Prospective Comparison of 24-Hour Urine Creatinine Clearance with Estimated Glomerular Filtration Rates in Chronic Renal Disease Patients of African Descent.

BACKGROUND: The 24-hour (24-h) creatinine clearance (CrCl) is the most common method for measuring GFR in clinical laboratories. However, the limitations of CrCl have resulted in the widespread acceptance of mathematically derived estimated glomerular filtration rate (eGFR) using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting eGFR. The aim of the study was to compare 24-h CrCl with eGFR derived from these formulae and to identify which could be the best alternative. METHOD: A prospective study was conducted involving 140 CKD patients. Creatinine and cystatin C concentrations were determined using the cobas 6000 analyzer. The eGFR was calculated using the CG formula, 4-variable MDRD and CKD-EPI equations, and Bland-Alman plots bias was determined. RESULTS: The CG and MDRD formulas had mean eGFR values similar to CrCl and correlation coefficients (r) were highest for CG (0.906) and lowest for MDRD (0.799). The CG equation was in agreement with 24-h CrCl in all but stage V CKD while the MDRD equation compared well in all except Stage IV CKD. The CG equation was positively biased (0.9857) while the MDRD had a negative bias (-0.05). CONCLUSION: The Cockcroft-Gault formula provides a more accurate assessment of GFR than 24-h CrCl and would be recommended as a substitute to provide the best estimate of GFR in our population.

Addressing the Challenge of Potentially Hazardous Elements in the Reduction of Hypertension, Diabetes and Chronic Kidney Disease in the Caribbean.

BACKGROUND: Environmental surveys have characterized trace elements such as lead (Pb), cadmium (Cd) and arsenic (As) as potential risk factors for non-communicable diseases. There have been few studies conducted in the Caribbean region to explore, define or clarify such findings locally. Furthermore, local pollution control efforts are often juxtaposed against more seemingly immediate economic concerns in poor communities. OBJECTIVES: The present commentary is a call to action for the evaluation of potentially hazardous elements as potential risk indicators and/or factors of common noncommunicable diseases in the Caribbean. DISCUSSION: Findings from Jamaican studies have identified exposure to potentially hazardous elements (PHE) via water, food, and other anthropogenic activities to the detriment of the resident population. Several attempts have been made to abate toxic metal exposure in children with relative success. However, high levels of PHE have been noted in vulnerable populations such as patients with hypertension, diabetes mellitus and chronic kidney disease. Currently, there is low priority towards infrastructure building within the Caribbean region that would promote and sustain long term monitoring and better inform environmental polices impacting chronic diseases. CONCLUSIONS: Further investigations are needed to clarify the role that PHE play in increasing the risk or progression of non-communicable diseases, especially in vulnerable groups. COMPETING INTERESTS: The authors declare no competing financial interests.

May Measurement Month 2019: an analysis of blood pressure screening results from Jamaica.

There is evidence of an elevated risk of hypertension in populations that are primarily of African origin. Hypertension is predominantly asymptomatic, necessitating increased awareness. May Measurement Month was a descriptive, population-based, cross-sectional study of blood pressure (BP) screening and awareness campaign conducted in 2019 in a sample of 2550 participants (≥18 years) in Jamaica. In total, 1791 (70.2%) of the participants were female, 756 (29.6%) were male, with an average age of 49.3 years, and a body mass index (kg/m2) of 28.5 (6.2). Of all participants, 2289 (89.8%) were black and 154 (6.0%) were of mixed races. Twenty-two (0.9%) had never had their BP measured, whereas 354 (13.9%) had their measurements more than a year ago, and 2129 (83.5%) had measured within the year. Of all 2550 participants, 1055 (41.4%) had hypertension, 69.9% of our subjects with hypertension were aware, whereas only 62.5% were on antihypertensive medication and 27.8% had controlled BP (systolic <140 mmHg and diastolic BP <90 mmHg). Of 660 participants on antihypertensive medication, 44.4% had controlled BP. Two hundred and seventy-six (15.4%) of women reported hypertension in a previous pregnancy. Hypertension with previous pregnancy was positively correlated with current elevation. These results suggest a high rate of raised BP among community dwellers whose hypertension had not been previously diagnosed by a health professional and warrant proactive approaches that promote community-based awareness, and regular measurements.

Cystatin C, Vitamin D and Thyroid Function Test Profile in Chronic Kidney Disease Patients.

BACKGROUND: The progression of chronic kidney disease (CKD) is concomitant with complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. The aim of this study is to determine serum cystatin C levels, and the prevalence of vitamin D deficiency and thyroid dysfunction in CKD patients. METHODS: A cross-sectional study was conducted involving 140 CKD patients (stages 1-5) that were referred to a renal clinic. Demographic data was collected and thyroid function tests, serum 25-OH-vitamin D, cystatin C levels, and routine biochemistry tests were determined using cobas 6000 analyzer. RESULTS: 129 (92.1%) of CKD patients had elevated serum cystatin C levels and there was a stepwise increase from stage 1-5. Overt hypothyroidism was present in one patient and nine had subclinical hypothyroidism. There was a stepwise reduction in serum 25-OH-vitamin D levels from stage 2-5, 31 (22.1%) had vitamin D insufficiency and 31 (22.1%) presented with deficiency. CONCLUSIONS: 25-OH-vitamin D deficiency and thyroid disorders are exhibited in chronic kidney disease patients and the severity of the former rises with disease progression, as indicated by elevated cystatin C levels. Routine screening and timely intervention is recommended so as to reduce the risk of cardiovascular diseases.

Role of Toxic Elements in Chronic Kidney Disease.

BACKGROUND: The kidney is central to many complex pathways in the body and kidney injury can precipitate multiple negative clinical outcomes. The resultant effect on nutrition and elemental body burden is bi-directional, confounding the very complex pathways that maintain homeostasis. These elemental changes themselves increase the risk of nutritional and biochemical disturbances. OBJECTIVES: The aim of the present study was to describe how toxic elements interface with complications of chronic kidney disease (CKD). METHODS: The present review included studies focusing on the molecular mechanisms induced by exposure to elements with known nephrotoxic effects and associated health complications in CKD patients. DISCUSSION: Many non-essential elements have nephrotoxic activity. Chronic injury can involve direct tubular damage, activation of mediators of oxidative stress, genetic modifications that predispose poor cardiovascular outcomes, as well as competitive uptake and element mobilization with essential elements, found to be deficient in CKD. Cardiovascular disease is the most common cause of mortality among CKD patients. Oxidative stress, a common denominator of both deficient and excess element body constitution, underlies many pathological derivatives of chronic kidney disease. Bone disorders, hematological dysfunction and dysregulation of acid-base balance are also prevalent in kidney patients. The largest contribution of toxic element body burden results from environmental exposure and lifestyle practices. However, standard medical therapies may also potentiate toxic element accumulation and re-injury of vulnerable tissue. CONCLUSIONS: For CKD patients, the cumulative effect of toxic elements persists throughout the disease and potentiates complications of CKD. Medical management should be coordinated between a medical team, dietitians and clinical researchers to mitigate those harmful effects. COMPETING INTERESTS: The authors declare no competing financial interests.

Late-onset Fanconi anemia in an African-Caribbean patient.

A 38-year-old female of African-Caribbean origin presented with symptomatic anemia and was found to have hypoplastic thumbs and patchy hypopigmentation. Peripheral blood examination revealed pancytopenia and the bone marrow biopsy confirmed marrow hypoplasia. Fanconi anemia was later confirmed by flow cytometry and diepoxybutane testing. Treatment was limited to transfusions after development of toxicity with cyclosporine and androgen therapy. She manifested classical features of transfusion-related hemosiderosis and died 12 years after initial presentation.