deaths and 14,754,000 disability-adjusted life years in 2004. However, the absence of kidney registries in most of the low- and middle-income countries has made it difficult to ascertain the true burden of CKD in these countries. The global increase in the incidence and prevalence of CKD is being driven by the global increase in the prevalence of diabetes mellitus, hypertension, obesity, and aging. Most patients in low- and middle-income countries die because they cannot access renal replacement therapy because of the exorbitant cost. Community surveys have shown that the number of people with end-stage kidney disease is just the tip of the "CKD iceberg." The preventive strategies to stem the tide of CKD should involve educating the population on how to prevent renal disease; identifying those at risk of developing CKD; raising the awareness of the general public, policy makers, and health care workers; modifying the lifestyle of susceptible individuals; detecting early stage of CKD; arresting or hindering the progression of disease; and creating facilities for global assistance.

Chronic renal failure at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.

UNLABELLED: BACKGROUND AND OBJECTIVES OF THE STUDY: Chronic kidney disease is a common cause of morbidity and mortality in Nigeria. This study aims at determining the pattern of chronic renal failure (CRF) in a Nigerian University Teaching Hospital. METHODS: The study was a 10-year retrospective study of consecutive cases of CRF seen at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. RESULTS: The frequency of CRF in the population was 3.6% (182 of 5,107). There were 90 males and 63 females (1.42:1). The peak age was between 20-49 years, with a mean of 39.6 +/- 14.8 (range 14-72 years). The commonest causes were chronic glomerulonephritis 63(41.2%), hypertensive nephrosclerosis 40(26.1%) and diabetes mellitus 20(13.1%). The commonest symptoms were oedema, vomiting, oliguria and dyspnea occurring at 118(77.1%), 96(62.7%), 89(58.2%) and 87(56.9%) respectively. The mean creatinine clearance value at presentation was 6.5 +/- 8.1 mls/min, while the commonest complications were hypertension 68 (44.4%), biventricular failure 32 (20.9%) and urinary tract infection 29 (19%). The mean presenting systolic and diastolic blood pressures were 167.34 +/- 37.6 mm Hg and 106.03 +/- 28.9 mmHg respectively. The mean total haemodialysis session per patient was 3.5 +/- 1.6 (range 1-7 sessions). Only 34(22.2%) of the patients were able to afford haemodialysis. The majority 21(61.8%) of these could only afford 3 haemodialysis sessions while only 2(5.9%) patients had up to 7 dialysis sessions in the center. CONCLUSION: Chronic glomerulonephritis, hypertensive nephrosclerosis and diabetes mellitus are the commonest causes of chronic renal failure in Nigeria. Most of the patients presented late. Cardiovascular complications and infections were responsible for a greater morbidity among the patients.

Diabetic nephropathy--a review of the natural history, burden, risk factors and treatment.

The earliest clinical evidence of diabetic nephropathy is microalbuminuria. Progression from microalbuminuria to overt nephropathy occurs in 20-40% within a 10-year period with approximately 20% of these patients progressing to end-stage renal disease. End-stage renal disease develops in 50% of type-1 diabetes patients with overt nephropathy within 10 years and in more than 75% by 20 years in the absence of treatment. In type-2 diabetes, a greater proportion of patients have microalbuminuria and overt nephropathy at or shortly after diagnosis of diabetes. The incidence of diabetes is increasing worldwide, with subsequent increase in the incidence of diabetic nephropathy. The risk factors identified in the development of DN from longitudinal and cross-sectional studies include race, genetic susceptibility, hypertension, hyperglycemia, hyperfiltration, smoking, advanced age, male sex, and high-protein diet. Treatment interventions in diabetic nephropathy include glycemic control, treatment of hypertension, hyperlipidemia, cessation of smoking, protein restriction, and renal replacement therapy. Multifactorial approach includes combined therapy targeting hyperglycemia, hypertension, microalbuminuria, and dyslipidemia.

Differential control of systolic and diastolic blood pressure in blacks with essential hypertension.

OBJECTIVE: The risk of cardiovascular and renal diseases has been shown to be higher for systolic blood pressure than diastolic blood pressure. The aim of this study was to assess the differential control of systolic and diastolic blood pressure in Nigerians with primary hypertension. DESIGN AND SETTING: This was a prospective observational study carried out at the Medical Outpatient Department of the State Hospital, Abeokuta, Nigeria. Ethical approval for the study was obtained from the ethical committee of the hospital. METHODOLOGY: The study population consisted of 185 consecutive patients (65 males, 120 females), aged 35-85 years with primary hypertension who had been on drugs one- to 25 years prior to the onset of the study. Clinic blood pressure control was assessed during a year period. Six consecutive clinic blood pressure readings were recorded for each patient and the average calculated (systolic blood pressure and diastolic blood pressure separately). Patients were classified into subgroups based on the pattern of blood pressure control. RESULTS: Clinic systolic blood pressure and diastolic blood pressure was controlled in 58 patients (31.4%). Systolic blood pressure control was less frequent than diastolic blood pressure control (35.7% versus 51.4%, p<0.05). Patients with uncontrolled systolic blood pressure were significantly older than patients with only uncontrolled diastolic blood pressure (66.7+/-7.4 versus 52.9+/-8.7 years, p<0.001). CONCLUSION: Systolic blood pressure is less frequently controlled than diastolic blood pressure in Nigerians treated for primary hypertension. This may increase the patient's risk of developing stroke, and cardiovascular and renal complications.