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.

Reference intervals for serum cystatin C and creatinine of an indigenous adult Nigerian population.

BACKGROUND AND AIM: Estimation of the glomerular filtration rate (GFR) is important for the evaluation of patients with kidney disease. Some studies suggest that GFR estimated from serum cystatin C (Cys C) is more accurate than that from serum creatinine (SCr). For Cys C to be used for this purpose, normal values need to be determined for various populations. This study determined the serum Cys C levels and reference intervals (RIs) of a Nigerian population. MATERIALS AND METHODS: Three hundred and four healthy adult subjects were analysed. Serum Cys C and SCr were determined by particle enhanced turbidimetric immunoassay and modified Jaffe kinetic method respectively. Data were analysed using the Statistical Package for Social Sciences version 17.0 (SPSS for Windows Inc., Chicago, IL, USA). Estimation of RIs was done as per the International Federation of Clinical Chemistry guidelines. RESULTS: The RIs for Cys C were 0.65-1.12 mg/L (median 0.86) for males, 0.62-1.12 mg/L (median 0.85) for females and 0.64-1.12 mg/L (median 0.86) for all the subjects. The RIs for SCr were 73-110 µmol/L (median 89) for males, 65-102 µmol/L (median 82) for females and 66-106 µmol/L (median 86) for all the subjects. There was no significant gender difference in the RIs for serum Cys C, (P > 0.05). The SCr levels and RI were significantly lower in females than in males (P < 0.001). CONCLUSION: This study has determined the serum Cys C levels and RI of an indigenous healthy adult black population in Nigeria.

Reference Intervals for Serum Cystatin C and Creatinine of an Indigenous Adult Nigerian Population

Background and Aim: Estimation of the glomerular filtration rate (GFR) is important for the evaluation of patients with kidney disease. Some studies suggest that GFR estimated from serum cystatin C (Cys C) is more accurate than that from serum creatinine (SCr). For Cys C to be used for this purpose; normal values need to be determined for various populations. This study determined the serum Cys C levels and reference intervals (RIs) of a Nigerian population.Materials and Methods: Three hundred and four healthy adult subjects were analysed. Serum Cys C and SCr were determined by particle enhanced turbidimetric immunoassay and modified Jaffe kinetic method respectively. Data were analysed using the Statistical Package for Social Sciences version 17.0 (SPSS for Windows Inc.; Chicago; IL; USA). Estimation of RIs was done as per the International Federation of Clinical Chemistry guidelines.Results: The RIs for Cys C were 0.65-1.12 mg/L (median 0.86) for males; 0.62-1.12 mg/L (median 0.85) for females and 0.64-1.12 mg/L (median 0.86) for all the subjects. The RIs for SCr were 73-110 ?mol/L (median 89) for males; 65-102 ?mol/L (median 82) for females and 66-106 ?mol/L (median 86) for all the subjects. There was no significant gender difference in the RIs for serum Cys C; (P 0.05). The SCr levels and RI were significantly lower in females than in males (P 0.001).Conclusion: This study has determined the serum Cys C levels and RI of an indigenous healthy adult black population in Nigeria

Cardiovascular risk factors in middle-aged and elderly residents in South-East Nigeria: the influence of urbanization.

Cardiovascular diseases (CVD) were previously considered a problem of the developed nations only. Emerging facts show that CVD and their risk factors are now prevalent in developing countries. We carried out a cross-sectional, population-based survey to determine the relation between place residence (rural or urban) and the burden of CVD risk factors in South East Nigeria. Hypercholesterolaemia, hypertension, abnormal blood glucose and obesity were assessed for, in middle-aged and elderly residents of two communities in Enugu, South East Nigeria. A total of 543 adults (308 at Ogwofia Owa and 235 at Emene) participated in the study. The mean and 95% CI for mean of the characteristics of subjects showed that they were in the middle-age group with apparently normal mean cardiovascular risk indices except for systolic and diastolic blood pressure indices which suggested pre-hypertension. The subjects residing in the rural area were older than those residing in the urban area but cardiovascular risk factors had higher mean values in urban residents except systolic blood pressure (SBP). The most prevalent cardiovascular risk factors in the study group were hypertension and obesity. Urban residence was found to influence the prevalence of risk factors, specifically obesity and diastolic hypertension.

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.

Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa.

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.

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.

Respiratory symptoms and ventilatory function tests in Nigerians with HIV infection.

BACKGROUND: The impact of the human immunodeficiency virus (HIV) infection on the respiratory system of Africans has been little studied. This study aimed to determine the pattern of respiratory symptoms and ventilatory functions in HIV infected Nigerians. METHODS: In this cross sectional study, Respiratory symptoms frequency, Forced vital capacity (FVC), Forced expiratory volume in one second (FEV(1)), FEV(1)/FVC ratio, Forced expiratory flow between 25% and 75% of FVC, were determined in 100 HIV positive subjects and compared with values in 100 HIV negative controls. RESULTS: HIV positive patients had significantly more respiratory symptoms and lower ventilatory function tests values compared to the matched controls (p<0.05). HIV patients with at least one respiratory symptom and those with CD4 count less than 200 cells/µl had lower ventilatory function values than their counterparts. 32% of the HIV patients had restrictive ventilatory functional impairment. (p<0.05). Using regression analysis, factors like HIV status, CD4 count and presence of respiratory symptoms were found to be associated with impairment in ventilatory functions. CONCLUSIONS: HIV infected patients had more frequent respiratory symptoms and lower ventilatory function values. Further lung function studies and CT scanning in HIV positive patients especially in those with respiratory symptoms are indicated.

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

Diabetic Nephropathy: A review of the Past, Present and Future Perspectives - Part I.

Diabetic renal disease is a serious problem resulting from microvascular complications in both type 1 and type 2 diabetes mellitus. There is increased mortality from cardiovascular causes in patients with diabetic nephropathy. However, in spite of plethora of studies in recent years on the possible pathogenetic mechanisms involved in diabetic nephropathy, the exact role of each individual mechanism is still inconclusive. Diabetic nephropathy is reviewed in two parts, the first part deals with historical background, pathophysiology and pathogenesis including the roles of chronic hyperglycaemia, renin-angiotensin system and several mediators in the renal changes in diabetes mellitus. While the second part reviews the treatment as well as current theories in treatment and possible intervention strategies of the future. Key words: diabetic nephropathy, microalbuminuria, pathogenesis, renin-angiotensin system, pathophysiology, treatment.

Diabetic Nephropathy: A review of the Past, Present and Future Perspectives - Part 2.

Diabetic renal disease is a serious problem resulting from microvascular complications in both type 1 and type 2 diabetes mellitus. There is increased mortality from cardiovascular causes in patients with diabetic nephropathy. However, in spite of plethora of studies in recent years on the possible pathogenetic mechanisms involved in diabetic nephropathy, the exact role of each individual mechanism is still inconclusive. Diabetic nephropathy is reviewed in two parts, the first part deals with historical background, pathophysiology and pathogenesis including the roles of chronic hyperglycaemia, renin-angiotensin system and several mediators in the renal changes in diabetes mellitus. While the second part reviews the treatment as well as current theories in treatment and possible intervention strategies of the future. Key words: diabetic nephropathy, microalbuminuria, pathogenesis, renin-angiotensin system, pathophysiology, treatment.

A case of fractured internal jugular catheter.

We report a case of fractured internal jugular catheter, a rare but life threatening complication of the use of intravascular catheter in a 73 year-old man. He had an internal jugular catheter in-situ for nine months, much longer than the manufacturer's recommended duration.