Acute kidney injury among medical and surgical in-patients in the Cape Coast Teaching Hospital, Cape Coast, Ghana: a prospective cross-sectional study.

BACKGROUND: Acute kidney injury (AKI) is a syndrome associated with high morbidity, mortality and high hospital costs. Despite its adverse clinical and economic effects, only a few studies have reported reliable estimates on the incidence of AKI in sub-Sahara Africa. We assessed the incidence and associated factors of AKI among medical and surgical patients admitted to a tertiary hospital in Ghana. METHODS: A prospective cross-sectional study was conducted among one hundred and forty-five (145) consecutive patients admitted to the medical and the surgical wards at the Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana from April 2017 to April 2018. Socio-demographic and clinical information were collected using structured questionnaires. AKI was diagnosed and staged with the KDIGO guideline, using admission serum creatinine as baseline kidney function. RESULTS: The mean age of the study participants was 46.6±17.7 years, whilst the male:female ratio was 68:77. The overall incidence of AKI among the participants was 15.9% (95% CI: 10.33 - 22.84%). Stage 1 AKI occurred in 56.5% of the participants, whilst stages 2 and 3 AKI respectively occurred among 4.1% and 2.8% of respondents. About 20% of the participants in the medical ward developed AKI (n= 15) whilst 12% of those in surgical ward developed AKI (n= 8). Among the participants admitted to the medical ward, 60.0%, 26.7% and 13.3% had stages 1, 2 and 3 AKI respectively. Whilst 50.0%, 25.0% and 25.0% respectively developed stages 1, 2 and 3 AKI in the surgical ward. Medical patients with AKI had hypertension (40%), followed by liver disease (33.3%); 37.5% of surgical inpatients had gastrointestinal (GI) disorders. CONCLUSION: The incidence of AKI is high among medical and surgical patients in-patients in the CCTH, Ghana, with hypertension and liver disease as major comorbidities.

High risk of coagulopathy among Type-2 Diabetes Mellitus clients at a municipal hospital in Ghana.

BACKGROUND: Persistent hyperglycaemia in diabetes mellitus causes coagulopathies due to glycation of haemoglobin, prothrombin, fibrinogen and other proteins involved in the clotting mechanism. Shortened activated partial thromboplastin time (APTT) and prothrombin time (PT) reflect hypercoagulable state, which is associated with an increased thrombotic risk and adverse cardiovascular effects. This study assessed the coagulation profile of type 2 diabetes mellitus (T2DM) clients at a municipal hospital in Ghana. METHODS: A hospital-based case-control study was conducted from January to April 2015 at the Agona Swedru Municipal Hospital. Sixty (60) persons with T2DM and 40 without were recruited and screened using appropriate protocols. Blood samples were collected for coagulation and biochemical tests. Demographic and clinical information were collected using pre-tested questionnaire. Data was analyzed with GraphPad Prism version 5. RESULTS: APTT and PT were significantly shorter among patients with T2DM compared to those without (20.88 ± 5.19 v 31.23 ± 5.41, P=0.0001; and 11.03 ± 2.06sec v 14.46 ± 1.86, P=0.0001 respectively). INR was decreased among patients with T2DM compared to those without (0.83 ± 0.18 v 1.13 ± 0.17, P=0.0001). No significant difference was found in platelet count between T2DM and non-diabetics (179.85 ± 66.15×103 /mm3 v 168.55 ± 35.77×103 /mm3, P=0.326). Serum magnesium was lower among the T2DM patients compared to the non-diabetics, while serum ionized calcium was significantly higher among the T2DM patients (P<0.05). CONCLUSION: Clients with T2DM may have a high coagulation risk evidenced by shortened APTT, PT and a high ionized calcium compared with controls. FUNDING: Study was funded by Lord Ampomah and Solomon Panford.

Determinants of isolated systolic hypertension among diabetic patients visiting the diabetic clinic at the Tamale Teaching Hospital, Northern Ghana.

BACKGROUND: Hypertension and diabetes mellitus, two of the leading risk factors for atherosclerosis, are associated with numerous complications, including heart attacks and strokes. AIM: This study established the prevalence and determinants of isolated systolic hypertension (ISH) in diabetes mellitus patients visiting the Tamale Teaching Hospital. MATERIALS AND METHODS: In this purposive cross-sectional study, 107 diabetes mellitus patients were recruited from the out-patient diabetes clinic of the Tamale Teaching Hospital (TTH). Blood and urine samples were collected for the estimation of fasting blood glucose (FBG) and routine urinalysis respectively. A well-structured pre-tested questionnaire was used to obtain socio-demographic data and clinical history of participants, and their blood pressure measured with a mercury sphygmomanometer. RESULTS: The prevalence of ISH among the participants was 37.4%. Mean age and FBG were significantly higher among participants with ISH than the normotensives (56.20 ± 10.60 v 48.44 ± 11.6, P= 0.022; and 8.80 ± 3.06 v 6.01 ± 0.50, P= 0.034 respectively). Type of diabetes mellitus was associated with ISH (P= 0.010) and age was a risk factor of ISH (OR= 1.057, P= 0.008). CONCLUSION: Isolated systolic hypertension was prevalent in 37.4% of diabetes mellitus patients and was associated with older age. Effective measures should, therefore, be instituted to prevent ISH in patients with type 2 diabetes especially the elderly.

Prevalence of chronic kidney disease among the high risk population in South-Western Ghana; a cross sectional study.

BACKGROUND: Chronic Kidney Disease (CKD) is a major global health problem. CKD is one of the most common complications of diabetes mellitus and hypertension and carries a risk of cardiovascular morbidity and mortality and progression to end-stage kidney disease. OBJECTIVES: This study sought to use the 2012 Kidney Disease Improving Global Outcomes (KDIGO) definitions to establish the prevalence and risk factors for CKD among a high risk population in the Sekondi-Takoradi metropolis. DESIGN: Cross sectional study. SETTING: Effia-Nkwanta regional and the Takoradi Government hospitals in South Western Ghana. PATIENTS: Two hundred eight consecutive adults with diabetes, hypertension or both. MEASUREMENTS: Serum creatinine and urine albumin-creatinine ratio respectively. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) was used to estimate glomerular filtration rate (GFR). METHODS: CKD was classified according to KDIGO. RESULTS: The prevalence of CKD was 30 %: 27 % in patients with diabetes, 22 % in patients with hypertension only and 74 % in patients with both diabetes and hypertension. GFR category G3a CKD was most prevalent stage (9 %). Albuminuria was highest among people with diabetes (39 %). LIMITATIONS: A convenience sample of patients attending clinics. CONCLUSION: CKD was prevalent in these high-risk patients.

CONTEXTE: L'insuffisance rénale chronique (IRC) est un problème majeur de santé globale. Elle se révèle l'une des plus fréquentes complications du diabète sucré et de l'hypertension. De plus, l'IRC pose un risque accru pour les patients de souffrir, voire de mourir de cardiopathie, ou alors de voir leur état progresser vers l'insuffisance rénale terminale. OBJECTIFS DE L'ÉTUDE: L'étude a cherché à établir la prévalence et les facteurs de risque de l'IRC dans la population prédisposée de la métropole de Sekondi-Takoradi (Ghana) en utilisant les définitions proposées par « Kidney Disease Improving Global Outcomes ¼ (KDIGO) en 2012. TYPE D'ÉTUDE: Il s'agit d'une étude transversale. CONTEXTE DE L'ÉTUDE: L'étude a été effectuée sur des patients de l'hôpital régional Effia-Nkwanta et de l'hôpital gouvernemental de Takoradi, dans le sud-ouest du Ghana. PATIENTS: L'étude était constituée d'une cohorte de 208 adultes atteints de diabète, d'hypertension ou d'une comorbidité. MESURES: Le rapport albumine-créatinine dans l'urine ainsi que le taux de créatinine sérique ont été mesurés, puis le débit de filtration glomérulaire (GFR) a été déterminé à l'aide de l'équation du « Chronic Kidney Disease Epidemiology Collaboration ¼ (CKD-EPI). MÉTHODOLOGIE: L'IRC a été déterminée selon les critères de KDIGO. RÉSULTATS: À la suite de cette étude, la prévalence d'IRC a été établie à 30 % parmi les patients de la cohorte. Elle s'établissait à 27 % chez les patients atteints de diabète seulement, 22 % chez les patients atteints d'hypertension seulement et de 74 % chez les patients présentant à la fois du diabète et de l'hypertension. Le stade d'IRC (9 %) le plus prévalent était de catégorie G3a. La prévalence d'albuminurie était plus élevée chez les patients diabétiques (39 %). LIMITES DE L'ÉTUDE: Il s'agit d'un échantillon de commodité formé de patients fréquentant les deux cliniques mentionnées plus haut. CONCLUSIONS: La prévalence d'insuffisance rénale chronique était plus élevée chez ce groupe de patients considérés à haut risque.