Pattern of haematologic abnormalities in incident dialysis patients and the effect of using locally derived haematologic reference ranges

Background: The aim of the study was to compare the prevalence of haematologic abnormalities seen in incident haemodialysis patients using standard laboratory reference ranges with reference ranges derived locally.Study Design and Method: This was a retrospective study of 97 patients with renal failure who received haemodialysis at a single dialysis unit in Lagos, Nigeria. All patients were 18 years of age or older, had renal failure requiring dialysis, and had not previously dialyzed. Patients with a history of haemoglobinoapthy or other red cell disorders, recent history of overt blood loss or blood transfusion and pregnancy were excluded.Results: Fifty six (57.7%) of the patients were males; and 55 (56.7%) had chronic kidney disease. There were no significant differences in baseline characteristics between males and females, however, patients with CKD had significantly higher mean systolic and diastolic blood pressures, mean serum creatinines and lower mean haemoglobin concentrations.Overall, anaemia was the most common haematologic abnormality (97.9%), followed by leukocytosis (34.0%). Leukopenia, thrombocytosis and thrombocytopenia were less common (3.1%, 7.2% and 10.3% respectively). The use of locally derived reference ranges was associated with significantly higher frequencies of occurrence of majority of the haematologic abnormalities studied.Conclusion: Haematological abnormalities occurred frequently in the study population. Use locally derived haematologic reference ranges was associated with significant differences in the frequency and pattern of some of the haematologic abnormalities. Further studies are needed to determine the clinical implications of these findings.Keywords: Haematologic abnormalities; chronic kidney disease; acute kidney injury; dialysi

Iron indices in adults with sickle cell nephropathy in Lagos, Nigeria

Introduction: Although several studies have explored iron indices in patients with sickle cell anaemia (SCA), there is a paucity of evidence regarding the iron status of patients with sickle cell nephropathy (SCN). This study evaluated the range of iron status of adult SCA patients with or without nephropathy in Lagos, Nigeria.Methods: This was a cross-sectional study performed at the Sickle Cell Clinic of the Lagos University TeachingHospital (LUTH). Patients who were aged 18–65 years were assessed for SCN by determining the albumin-to creatinine ratio (UACR) on a spot urine sample, and determining the estimated glomerular filtration rate, using the CKD–EPI formula, on a steady-state serum creatinine concentration. Iron indices including serum ferritin, serum iron and total iron-binding capacity (TIBC) were measured, and percentage transferrin saturation (TSAT) was calculated. Data were analysed with the Statistical Package for the Social Sciences (SPSS) version 23. Results: A total of 200 patients were included, of whom 119 had SCN. There were no statistically significantdifferences in iron indices in participants with or without SCN. The median serum ferritin and TSAT of patients with SCN were 265 ng/mL and 31.8%, respectively, while the values were 255 ng/mL and 33.5% in those without SCN, respectively. Few participants were noted to have iron overload based on ferritin and TSAT values, regardless of SCN diagnosis. Although not statistically significant, females tended to have higher ferritin and serum iron values compared to males, irrespective of the presence or absence of SCN; whereas females without SCN had statistically significant higher TSAT values compared to males without SCN (36.2 ± 15.0% and 28.8 ± 11.5%, P = 0.03).Conclusion: Although iron overload is common in patients with SCA, our findings indicate that patients with SCNmay require routine evaluation of iron indices because few were iron overloaded. For this reason, the evaluation of iron indices in patients with SCN should be individualised to guide the direction of care and improve clinicaloutcomes. &nbsp

A study of outcome and complications associated with temporary hemodialysis catheters in a Nigerian dialysis unit

Hemodialysis (HD) catheters are commonly used as temporary vascular access in patients with kidney failure who require immediate HD. The use of these catheters is limited by complications such as infections, thrombosis resulting in poor blood flow. We studied the complications and outcomes of nontunneled catheters used for vascular access in our dialysis unit. The records of all patients, with renal failure who were dialyzed over a two-year period and had a double lumen nontunneled catheter inserted, were retrieved. Catheter insertion was carried out under ultrasound guidance using the modified Seldinger technique. The demographic data of patients, etiology of chronic kidney disease, and complications and outcomes of these catheters were noted. Fifty-four patients with mean age 43.7 ± 15.8 years had 69 catheters inserted for a cumulative total of 4047 catheter-days. The mean catheter patency was 36.4 ± 37.2 days (range: 1-173 days). Thrombosis occluding the catheters was the most common complication and occurred in 58% of catheters leading to catheter malfunction, followed by infections in18.8% of catheters. During follow-up, 30 (43.5%) catheters were removed, 14 (20.3%) due to catheter malfunction, eight (11.6%) due to infection, five (7.2%) elective removal, and three (4.3%) due to damage. Thrombotic occlusion of catheters was a major limiting factor to the survival of HD catheters. Improvement in catheter patency can be achieved with more potent lock solutions

Chronic kidney disease in the emergency centre: A prospective observational study

Introduction: Late presentation, usually to the emergency centre (EC), is frequently reported among patients with chronic kidney disease (CKD) in resource-limited settings, and is known to be associated with poor outcomes. This study aims to describe the pattern of EC presentation of adults with CKD in Southwest Nigeria. Methods: This was a prospective observational study of 158 consecutively presenting CKD patients at the EC of two tertiary hospitals in Southwest Nigeria. Patients 18 years of age or older who were admitted into the EC at either study site with an admitting diagnosis of CKD and who consented to participate in the study were recruited. Socio-demographic characteristics, primary reason(s) for admission into the EC, requirement for dialysis, as well as the indication for dialysis were documented. The patients were followed-up for the duration of their stay in the EC and the outcome of EC admission documented. Results: Overall, 54 (34.2%) were females, median age was 49 years and 74.1% were not known to have CKD prior to EC admission. The commonest indications for admission into the EC were uraemia, sepsis and hypertensive crisis, with 73.4% of the patients having at least one indication for dialysis at EC admission. The commonest indications for dialysis were uraemia, marked azotaemia and acute pulmonary oedema. The median time to first session of dialysis was 48 h and 24.1% of patients who required dialysis were not dialysed. Death during the period of EC admission occurred in 14 (8.9%) patients all of whom were not previously known to have CKD. Discussion: There is a large pool of undiagnosed CKD among the general population. In many of these, the diagnosis will likely be made only when they present to the EC with complications. Late diagnosis is associated with worse outcomes. Keywords: Chronic Kidney Disease, Late Presentation, Emergency Centre in the Article Info Sectio

Health care-seeking behavior among patients with chronic kidney disease: A cross-sectional study of patients presenting at a single teaching hospital in Lagos

Introduction: Health care-seeking behavior of individuals determines how early they present for appropriate care. In patients with chronic kidney disease (CKD), late presentation to the nephrologist is associated with poor outcomes. This study aims to describe the health care-seeking behavior of patients with CKD attending the nephrology outpatient clinic of a teaching hospital located in Lagos, Nigeria. Materials and Methods: This was a cross-sectional survey conducted on 104 consecutive adult patients with CKD, presenting for the first time at the nephrology outpatient clinic of a teaching hospital located in Lagos, South West Nigeria. Information was retrieved from the study participants using a structured interviewer-administered questionnaire, entered into an Excel spreadsheet, and analyzed using Epi Info® statistical software version 7.0. Results: Overall, 74 (71.2%) patients sought help, first from a trained health care provider, and their health care-seeking behavior was adjudged to be appropriate. Compared to patients with appropriate health care-seeking behavior, those with inappropriate health care-seeking behavior had a lower mean age (40.4 ± 13.7 years vs 47.3 ± 15.6 years;P = 0.03), were less likely to see their illness as a medical problem (46.7% vs 67.6%;P = 0.04), more likely to have a monthly income less than N25,000 ($150) (80.0% vs 59.5%;P = 0.04), and have received below tertiary level education (20.0% vs 48.6%; P < 0.01). They were also more likely to have consulted more than one health care provider before being referred to our clinic. The factors predicting inappropriate health care-seeking behavior were education below the tertiary level and age less than 45 years. Conclusion: Though health care-seeking behavior was appropriate in majority of our patients with CKD, there remains a need for improved public health awareness

Effects of gender on patient's satisfaction with physician care and communication skills in a tertiary hospital in Nigeria

Patient satisfaction is an important indicator of quality of care. Satisfied patients tend to be more adherent to medical recommendations and are less likely to disenroll from healthcare plans. The study set out to empirically investigate the influence of patient and physician gender on patient’s satisfaction with the clinical care and physician’s communication skills. The study is a cross sectional survey of 300 patient-physician pairs at 5 adult outpatient clinics of a tertiary hospital in Nigeria. Satisfaction to the clinical care received and communication skills of the physician were assessed by the patients using the adapted Patients Satisfaction Questionnaire Form 18 (PSF-18). Three hundred patient-physician pairs were examined, and they made up of 300 patients and 150 physicians. Two hundred and eleven (70.3%) and 249 (83%) respondents were satisfied with the clinical care and physician’s communication skills respectively. Respondents attended to by female physicians were more likely to be satisfied with the clinical care [female 72.8% vs male 62.8%, p &lt; 0.01] and communication skills [female 88.8% vs male 77%, p &lt; 0.01] than those attended to by male physicians. Respondent’s gender had no influence on both the clinical care [male 49.7% vs female 50.3%, p - 0.90] and physician’s communication skills [male 49.0% vs female 51.0%, p - 0.44]. Physician’s gender [Odd Ratio (OR), 2.4] and cadre (OR, 3.8) independently predict patient’s satisfaction to the clinical care received, while only physician’s gender (OR, 1.7) predicts patient’s satisfaction to communication skills. This study showed that physician’s gender influenced patient’s satisfaction to both the clinical care and physician’s communication skills during medical consultation.Keywords: Communication, Clinical care, Gender, Physician, Satisfaction