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

In vitro Angiotesin-1-converting enzyme,α-amylase andα-glucosidaseinhibitory and antioxidant activities ofLuffa cylindrical(L.) M. Roem seed protein hydrolysate

In recent times, researchers have explored food derived peptides to circumvent the side effects of synthetic drugs.This study therefore examined the amino acid constituents,in vitroantioxidant activities, angiotensin-1-converting enzyme (ACE),α-glucosidase andα-amylase inhibition kinetics of protein hydrolysate obtainedfrom the seed ofLuffa cylindrica. The peptide yield by pepsin (16.93�0.28%) and trypsin (13.20�1.02%) weresignificantly lower than that of Alcalase (34.04�1.96%). Alcalase hydrolysate however displayed the highestferric reducing antioxidant capacity (FRAC), 1,1-diphenyl-2-picrylhydrazyl (DPPH) and H2O2scavenging activ-ities (0.63%, 85.88% and 41.69% respectively), while the highest superoxide scavenging activity was shown bypeptic hydrolysate (57.89%). The ACE inhibition by the hydrolysates with IC50of 0.32–0.93 mg/mL, increased asthe concentration of the peptic hydrolysate increased with the highest ACE-inhibitory activity (74.99�0.43%) at1.2 mg/mL of peptic hydrolysate. Tryptic and Alcalase hydrloysates exhibited a strongα-amylase inhibitionhaving 27.96�0.06% and 36.36�0.71% inhibitory capacity respectively with IC50of 1.02–3.31 mg/mL.Alcalase hydrolysates demonstrated the strongest inhibition (65.81�1.95%), followed by tryptic hydrolysates(54.53�0.52%) in a concentration-dependent inhibition ofα-glucosidase (IC50,0.48–0.80 mg/mL). Kineticanalysis showed that ACE-inhibition by different concentrations of Alcalase, pepsin and trypsin hydrolysates isuncompetitive, mixed-type and non-competitive respectively.α-Amylase was non-competitively inhibited whileα-glucosidase was un-competitively inhibited by all the hydrolysates. The total amino acid concentration forAlcalase, trypsin and pepsin hydrolysates was 53.51g/100g, 75.40g/100g and 85.42g/100g ofLuffa cylindricaseed protein hydrolysate respectively, with glutamate being the most concentrated essential amino acid in all thethree hydrolysates. From these results, it can be deduced thatLuffa cylindricaseed Alcalase and tryptic proteinhydrolysates may play critical and indispensible role as bio-tools in diabetes and hypertension treatment

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

Assessment of factors affecting treatment adherence in patients with chronic kidney disease in Nigeria: A survey from a tertiary health-care centre

Background: Chronic kidney disease (CKD) is a growing global public health problem with the poorest populations being at the highest risk. Strict adherence to treatment has been found to reduce and may halt progression to end-stage kidney disease. Unfortunately, no data on this is available in this clime. The study was carried out to evaluate factors associated with treatment adherence in patients with CKD attending Lagos University Teaching Hospital. Patients, Materials and Methods: This was a cross-sectional study of 124 previously diagnosed CKD patients being managed at the nephrology unit of Lagos University Teaching Hospital, Nigeria. Using a semi-structured questionnaire, data were collected to evaluate the factors affecting treatment adherence in these patients. Results: The mean age of participants was 50.47 ± 13.7 years. Majority were male 71 (57.3%), married 84 (67.7%), employed 71 (57.3%), Christians 85 (68.5%), and had tertiary education 92 (74.1%). More than half of the population (57%) adhered to the prescribed treatment. However, the majority (69%) of the study population also practiced alternative treatment. Major reasons for nonadherence included alternative medications (69%), forgetfulness 30 (24.2%), high cost of medication 28 (22.6%), high pill burden 28 (22.6%), and being tired of drugs (22%). Conclusion: There is an appreciable level of adherence to treatment among our study population mainly affected by high education and income levels with being gainfully employed. However, a lot more needs to be done to further improve compliance through continuous counseling, reduced pill burden, and lowering the cost of treatment

Rationale and Design of the Diet, CKD, and Apolipoprotein L1 Study in Low-Income and Middle-Income Countries

IntroductionDiet, chronic kidney disease (CKD), and Apolipoprotein L1 (APOL1) (DCA) Study is examining the role of dietary factors in CKD progression and APOL1 nephropathy. We describe enrollment and retention efforts and highlight facilitators and barriers to enrollment and operational challenges, as well as accommodations made in the study protocol.MethodsThe DCA study is enrolling participants in 7 centers in West Africa. Participants who consented were invited to complete dietary recalls and 24-hour urine collections in year 1. We conducted focus groups and semistructured interviews among study personnel to identify facilitators and barriers to enrollment as well as retention and operational challenges in the execution of the study protocol. We analyzed emerging themes using content analyses.ResultsA total of 712 participants were enrolled in 18 months with 1256 24-hour urine and 1260 dietary recalls. Barriers to enrollment were the following: (i) a lack of understanding of research, (ii) the burden of research visits, and (iii) incorporating cultural and traditional nuances when designing research protocols. Factors facilitating enrollment were the following: (i) designing convenient research visits, (ii) building rapport and increased communication between the research team and participants, and (iii) cultural sensitivity - adapting research protocols for the populations involved. Offering home visits, providing free dietary counseling, reducing the volume of study blood collection, and reducing the frequency of visits were some changes made in the study protocol that increased participant satisfaction.ConclusionAdopting a participant-centered approach with accommodations in the protocol for cultural adaptability and incorporating participant feedback is vital for carrying out research in low-income and middle-income regions