Effects on household income and earnings from chronic kidney disease of non-traditional origins: PREP project findings from Chichigalpa, Nicaragua.

OBJECTIVE: Our purpose with this study is to examine the socioeconomic outcomes associated with chronic kidney disease not related to well-known risk factors (CKDnt) in four communities in Chichigalpa, Nicaragua that are home to a substantial number of sugarcane workers. METHODS: We employed a cluster-based systematic sampling design to identify differences in outcomes between those households affected directly by CKDnt and those that are not. RESULTS: Overall, we find that approximately one-third of households surveyed had a household member diagnosed with CKDnt. 86% of CKDnt households reported that the head of the household had been without work for the last 6 months or more, compared with 53% of non-CKDnt households. Non-CKDnt households took in more than double the earnings income on average than CKDnt households ($C52 835 and $C3120, respectively). Nonetheless, on average, CKDnt households' total income exceeded that of non-CKDnt households due to Nicaragua's national Instituto Nicaraguense de Seguridad Social Social Security payments to CKDnt households, suggestive of a substantial economic burden on the state resulting from the disease. Households headed by widows or widowers who are widowed as a result of CKDnt demonstrate distinct deficits in total income when compared with either non-widowed households or to households widowed by causes other than CKDnt. CONCLUSIONS: Despite strong similarities in terms of demographic characteristics and despite residing in the same communities with similar access to the available resources, households experiencing CKDnt exhibit distinct and statistically significant differences in important socioeconomic outcomes when compared to non-CKDnt households.

Clinical utility and outcome analysis of faecal calprotectin in Hawkes Bay District Health Board.

AIM: An audit to review the outcome in the use of faecal calprotectin (FCP) to differentiate irritable bowel syndrome (IBS) from active inflammatory bowel disease (IBD) patients, and to detect active flares in known IBD patients in the local Hawkes Bay District Health Board (HBDHB) population from October 2013 to October 2014. METHOD: Retrospective review of all FCP specimens requested in the HBDHB region from October 2013 to October 2014. Their indication, final diagnosis from clinical records, and endoscopic results are reviewed. RESULTS: There were 104 FCP registrations during this period. They were ordered by gastroenterologists (67%), followed by medical specialists (31%), GPs (4%) and surgeons (2%). There were 85 FCP samples requested to differentiate IBS from active IBD. Thirty were diagnosed with IBS. The mean FCP level for the 30 patients was 27.23 mcg/g (range 14.1-41.4), which was exclusive of 50 mcg/g. Using the null value of 50 mcg/g from international studies, its p-value was <0.001. There were 19 FCP samples requested to detect a flare in known IBD patients. Seven patients were diagnosed with an active flare endoscopically. The mean FCP for the 7 patients was 378.4 mcg/g (range 275.1-481.8). This was exclusive of 250mcg/g. Using the null value of 250 from international studies, its p-value was 0.007). CONCLUSION: The use of FCP is effective to both differentiate IBS from active IBD patients, and to detect flares in known IBD patients in the HBDHB population.