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OBJECTIVE: To estimate the prevalence of chronic kidney disease (CKD) among patients attending the University Hospital of the West Indies (UHWI) Diabetes Clinic and to determine the proportion of patients at high risk for adverse outcomes. METHODS: We conducted a cross-sectional study among patients attending the UHWI Diabetes Clinic between 2009 and 2010. Trained nurses administered a questionnaire, reviewed dockets, and performed urinalyses. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Albuminuria was assessed using urine test strips for protein and microalbumin. Chronic kidney disease was defined as an eGFR < 60 ml/min/1.73m2 or albuminuria ≥ 30 mg/g creatinine. Risk of adverse outcome (all-cause mortality, cardiovascular disease and kidney failure) was determined using the Kidney Disease: Improving Global Outcome (KDIGO) 2012 prognosis grid. RESULTS: Participants included 100 women and 32 men (mean age, 55.4 ± 12.9 years, mean duration of diabetes, 16.7 ± 11.7 years). Twenty-two per cent of participants had eGFR < 60 ml/min/1.73m2. Moderate albuminuria (30-300 mg/g) was present in 20.5% of participants and severe albuminuria (> 300 mg/g) in 62.1%. Overall prevalence of CKD was 86.3% (95%CI 80.4%, 92.2%). Based on KDIGO risk categories, 50.8% were at high risk and 17.4% at very high risk of adverse outcomes. CONCLUSION: Most patients at the UHWI Diabetes Clinic had CKD and were at high or very high risk of adverse outcomes. Further studies to determine the burden of CKD in other clinical settings and to identify the best strategies for preventing adverse outcomes in developing countries need to be conducted.
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Vitamin D has important effects on the immune system as it has been shown to exert antiproliferative and relative immunosuppressant effects. Low levels of this hormone may contribute to the immune activation in systemic lupus erythematosus (SLE) and other autoimmune diseases. Serum levels of 25-OH vitamin D were measured in 75 patients with SLE in Jamaica, using an enzyme-linked immunoassay. Correlations with clinical data and disease activity as determined by the BILAG index were determined. Of a total of 75 patients, 33 (44%) had vitamin D sufficiency with mean vitamin D level of 39.45 ng/ml (range, 30.35-58.16). Forty-two (56%) patients had either vitamin D deficiency or insufficiency, 30 (40%) had vitamin D insufficiency, mean 26.36 ng/ml (range, 20.26-29.88), and 12 (16%) had vitamin D deficiency, mean 16.07 ng/ml (range, 7.78-19.90). There was an overall negative relationship between the total disease activity score using the BILAG index and vitamin D levels, and this was influenced primarily by the relationship seen among the vitamin D-deficient subgroup. This was also impacted on by a patient population that was significantly skewed toward low disease activity. The negative association trended toward statistical significance. Vitamin D deficiency is prevalent among patients with SLE in Jamaica. A relationship between low serum levels of vitamin D and SLE activity may occur.
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Lúpus Eritematoso Sistêmico/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Criança , Feminino , Hospitais Universitários , Humanos , Jamaica/epidemiologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Sexual performance and gratification impact quality of life. Although recognized in the literature as a problem, sexual dysfunction among patients with end stage renal disease (ESRD) has never been studied in Jamaica. SUBJECTS AND METHOD: The prevalence of sexual dysfunction was determined among 268 adult Jamaican patients (166 males, 102 females) with ESRD who had been on haemodialysis for at least three months. Erectile dysfunction (ED) was assessed using the International Index of Erectile Function (IIEF). Female sexual dysfunction (FSD) was determined using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and International Classification of Diseases (ICD)-10 classifications of sexual disorders. Prevalence, severity of sexual dysfunctions and relationships with the primary aetiology of ESRD and anaemia were assessed. RESULTS: Erectile dysfunction, desire and orgasmic disorderS were found in 91.4%, 88.3%, and 81.6% of male subjects, respectively. The majority of male patients were dissatisfied with their performance at intercourse after progressing to ESRD. Hypoactive sexual disorder, sexual arousal and orgasmic disorders, and aversion sexual disorder were prevalent, found in 96%, 88.1% and 87.1% of female patients. All diabetic patients with ESRD reported hypoactive sexual disorder and orgasmic dysfunction; arousal disorder was found in 94.7%. Aversion sexual disorder was found more among patients with underlying chronic glomerulonephritis. All patients with severe anaemia were found to have hypoactive sexual disorder and among these, 87.5% and 97.8% had severe arousal and orgasmic disorders, respectively. CONCLUSION: Sexual dysfunction among patients with ESRD in Jamaica was prevalent in males and females. Associations exist between sexual dysfunction and diabetes mellitus, chronic glomerulonephritis and anaemia.
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BACKGROUND: The epidemiological transition has seen a trend from communicable to non-communicable diseases in developing countries. At the pinnacle of these chronic diseases is hypertension, pre-hypertension, diabetes and obesity. This leads to increased cardiovascular morbidity and mortality worldwide. In addition, environmental and behavioural changes such as lifestyle habits represent modifiable risk factors for the development of cardiovascular diseases. The Caribbean is not immune to this trend. METHODS: This was a cross-sectional survey conducted between June and September 2009 and involved individuals 15-74 years of age. Age-gender was weighted to get as close a representative sample of the general population living in the British Virgin Islands (BVI) for more than two years to a total of 301 (n = 301, M: 144, F: 157; CI 95% +/- error 5%). The study was carried out using a handout questionnaire that included variables on age, gender socio-economic status (SES), income level, cigarette smoking, physical activity, weight, height, body mass index (BMI), blood pressure, fasting blood glucose and cholesterol. RESULTS: This study shows a prevalence of hypertension of 16.6%, pre-hypertension--29.9%, diabetes mellitus--10.0% [M: 5.6%, F: 14%, p < 0.01], impaired fasting glucose (IFG)--16.9% [M: 13.9%, F: 19.7%, p < 0.01], overweight--25.6% (M: 19.4%, F: 31.2%, p < 0.001), obesity (body mass index > 30)--23.6% (M: 17.4%, F: 29.3%, p < 0.001) [all significantly higher in women], smoking habits--16.6% and alcohol--51.2% [significantly higher in men: 22.5% and 56.7%, respectively]. Of the respondents, 43.2% had a low/inactive physical activity level. Clustering of greater than one risk factor was more pronounced for women than for men 29.6% (M: 27.1%, F: 31.8%, p < 0.05). Sedentary lifestyle (low/inactive physical activity) and obesity were the only risk factors that had a positive correlation with all four chronic diseases (p < 0.05). CONCLUSION: The above results indicate that a national strategy needs to be implemented to control cardiovascular diseases, educate the population and promote healthy lifestyle habits with particular attention to low physical inactivity and obesity.
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Doenças Cardiovasculares/epidemiologia , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Doença Crônica , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índias Ocidentais/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by multisystem microvascular inflammation with the generation of autoantibodies. There are reports on demographic data and clinical manifestation of lupus in the United States of America and some other developed countries. There is a single study that has reported on the clinical and immunological features of SLE patients in Jamaica and another that reported that the prevalence of SLE in Jamaica was 5-17/100,000 in 1979. METHOD: A Jamaican lupus registry was established in 2008 at the Department of Medicine, The University of the West Indies. Data were collected using patient records and interview of patients fulfilling the American College of Rheumatology revised diagnostic criteria for SLE. Information on demographics, presence of diagnostic criteria for SLE, presence of complications and other clinical parameters were collected. RESULTS: There were a total of 107 patients that met the criteria for diagnosis of SLE at the referral centre, 96.3% of them female. Positive ANA (90.7%), arthritis (70.0%), malar rash (53.5%) and a positive dsDNA (40.1%) were the more frequent manifestations and diagnostic indices of the disease. Up to 41.7% of the SLE population suffered some form of complication. CONCLUSIONS: The initiation of a lupus registry has allowed for reporting ofpreliminary demographic, clinical and serological data and identifying of disease burden.
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Lúpus Eritematoso Sistêmico/epidemiologia , Sistema de Registros , Feminino , Humanos , Jamaica/epidemiologia , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , PrevalênciaRESUMO
OBJECTIVES: The main objective of the study is to assess the nutritional status in patients on chronic haemodialysis in Jamaica using the Subjective Global Assessment tool and to correlate this with measured serum nutritional biomarkers, and also to identify nutritional biomarkers that can be used to assess nutritional status of patients with end-stage renal disease (ESRD). SUBJECT AND METHODS: Two hundred and nine consecutive patients on haemodialysis were selected from dialysis centres in Kingston, the capital of Jamaica, St. Catherine and Manchester Jamaica. The nutritional status of each participant was assessed using the Subjective Global Assessment tool in an interview performed by the researcher. Serum albumin, blood urea nitrogen and creatinine, highly sensitive complement reactive protein (hsCRP) and total fasting cholesterol were determined from a single serum sample. Only patients with ESRD were selected. Patients with acute renal failure or those with ESRD who were admitted in the previous two weeks were excluded from the study. Informed consent was obtained prior to interview and obtaining blood samples. RESULTS: Of the total participants, 54.5% (n=114) were male and 45.5% (n=95) female. The mean age for males was 51.9 years and females 47.6 years. Diabetes was documented as the most common cause of chronic renal disease and was found in 29.7%, hypertension in 24.4% and chronic glomerulonephritis in 22% of the participants. Approximately 80% of the study population had moderate malnutrition. There was a significant association between moderate malnutrition and a diagnosis of ESRD secondary to diabetes mellitus, p = 0.03. Being on haemodialysis for < or = six months was significantly associated with moderate malnutrition p = 0.002. Also associated with moderate malnutrition were presence of an arteriovenous (AV) fistula (p = 0.01), serum albumin of < 40 g/L (OR 3.68, p = 0.001), pre-dialysis creatinine of <880 micromol/L (p = 0.02) and cholesterol < 3.9 mmol/L (p = 0.04). Highly sensitive complement reactive protein levels of >10 mg/L was associated with moderate malnutrition, though statistical significance was not met (p = 0.39). CONCLUSION: Factors associated with malnutrition in patients on dialysis were having ESRD secondary to diabetes mellitus, dialysis duration for < or = six months, low serum albumin, pre-dialysis serum creatinine of 880 micromol/L, low total cholesterol and presence of AV fistula access.
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Falência Renal Crônica/terapia , Estado Nutricional , Diálise Renal , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Jamaica , Falência Renal Crônica/sangue , Masculino , Desnutrição/diagnóstico , Desnutrição/etiologia , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: This paper seeks to summarize the estimation of two rounds of Nigeria's National Health Accounts (NHA), 1998-2002 and 2003-2005 and draw some lessons on the NHA methodology and health financing policy challenges towards enhancing government stewardship role in the health sector. METHOD: The paper uses the results of the two rounds of NHA estimations for Nigeria a s basis fo ranalysis. In each round of estimation, three matrices were estimated. Additional three matrices of sub-National Health Accounts were also estimated for 17states in the second round. RESULTS: With Nigeria's per capita Total Health Expenditure (THE) increasing from US 9.39 dollars in 1998 to US 55.04 dollars in 2005, the THE represent about 5% of GDP. The households accounted for around 68.6% of THE, while government shoulders about 25%. Major lessons learnt relate to skewed spending, challenges of recordkeeping and data collection at the federal and state levels, and commitment of government and other stakeholders in ensuring institutionalized procedures for collection, reporting, and retrieval of health financing data. CONCLUSION: Though NHA results indicate increase in spending on health over time, there is a very high burden on households. Besides, there are institutional challenges inhibiting the estimation process. There is need for government to lessen burden on households to improve its stewardship by increasing its contribution. The institutional capacity need to be strengthen to collect and analyse health expenditure data and interpret results in terms of their policy implication, while government takes ownership of the process to ensure the institutionalization and sustainability of the estimation process.
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Contabilidade/métodos , Financiamento Governamental/economia , Gastos em Saúde/estatística & dados numéricos , Financiamento da Assistência à Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , NigériaRESUMO
Treatment of hypertension in the elderly is a challenge. Elevated blood pressure (> 140/80 mmHg) in the elderly (60+ years) can be either systolic, diastolic or combination of both. Arterial stiffness, intimal hyperplasia and non-compliance of the vascular tree have been underlying factors. Prevalence of hypertension increases with advancing age and varies with the population under study; therefore screening this population should not only be limited to those at risk. Presentation is often due to complications such as stroke, cardiovascular events, and erectile dysfunction or due to presentation of an unrelated disorder The presence of co-morbidity, drug interaction and their side effects should be considered in the management of hypertension in the elderly. With the advent of several classes of antihypertensives, there is no shortage of drug options for treatment of hypertension in the elderly, but a careful and individualized approach is needed.
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Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/efeitos adversos , Comorbidade , Estudos Transversais , Interações Medicamentosas , Inquéritos Epidemiológicos , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Jamaica , Programas de RastreamentoRESUMO
Globally, diabetes mellitus and hypertension are major causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Reports from the Caribbean renal registry have also identified diabetes mellitus and hypertension as the leading causes of chronic kidney disease and end-stage renal failure. Chronic non-communicable diseases including chronic kidney disease continue to be a major financial challenge in the Caribbean. Patients with chronic kidney disease have high rates of healthcare utilization, morbidity and mortality, and hence constitute a significant economic and clinical burden to the healthcare system. Emphasis should be placed on ways to reduce the incidence of kidney disease and the progression to dialysis. The most economically feasible form of renal replacement therapy that offers the best quality of life should be sought.
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Insuficiência Renal Crônica/epidemiologia , Região do Caribe/epidemiologia , Efeitos Psicossociais da Doença , Países em Desenvolvimento , Saúde Global , Humanos , Falência Renal Crônica/epidemiologia , Transplante de Rim/estatística & dados numéricos , Diálise Peritoneal/estatística & dados numéricos , Sistema de Registros , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/economia , Obtenção de Tecidos e Órgãos/organização & administraçãoRESUMO
OBJECTIVE: To characterize and evaluate complications and outcomes of the patients treated with automated peritoneal dialysis (PD) at the University Hospital of the West Indies (UHWI), Jamaica. METHOD: Retrospective data were collected from peritoneal dialysis patients' case files retrieved from the medical records department of UHWI. Demographic data (age, gender address, marital status), year of dialysis commencement, cause of end stage renal disease (ESRD), haemoglobin, serum electrolytes, serology, blood pressure readings, medications used, blood transfusion and erythropoietin use were collated. Complications such as infections (pneumonia, catheter-related infections), cardiac related disorders (congestive cardiac failure, acute coronary syndrome, pericarditis/pericardial effusion), cerebrovascular diseases, renal osteodystrophy, complications of the procedure and of end stage renal disease (ESRD), outcome and cause of death were retrieved from patients' case files for analysis. RESULTS: There were 202 patients receiving peritoneal dialysis between September, 1999 and December 2008. Data on 190 were analysed. The case files of 12 patients were not included because of incomplete data. The ages of the studied PD patients ranged between 33 and 65 years. The mean haemoglobin was 7.4 g/dL, serum calcium of 2.1 mmol/L, serum phosphate of 1.9 mmol/L and calcium/phosphate product of 4.1mmol2/L2. The serum albumin was 32 g/L and serum total cholesterol/HDL ratio of 5.3. Most patients were from Kingston and St Andrew (56.8%), St Catherine (18.9%) and Clarendon (7.4%). Hypertension (27.9%), chronic glomerulonephritis (17.9%) and diabetes mellitus (17.4%) were the commonest causes of ESRD. There were 70.5% unmarried persons and 81.6% of patients were unemployed. HIV, Hepatitis B and Hepatitis C seropositivity were discovered in 4.1%, 1.1 and 0.5% of patients respectively. Only 20% of the patients used erythropoietin and of this 92% used it less than 50% of the prescribed frequency. Infections (43.2%) such as pneumonia, peritonitis, catheter tunnel infection, exit site infection and cardiac related complications (37.4%) such as congestive cardiac failure, acute coronary syndrome, pericarditis/pericardial effusion were the most frequently encountered complications. Forty-one per cent of patients were transferred to haemodialysis mainly on account of inadequate dialysis clearance. Sepsis (42%) such as pneumonia, urinary tract infection, peritonitis and cardiac related causes (31%) such as congestive cardiac failure and acute coronary syndrome were the two major causes of death. Of those who died of sepsis, 45.2% had pneumonia. Only 9.5% (4/42) of patients had confirmed peritonitis during their illness. CONCLUSION: Infection and cardiovascular disease were common complications observed in this study. Therefore intensive management of risk factors (hypertension, diabetes and dyslipidaemia) and prompt recognition of infection is hereby recommended. Early recognition and appropriate management of sepsis in peritoneal dialysis patients should be initially based on standard protocol. The use of erythropoietin in peritoneal dialysis patients will enhance better management of anaemia and improve quality of life.
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Diálise Peritoneal , Adulto , Idoso , Comorbidade , Diabetes Mellitus/epidemiologia , Hospitais Universitários , Humanos , Hipertensão/epidemiologia , Jamaica , Falência Renal Crônica/epidemiologia , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Estudos RetrospectivosRESUMO
OBJECTIVES: To document the histopathological spectrum of atypical nephrotic syndrome in Jamaican children and to make clinicopathological correlations which will assist physicians in identifying patients needing nephrology consultation. METHODS: This was a retrospective review of renal biopsy data of Jamaican children who were referred to the University Hospital of the West Indies and the Bustamante Hospital for Children between January 1985 and December 2008. The study population consisted of children < 12 years old with atypical nephrotic syndrome. RESULTS: Biopsies were done in 157 children--85 males and 72 females (mean age 8.91 +/- 3.44 years). Indications for biopsy were steroid resistance (35%), frequent relapses (8.9%) and other atypical presentations (56.1%). Overall, mesangial proliferative glomerulonephritis (MesGN) was the commonest histology (49/157, 31.2%), followed by minimal change disease (MCD) (36/157, 22.9%) and diffuse proliferative glomerulonephritis (DPGN) (26/157, 16.6%). Infection was present in 38/157 (24%) cases. Diffuse proliferative glomerulonephritis was the predominant type associated with streptococcal infection (52.9%) while Hepatitis B was seen in 83% of cases of membranous nephropathy. CONCLUSION: Mesangial proliferative glomerulonephritis is the commonest histology seen in Jamaican children with atypical nephrotic syndrome. Most membranous nephropathy is Hepatitis B related. Hypertension with hypocomplementaemia, renal failure and anaemia are features of more serious renal disease (eg membranoproliferative glomerulonephritis and crescentic nephritis) rather than MCNS and should warrant urgent nephrology consultation for renal biopsy.
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Rim/patologia , Síndrome Nefrótica/patologia , Criança , Pré-Escolar , Feminino , Glomerulonefrite Membranoproliferativa/patologia , Glomerulonefrite Membranosa/microbiologia , Glomerulonefrite Membranosa/patologia , Humanos , Jamaica , Masculino , Nefrose Lipoide/patologia , Infecções Estreptocócicas/patologiaRESUMO
OBJECTIVE: To document the histological findings in Jamaican children undergoing renal biopsy in order to determine the relative prevalence of varying types of glomerular disease in the island. METHODS: This study analyses retrospectively the renal histology in all Jamaican children less than age 12 years undergoing their first adequate renal biopsy between January 1985 and December 2008. Clinicopathological data were obtained solely from the histology reports from the University Hospital of the West Indies where all paediatric renal biopsies are processed. RESULTS: Of the 270 children, aged 1 month to 11 years (mean 7.58 years), 147 [58.1%] were males. The commonest indications for renal biopsy were nephrotic syndrome (57.4%) and glomerulonephritis (30%). Most biopsied children (260/270) had glomerular disease. The predominant glomerulonephritides were diffuse proliferative glomerulonephritis (DPGN) (27.7%) and mesangial proliferative glomerulonephritis (MesGN) (25.5%). Glomerular disease was idiopathic in 136/260 (53%) but was infection-associated in 32.3% (84 cases) of which Poststreptococcal glomerulonephritis (PSGN) was the commonest (75%)--predominantly DPGN (74.6%). Hepatitis B followed at 15.5% (13/84) manifested as membranous nephropathy in 83.3% (10/12). In patients with SS disease, DPGN was the commonest histology (47.4%). Systemic lupus erythematosus accounted for 5% of all renal biopsies. Over time, PSGN occurred less frequently, with a parallel reduction in DPGN and MesGN. CONCLUSION: In Jamaican children, DPGN is the commonest nephritis. Membranous nephropathy is primarily due to Hepatitis B. The commonest histology in SS disease is DPGN. The role of infection in the pathogenesis of renal disease in Jamaican children is probably underestimated.
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Glomerulonefrite/patologia , Rim/patologia , Síndrome Nefrótica/patologia , Biópsia por Agulha , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Jamaica , Nefropatias/epidemiologia , Glomérulos Renais/patologia , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate the association of serum biochemical markers in patients with chronic kidney disease (CKD) in Jamaica for early detection of renal osteodystrophy (ROD). METHODS: The study contained two groups: CKD group (221) which consisted of adult patients, from dialysis units and renal clinics, with stage III to V CKD. The control group (237) had adult individuals, from the medical outpatient clinics, with mild and controlled chronic diseases and absence of renal failure. The patients in the study were between 18-80 years of age and gave informed consent to participate in the study. The differences in distribution of demographic, clinical and pathologic variables between the two groups were evaluated. Pearson's chi-squared test and Spearman' rho correlation coefficient test was used, with p < 0.01 considered statistically significant. Data analysis was conducted using the statistical package for the social sciences (SPSS) version 17.0. RESULTS: Among the 221 CKD patients in the study, 174 (78.7%) had ROD based on serum intact parathyroid hormone (iPTH) levels. The majority of patients in the control group did not have bone disease ie 95-96%. The majority of CKD patients (70.0%) had high-turnover (HTO) bone disease compared to 29.3% of patients with low-turnover (LTO) bone disease. Dialysis patients who had HTO bone disease compared with those with LTO had significantly higher levels of iPTH and total serum alkaline phosphatase (ALP). A similar relationship was observed among CKD patients not on dialysis. There was a significant individual variation in bone turnover biochemical markers. A total of 237 patients were recruited in the control group. Based on the levels of iPTH and tALP six of them were found to have bone disease. The majority of these patients with bone disease were diabetic (83.3%) while the other patient had cancer (16.7%). The six patients in the control group with bone disease were within the age cohort of 64-80 years, most of whom were 78 years old. CONCLUSION: A combination of serum biochemical markers might predict underlying renal osteodystrophy better that would individual biochemical markers. A predictive model using bone histology and biochemical markers can be developed in the future.
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Biomarcadores/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Insuficiência Renal Crônica/complicações , Adulto JovemRESUMO
Pancreatitis complicating a diagnosis of systemic lupus erythematosus (SLE) is rarely reported in the literature and there are no known published cases thus far in the Caribbean. A 50-year old female diagnosed with SLE and discoid lupus erythematosus (DLE) since 1990, presented in February, 2009, to the University Hospital of the West Indies (UHWI), Kingston, Jamaica, with symptoms suggestive of lupus pancreatitis. Serum amylase level was 2341 IU/L and serum lipase was 203 IU/L. Pancreatitis has a 3-8% rate of occurrence in adult patients with SLE. Aetiology and management of this entity remains controversial in these cases, but one must bear the diagnosis in mind, when faced with a SLE patient presenting with abdominal pain, vomiting and diarrhoea.
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Lúpus Eritematoso Sistêmico/complicações , Pancreatite/etiologia , Amilases/sangue , Feminino , Humanos , Jamaica , Lipase/sangue , Lúpus Eritematoso Discoide/sangue , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Sistêmico/sangue , Pessoa de Meia-Idade , Pancreatite/sangueRESUMO
AIM: Development of the renal registry to include patients at different stages of chronic kidney disease (CKD). BACKGROUND: The 2007 renal registry include cases at different stages of CKD based on the current guidelines according to the National Kidney Foundation (NKF) Kidney Disease Outcome Initiative (K/DOQI) staging. There was an increase in the number of participating countries, with the addition of Antigua and Barbuda, St Lucia and Turks and Caicos. METHODS: Data were collected using a questionnaire form. Data were stored and analysed in Words Excel for Windows or SPSS 12.0. RESULTS: Data were available for Antigua and Barbuda (n = 43), British Virgin Islands (n = 69), Cayman Islands (n = 45), Trinidad and Tobago (n = 564), Jamaica (n = 920), Turks and Caicos (n = 64), St Lucia (n = 51) and Bahamas (n = 121). The registry identified hypertension, diabetes mellitus and Chronic Glomerulonephritis (CGN) as the commonest causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in these countries. The leading cause of death reported was listed as ischaemic heart disease/heart failure, sepsis and cerebrovascular accident. CONCLUSIONS: The majority of patients with CKD and ESRD had hypertension, diabetes mellitus and CGN as the major causes. Collection of data for patients with CKD at different stages was met with some challenges, and resulted in underestimation of the true number of persons with CKD across these Caribbean countries. More emphasis will continue to be placed on improving data collection so the true incidence, prevalence and healthcare burden of CKD is known in the Caribbean. A web based programme is being developed to improve data collection.
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Falência Renal Crônica/epidemiologia , Adulto , Distribuição por Idade , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Distribuição por Sexo , Índias Ocidentais/epidemiologiaRESUMO
BACKGROUND: Quality of Life (QOL) in patients with End Stage Renal Disease (ESRD) is an important measure of dialysis adequacy. Health related QOL is an independent risk factor for mortality in ESRD. The Kidney Disease QOL questionnaire is a highly validated disease targeted instrument with global application. We sought to document QOL and the predictive factors in a cohort of patients with ESRD in Jamaica and Panama. METHODS: Two hundred patients were recruited consecutively from November 2006 - November 2007. Seventy patients were from a tertiary hospital based outpatient dialysis centre, the University Hospital of the West Indies (UHWI), and 40 patients from a private centre, Diabetes Association Renal Unit (DARU) both in Kingston, Jamaica. Ninety patients were consecutively recruited from a tertiary hospital based outpatient dialysis centre in Panama City, Panama. The Kidney Disease Quality of Life - Short Form Questionnaire was administered. Each QOL domain was scored from 0 - 100 with higher scores representing better rating. RESULTS: Mean age was 50 +/- 4 years, with no difference between the cohorts. Panama, however, had significantly higher parameters than the Jamaican cohorts: mean haemoglobin (Hb) 12.4g/dL (p = 0.004), mean serum albumin 45g/dL (p = 0.03) and Urea Reduction Ratio (URR) 78% (p = 0.004). Diabetes Association Renal Unit recorded mean Hb 11.4 +/- 1.3g/dL, mean serum albumin 42.1 +/- 2.3g/dL and URR 72%. The University Hospital of the West Indies documented mean Hb 11.2 +/- 2.4g/dL, mean serum albumin 41 +/- 4.5g/dL and URR 68%. All three cohorts had good overall QOL scores when compared with the reference population. Patients from Panama had higher overall QOL scores than Jamaican patients (p = 0.02). By centre, UHWI had higher overall QOL scores than DARU (p = 0.04). Burden of Kidney Disease domain recorded the lowest overall scores (Reference Population 49, DARU 19.0 (p = 0.001), UHWI 24.0 (p = 0.002), Panama 32.9 (p = 0.03). Patient Satisfaction scores were also significantly reduced across all cohorts (Reference population 72, DARU 52, UHWI 54, Panama 58). The University Hospital of the West Indies had significantly decreased dialysis staff encouragement (p = 0.003). The Diabetes Association Renal Unit noted significant reductions in general health (p = 0.04), physical functioning (p = 0.001), physical role (p = 0.001) and emotional role (p = 0.005) domains. Panama had the lowest overall physical functioning (p = 0.01), pain (p = 0.01) and social support (p = 0.04) scores. In the Panamanian cohort, age< 65 years (p = 0.0004). Hb > 11.1 g/dL (p = 0.01), albumin > 40g/dL (p = 0.01), URR > 65% (p = 0.03), race (p = 0.04), at least high school educational attainment (p = 0.01) and household yearly salaries > US$5000 (p = 0.002) predicted good QOL scores. These accounted for 55% of the variance. In the Jamaican cohort, however, younger age (p = 0.02), race (p = 0.001), higher URR (p = 0.01) and higher serum haemoglobin (p = 0.001) predicted higher QOL scores, accounting for only 40% of the variance. By modality, haemodialysis patients had significantly higher haemoglobin (p = 0.003) and albumin (p = 0.002) levels and ultimately higher overall QOL scores (p = 0.01). CONCLUSION: Overall, QOL is good in patients with ESRD. Domains of highest concern include Burden of Kidney Disease and Patient Satisfaction. The role of spirituality, depression and nutritional markers (eg prealbumin) needs to be assessed. Quality of Life must therefore be routinely documented in ESRD patients and targeted interventions implemented.