Perspectives of relatives of patients with end-stage kidney disease on kidney sources, commercial kidney donation, and barriers to living kidney donation in Nigeria: a qualitative study.

BACKGROUND: Kidney transplantation is the best mode of kidney replacement therapy. However, the shortage of organ donations has been a major challenge globally. Relatives of patients with end-stage kidney disease (ESKD) are potential kidney donors. We explored their perspectives about kidney donation, kidney commercialisation, and barriers to kidney donation. METHODS: In-depth interviews were conducted among 28 relatives of ESKD patients across the six geopolitical zones and Federal Capital Territory of Nigeria. The interview focused on potential sources of kidney donors, kidney commercialisation and barriers to kidney donation. ATLAS.ti version 9.0.22.0 was used for data analysis. RESULTS: Mean age of the study participants was 41.57 ± 14.55 years; 54% were females, 60.7% were married, 93% had tertiary education and 75% were first degree relatives of ESKD patients. There were 7 themes and 28 subthemes generated in this study. The potential sources of kidney donors identified by the study participants included commercial, hospital, family and non-family member donors. While some opined that a family member is the best choice as a kidney donor, others preferred a commercial donor. The majority of those interviewed do not believe that it is wrong to purchase a kidney, and would be willing to do so. Identified factors that promote kidney commercialisation were unwillingness of a family member to donate, having the financial capacity to purchase a kidney, non-fitness of family members to donate. Identified barriers to kidney donation were age, poor health status, polygamy, perceived poor expertise of the medical team, perceived risk of the procedure, parental influence and religious beliefs. CONCLUSIONS: The majority of participants lacked correct information about kidney donation. Implementation of educational program policies and laws regulating and reinforcing ethical principles of kidney donation and transplantation should be ensured.

Serum lipid profile of Nigerian diabetics with end stage renal disease.

BACKGROUND: End stage renal disease (ESRD) and diabetes mellitus may have lipid abnormalities that act synergistically to place diabetics with ESRD at an augmented risk for cardiovascular morbidity and mortality. We studied serum lipid profile and risk ratio in Nigerian diabetics with ESRD as there is no data in this regard. MATERIALS AND METHOD: Serum lipid profile was determined in the fasting state for consecutive diabetic patients with ESRD seen in the Nephrology Unit of the Jos University Teaching Hospital over a 2- year period. A similar group of non- diabetic patients with ESRD and healthy individuals served as controls. RESULTS: A total of 21 diabetics and 30 non- diabetics both with ESRD and 36 controls were studied. High-density lipoprotein (HDL) cholesterol levels were lower in diabetics compared to controls (1.55 +/- 1.14 mmol/L vs. 2.38 +/- 0.57 mmol/L, p < 0.05) but similar to that of the non- diabetic group. On the contrary, low-density lipoprotein (LDL) cholesterol levels were higher in diabetics compared to controls (2.87 +/- 2.07 mmol/L vs. 1.44 + 0.52 mmol/L, p < 0.05). Serum Triglyceride and total Cholesterol levels were similar in all study groups. The LDL/HDL cholesterol ratio was higher in diabetics compared to non- diabetics and controls (3.65 +/- 3.97, 2.08 +/- 1.72, 0.61 +/- 0.30 respectively, p < 0.0001; multiple comparison p < 0.05). CONCLUSION: Cardiovascular risk as imposed by lipid abnormalities is elevated in Nigerian diabetic persons with ESRD compared to their non- diabetic counterparts as reported elsewhere.