Disease severity and renal function among sickle cell anaemia patients in a tertiary hospital, South-south, Nigeria: a cross sectional study.

Background: Renal disease is a recognized complication of sickle cell anaemia (SCA), especially from the third decade of life and is linked to disease severity. This study assessed the association between disease severity and renal function among SCA patients using routine and newer markers of renal function. Methods: This cross-sectional study recruited 85 SCA patients. Disease severity was assessed using modified Adegoke criteria which include the frequency of transfusion, painful crises, packed cell volume, and history of complications such as hypertension and chronic leg ulcers. Renal function was assessed using urea, creatinine, and beta-2-microglobulin (ß2-M). Association was determined between renal function and disease severity using Pearson's correlation. P-value < 0.05 was taken as significant. Results: The mean age of participants was 27.2 ± 7.6 years with 41(48.2%) males and 44 (51.8%) females. The mean packed cell volume, serum creatinine, serum urea, and ß2-M were 24.0± 4.1%,17.6±7.5 mg/dL, 0.7±0.3mg/dL, 3.4±1.2mg/l respectively. A majority (54.1%) of them had a mild disease while 35.3% and 10.6% had moderate and severe diseases, respectively. Forty of the SCA patients had urine specific gravity below 1.010. The mean values of systolic blood pressure (p=0.001) diastolic blood pressure (p=0.001), serum creatinine (p=0.028) and ß2M (p=0.019) significantly increased with disease severity. There was a significant positive correlation between SCA disease severity and serum urea (r=0.229; p=0.035), and serum ß2-microglobulin (r=0.270; p=0.012). Conclusion: Sickle cell anaemia severity is associated with a decline in renal function using both traditional and novel renal markers. Serum ß2-M may serve as a useful marker of renal function and disease severity in SCA.

Knowledge of acute kidney injury among Pakistani nurses: A cross-sectional survey.

Nurses are increasingly being regarded as the nucleus of the health care system, as well as serving as an advocate for health-care consumers. Therefore, adequate acute kidney injury (AKI) knowledge of nurses would definitely have a positive impact on an early diagnosis, management, and outcome of AKI. This cross-sectional study was aimed to assess the knowledge of AKI among nurses working at public and private hospitals at Lahore and Sialkot, Pakistan. The study was conducted from October 2017 to March 2018. A convenient sampling method was used and data were gathered using a self-administered questionnaire. The median knowledge score of the study population (n = 200) was 29, with majority (78.5%) having moderate knowledge (score 26-38). Only 2.5% of nurses had good AKI knowledge whereas 19.0% were found to have poor knowledge. Nurses' age, rank, and their departments had no significant impact on the knowledge scores. Furthermore, there was no significant difference of knowledge among participants who had previously attended any seminar/special training session regarding AKI and those who had not. In conclusion, majority of Pakistani nurses had moderate AKI knowledge. Therefore, in-service training sessions on AKI should be conducted to equip nurses with up-to-date AKI knowledge.

Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria.

BACKGROUND: Malnutrition is a complication in chronic kidney disease (CKD) known to affect quality of life and prognosis although not often diagnosed. It is associated with rapid progression to end stage renal disease (ESRD) and mortality. Early identification and treatment will slow down progression to ESRD and mortality. OBJECTIVE: To determine the prevalence and pattern of malnutrition in pre-dialysis CKD patients in Southern Nigeria. METHODS: One hundred and twenty consecutive pre-dialysis CKD and 40 control subjects without CKD were studied. Data obtained from participants were demographics, body mass index (BMI), and aetiology of CKD. Indices used to assess presence of malnutrition were low BMI, hypocholesterolaemia and hypoalbuminaemia. Statistical significance was taken at 0.05 level. RESULTS: The mean age of the CKD subjects was 48.8±16.6years with a male: female ratio of 1.7:1. Prevalence of malnutrition in the CKD subjects was 46.7%, higher than 27.5% observed in the controls (p=0.033). Prevalence of malnutrition increased significantly across CKD stages 2 to 5 (p=0.020). It was significantly commoner in elderly patients (p=0.047) but not significantly different between males and females(p=0.188). CONCLUSION: Malnutrition is common in pre-dialysis CKD patients even in early CKD stages. Prevalence of malnutrition increases with worsening kidney function and increasing age.

Aetiologies and Short-term Outcomes of Acute Kidney Injury in a Tertiary Centre in Southwest Nigeria.

BACKGROUND: Acute kidney injury (AKI) has become a global health problem and is associated with increased morbidity, mortality and overall health expenditure. Information on the epidemiology and outcomes of AKI will help to audit practice and advocate for policies that will reduce this burden. This study determined aetiologies, short term outcomes and their predictors in AKI patients in a tertiary hospital in Southwest Nigeria. METHODS: This was an 18-month retrospective study that involved 91 patients with AKI. The socio-demographic information, aetiology, severity and the treatment given to patients were recorded. Outcomes and their predictors were determined using multivariate analysis. P value < 0.05 was taken as statistically significant. RESULTS: The mean age of the study population was 45.12 ±20.67 years. Common causes of AKI were sepsis in 50(54.9%), hypovolaemia in 23(25.3%), cardiac failure in 7(7.7%) and eclampsia in 6(6.6%). Fifty-seven (62.6%) presented with stage 3. Thirty-one (34.1%) had haemodialysis. Forty-eight (52.7%) had complete renal recovery, 35(38.5%) died and 3(3.3%) left against medical advice while five (5.5%) were referred to other hospitals. Stage 3 AKI (Adjusted odd ratio: 6.79, confidence interval: 1.21:38.04, p = 0.029) and age ≥ 65 years (Adjusted odd ratio: 4.14, confidence interval: 1.32-13.04, p = 0.015) were significant predictors of mortality in AKI patients. CONCLUSION: Sepsis and hypovolaemia were the commonest causes of AKI. The associated mortality is still high and factors associated with mortality were late presentation and older age. Early presentation, treatment and making haemodialysis affordable are key to improving AKI outcomes.