Haematological Indices and Iron Status in Pre-Dialysis Chronic Kidney Disease Patients.

BACKGROUND: Chronic kidney disease (CKD) is associated with haematological changes, the commonest being anaemia. The number and function of white blood cells (WBC) and platelets are equally affected. Iron deficiency is a common cause of anaemia in the CKD population and anaemia has been associated with reduced cardiac function, increased rates of hospitalization, morbidity and mortality. This study aimed to determine the haematological indices and iron status among pre-dialysis CKD patients. METHOD: A hospital-based cross-sectional study involving 95 predialysis CKD patients and 95 age- and sex-matched apparently healthy controls. Full blood count, peripheral blood film, serum ferritin, transferrin saturation, C-reactive protein (CRP), electrolytes, urea and creatinine, serum folate and vitamin B12 were done in all study participants. Comparisons were made between results obtained from participants in both groups. RESULT: The mean ages were 58.1 ± 14.9 years and 58.3 ± 15.0 years in the CKD group and controls, respectively. The male:female ratio was 1:0.9 in both groups. The prevalence of anaemia was 51.6% and 3% in patients with CKD and controls, respectively. There was no significant difference in the total WBC count, neutrophil and lymphocyte differentials, platelet count, serum vitamin B12 and folate in patients with CKD and controls. The prevalence of iron deficiency among patients with CKD was 32.6%, of which 62.5% were absolutely iron-deficient while 37.5% were functionally iron-deficient. The median ferritin and CRP were also higher in CKD. (p =0.001). CONCLUSION: Anaemia and iron deficiency are common in predialysis CKD patients. Early diagnosis and treatment are important to avoid the problems associated with them. MOTS-CLÉS: Maladie rénale chronique, Anémie, Carence en fer, Pré-dialyse.

Relationship between Kidney Dysfunction, Stroke Severity, and Outcomes in a Nigerian Tertiary Hospital: A Prospective Study.

BACKGROUND: Stroke is a common neurologic disease associated with fatal outcomes. Kidney dysfunction may be an important predictor of stroke severity and outcome. AIM: To determine the relationship between kidney dysfunction at admission and stroke severity and 30-day outcome. MATERIALS AND METHODS: This was a prospective study that involved 150 stroke patients. Stroke severity at admission was assessed using the National Institutes of Health Stroke Scale (NIHSS). Renal dysfunction was assessed by the presence of albuminuria and or reduced glomerular filtration rate (GFR) at admission. Neurological outcome was assessed using mortality, modified Rankin Scale (mRS), and Glasgow Outcome Scale (GCS). RESULTS: The mean age of the study participants was 61.0 ± 13.2 years. Renal dysfunction was present in 66% of the participants while the case fatality rate of stroke was 26%. Poor neurological outcome at 30 days was found in 44.1% of survivors. Those with albuminuria had lower GCS (P = 0.041), lower GFR (P = 0.004), higher mRS score on day 14 (P = 0.041) and day 30 (P = 0.032), and higher NIHSS score (P = 0.034). Independent predictors of 30-day mortality were albuminuria (Adjusted Odd Ratio (AOR) 3.60, 95%CI: 1.07-12.17) and increasing NIHSS score (AOR = 1.15, 95%CI: 1.04-1.28). Lower GCS (P < 0.001), elevated white blood cells (P = 0.003), serum creatinine (P = 0.048), and NIHSS score (P < 0.001) were associated with poor neurological outcome. NIHSS score was the only significant predictor of neurologic outcome (AOR: 1.25; CI: 1.11-1.41; P ≤ 0.001). CONCLUSIONS: Kidney dysfunction was associated with stroke severity and mortality. However, it was not an independent predictor of neurological outcome.

Self-perceived Burden on Caregivers, Anxiety and Depression among Chronic Kidney Disease Patients in Southern Nigeria.

Introduction: Psychosocial problems are common in chronic kidney disease (CKD) patients and are associated with poor overall outcomes; however, their evaluation has not received the deserved attention. This study assessed self-perceived burden on caregivers, psychosocial wellbeing, anxiety and depression among CKD patients, and the impact on their quality of life (QoL) in two hospitals in Nigeria. Methods: This was a cross-sectional study. Self-perceived burden on caregivers, QoL, anxiety, and depression of the patients, were assessed using the Cousineau questionnaire, modified SF-12 questionnaire, Hospital Anxiety and Depression Scale, respectively. Results: There were 141 participants in the study comprising 50 haemodialysis (HD) patients, 41 pre-dialysis CKD patients and 50 controls. The male: female ratio for CKD patients and controls were 1.1 and 1.4 respectively. Prevalence of depressive and anxiety symptoms in the CKD patients were 46.2% and 33.0% respectively. The QoL score was significantly higher in the control group compared to the CKD patients (p= <0.001) and significantly lower in the HD patients compared to the pre-dialysis CKD patients (p= <0.001). Self-perceived burden score was significantly higher in the HD group compared to the pre-dialysis CKD group (p = < 0.001) There was a negative correlation between QoL score and self-perceived burden, hospital anxiety score and hospital depression score (p =<0.001). Conclusion: Psychological disorders and self-perceived burdens are highly prevalent among CKD patients. They have negative impact on their QoL, hence regular evaluation and management of these disorders should be incorporated into the care of CKD patients.

Introduction: Les problèmes psychosociaux sont commun chez les patients atteints d'insuffisance rénale chronique (MRC) et associés à de mauvais résultats globaux, mais leur évaluation n'a pas reçu l'attention méritée. Cette étude a évalué le fardeau autoperçu par les patients sur les soignants, le bien-être psychosocial des patients atteints d'IRC et l'impact sur leur qualité de vie (QoL) dans deux hôpitaux en Nigéria. Méthodes: Il s'agissait d'une étude transversale qui évaluait lefardeau auto-perçu des patients sur les soignants, la qualité de vie, l'anxiété et la dépression à l'aide du questionnaire Cousineau, du questionnaire SF-12 modifié et de l'échelle d'anxiété et de dépression hospitalière respectivement chez les patients atteints d'IRC et les témoins. Résultats: Il y avait 141 participants à l'étude comprenant 50 patients hémodialysés d'entretien (HD), 41 patients atteints d'IRC en pré-dialyse et 50 témoins. Le rapport homme: femme pour les patients atteints d'IRC et le groupe témoin était respectivement de 1,1 et 1,4. La prévalence des symptômes dépressifs et anxieux chez les patients atteints d'IRC était de 46,2% et 33,0% respectivement. Le score de qualité de vie était significativement plus élevé dans le groupe témoin par rapport aux patients atteints d'IRC (p = <0,001). Le score de qualité de vie était significativement plus faible chez les patients HD par rapport aux patients atteints d'IRC en pré- dialyse (p <0,001). Le score d'autoévaluation du fardeau était significativement plus élevé dans le groupe HD que dans le groupe avant la dialyse CKD (p = <0,001) Il y avait une corrélation négative significative entre la qualité de vie et l'auto-perception du fardeau, le score d'anxiété hospitalière et le score de dépression hospitalière (p = < 0,001). Conclusion: Les maux psychologiques sont très répandus chez les patients atteints d'IRC et ont un impact négatif sur leur qualité de vie. Une évaluation et une prise en charge régulières de ces maux doivent être intégrées dans la prise en charge des patients atteints d'IRC. Mots clés: anxiété, dépression, qualité de vie, fardeau pour les soignants, maladie rénale chroniq.

Metabolic Syndrome and Atherosclerotic Cardiovascular Risk in a Population Of Market Women in a Semi-Urban Town, South-West Nigeria.

BACKGROUND: Metabolic Syndrome (MS) is a non-communicable disease of global significance. The presence of MS denotes increased risk of cardiovascular disease. The global prevalence of MS is on the increase because of lifestyle changes like consumption of high calorie, low fibre foods coupled with reduced physical activity OBJECTIVES: To determine the prevalence of MS and its components and to estimate atherosclerotic cardiovascular disease (ASCVD) risk in a population of market women. METHODS: A cross-sectional, observational study among female traders in a market in South-western Nigeria. MS was determined using the harmonized NCEP-ATPIII and IDF criteria. The ASCVD risk estimator by the American College of Cardiologists and American Heart Association was used to assess ASCVD risk. RESULTS: One hundred and sixty-nine female traders aged 23 to 80 years with a mean age of 52.8±13.2 years were involved in the study. Overweight and obesity were seen in 61 (36.5%) and 57 (34.1%) participants respectively. Prevalence of MS was 34.9% and the most frequent components of MS were hypertension (62.1%), low HDL-cholesterol (53.8%) and elevated serum triglycerides (18.3%). MS was associated with increasing age (p= 0.010) and BMI (p= 0.009). Significant 10-year ASCVD risk was found in 63 (52.1%) out of 121 participants eligible for ASCVD risk estimation. Significant 10-year ASCVD risk was found in 33(67%) out of 59 participants with MS. CONCLUSION: This study demonstrated significant risk for cardiovascular disease in a population of market women. A more active lifestyle, appropriate diet and treatment of hypertension, diabetes and dyslipidaemia should be encouraged.

Factors associated with blood pressure control in predialysis chronic kidney disease patients: Short-term experience from a single center in Southern Nigeria.

BACKGROUND: Hypertension is a leading cause of kidney disease worldwide, and chronic kidney disease (CKD) is a known cause of secondary hypertension. Blood pressure (BP) control is a main-stay in the management of CKD because it retards the progression of established CKD. AIM: To determine BP control and its associated factors in predialysis CKD patients in a tertiary hospital setting. METHODOLOGY: CKD patients who attended the renal outpatient clinic during the period from December 2013 to June 2014 were recruited into the study. Demographic and clinical information were obtained from their case records. The average of the three most recent clinic BPs was calculated for each patient. Good BP control was taken as an average BP of <140/90 mmHg. RESULTS: One hundred and three patients (53 males and 50 females) met inclusion criteria for the study. The mean age of the patients was 40.6 ± 17.4 years. Estimated glomerular filtration rate was <60 ml/min in 49.5% of patients. Good BP control was seen in 57 (55.3%) patients. Poor BP control was associated with middle age, proteinuric CKD, and prescription of 3 or more BP medication. CONCLUSION: BP control in predialysis CKD patients still needs to be optimized. Special attention should be given to middle-aged patients who have proteinuric CKD and those on multiple BP drugs without optimal BP control.

Impact of socio-economic factors on quality of life in patients on continuous ambulatory peritoneal dialysis in an African setting.

BACKGROUND: Quality of life (QOL) is an important outcome following the treatment of disease. It is influenced by physical, psychological, social and economic factors. We proposed to determine the effect of some socioeconomic factors on QOL of patients on CAPD. STUDY DESIGN: A cross sectional study in which all patients on CAPD attending three clinics attached to the University of the Witwatersrand, Johannesburg were recruited excluding those with intercurrent illness. The WHO quality of life instrument, WHOQOL-Bref, was used to measure QOL. The patients were grouped according to marital status, highest level of education attained, income, employment, and QOL domain scores were compared using ANOVA and Student t test. RESULTS: A total of 140 patients comprising 80 males and 40 females were assessed. The mean age of patients was 41.9 ± 11.5 years, 95%of patients were black, 44.3% married, 69.3% had secondary education, 22% were employed and 51.4% had a monthly income of less than five thousand Rand (500 US dollars). Single patients scored better in the social relationships domain compared to separated patients (p=0.02, CI: 5.6-32.9). The group with secondary education scored low in the psychological domain compared with those with primary education (p=0.02, CI: 1.35-15.8) and those with tertiary education (p=0.02, CI: 1.72-18.07).The highest income group had best scores in all domains except the physical domain. Those in employment had better scores in the physical domain (p=0.04, CI: 0.356-12.549). CONCLUSION: Income had the most impact on QOL in study participants.

ESTIMATED GLOMERULAR FILTRATION RATE AND RISK OF SURVIVAL IN ACUTE STROKE.

OBJECTIVE: To assess the risk of survival in acute stroke using the MDRD equation derived estimated glomerular filtration rate. DESIGN: A prospective observational cross-sectional study. SETTING: Medical wards of a tertiary care hospital. SUBJECTS: Eighty three acute stroke patients had GFR calculated within 48 hours of admission after basic data were captured. OUTCOME MEASURES: Stroke outcome was defined as either discharged or still-in-care (survived) or all cause in-hospital death. GFR was estimated by the MDRD equation, stroke severity was assessed by the Canadian Neurological Scale (CNS). Data were compared between the GFR groups of < 60 ml/min and ≥ 60 ml/min. Relative risks (RR) and odds ratios (OR) for stroke outcomes (survival and death) were estimated between the GFR groups and the homogeneity of the odds ratios among the different layers of stroke severity (CNS < 6.5 and ≥ 6.5) was determined by Breslow-Day and Tarone's test. Matanel Hazensel and Cochran's tests were used to determine conditional independence and the common odds ratio with stroke severity as a layering variable. RESULTS: No significant differences were found between the age and sex distribution of the two GFR groups. Serum urea and creatinine and CNS were significantly different between the GFR groups (p < 0.001, < 0.001, < 0.001). RR of survival and death for the GFR groups-less than 60 ml/min and above or equal to 60 ml/min were (0.425 and 1.204) and (2.360 and 0.830). The OR of survival for GFR below 60 ml/min compared to GFR above or equal to 60 ml/min was 0.353. There was homogeneity across the two layers of stroke severity (CNS score less than 6.5 and above or equal to 6.5), p = 0.612 and 0.612. CONCLUSION: Independent of stroke severity, GFR is a surrogate in the assessment of the risk of survival in acute stroke.

Twenty-one-year-old male with congenital anomalies, obstructive uropathy and chronic renal failure: is this a case of Townes Brocks syndrome?

Townes Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear anomalies/hearing loss, limb defects, anal, genitourinary, eye, spine anomalies, heart defects and sometimes mental retardation. This report presents the case of a 21-year-old secondary school leaver as a likely case of Townes-Brocks syndrome. He was born with congenital abnormalities consisting of fixed flexion deformities of hands, wrist and elbows, urethral meatal stenosis, scoliosis and aortic stenosis. He was diagnosed with obstructive uropathy at the age of 19 years and subsequently developed chronic renal failure. The report aims to highlight the need for early recognition of potentially preventable conditions, which, if left unattended to, can lead to unnecessary fatality.