Serum C-reactive protein levels in pre-dialysis chronic kidney disease patients in southern Nigeria

Background: Cardiovascular disease is the major cause of hospitalization and mortality in chronic kidney disease (CKD). C- reactive protein (CRP) is a marker of cardiovascular disease and predictor of mortality in CKD patients. CKD patients with elevated CRP should be identified early with institution of measures to treat cardiovascular risk factors in order to reduce attendant mortality.Aims: Determination of serum CRP levels in CKD patients and associated factors.Methods: This was a case-control study involving 80 consecutive CKD patients and 40 control subjects without CKD. Data obtained from participants included demographics, body mass index (BMI), and aetiology of CKD. Serum CRP levels, albumin, creatinine and lipid profile were determined. Cases and controls were compared. P values <0.05 were taken as significantResults: The mean age of the CKD subjects was 49.09±16.85 years. The median CRP value was significantly higher in the CKD group compared to controls (p=<0.001). Low, average and high cardiovascular event risk according to CRP values were present in 51(63.8%), 13(16.2%) and 16(20%) of the CKD patients respectively. Cardiovascular event risk was significantly higher in CKD subjects (p <0.001). Serum creatinine, BMI, triglyceride and atherogenic index of plasma correlated positively with CRP. Estimated glomerular filtration rate (eGFR), high density lipoprotein-cholesterol and albumin correlated negatively with CRP. Elevated serum CRP was significantly predicted by low eGFR and high BMI on multivariate analysis.Conclusion: Chronic kidney disease patients have increased cardiovascular event risk. Interventions aimed at reducing weight and treating dyslipidaemia should be instituted early in order to reduce this risk.Keywords: C-reactive protein, chronic kidney disease, Nigeri

Organ Donation and Transplantation in Sub-Saharan Africa: Opportunities and Challenges

Sub-Saharan Africa (SSA), occupying about 80% of the African continent is a heterogeneous region with estimated population of 1.1 billion people in 47 countries. Most belong to the low resource countries (LRCs). The high prevalence of end-organ diseases of kidney, liver, lung and heart makes provision of organ donation and transplantation necessary. Although kidney and heart transplantations were performed in South Africa in the 1960s, transplant activity in SSA lags behind the developed world. Peculiar challenges militating against successful development of transplant programmes include high cost of treatment, low GDP of most countries, inadequate infrastructural and institutional support, absence of subsidy, poor knowledge of the disease condition, poor accessibility to health-care facilities, religious and trado-cultural practices. Many people in the region patronize alternative healthcare as first choice. Opportunities that if harnessed may alter the unfavorable landscape are: implementation of the 2007 WHO Regional Consultation recommendations for establishment of national legal framework and self-sufficient organ donation/transplantation in each country and adoption of their 2020 proposed actions for organ/transplantation for member states, national registries with sharing of data with GODT, prevention of transplant commercialization and tourism. Additionally, adapting some aspects of proven successful models in LRCs will improve transplantation programmes in SSA

Awareness of blood pressure status, undiagnosed hypertension and proteinuria among adults in Umuahia, South-East Nigeria

Background: Hypertension and proteinuria are risk factors for cardiovascular disease. They are also important risk factors for further deterioration of renal function in chronic kidney disease (CKD) irrespective of the cause of CKD. Both are asymptomatic at early stages and can only be detected during medical consultation for a related or unrelated illness. Materials and Methods: This was a cross-sectional study carried out to assess awareness of blood pressure (BP) status among adults in a semi-urban community in Southern Nigeria. The magnitude of undiagnosed hypertension and proteinuria in the community was also assessed. BP measurement was by standardized method while proteinuria was detected by use of urinary dipstick. Data was analyzed using SPSS version 21.0. Results: A total of 389 people were recruited. There were 223 (57.3%) males and 116 (42.7%) females. Only 104 (26.7%) were aware of their BP status before the study. Awareness was higher in females but did not differ significantly among the different age groups, educational status or occupations. Hypertension was newly diagnosed in 105 (27%) of the participants while proteinuria was diagnosed in 47 (12.1%). Proteinuria and overweight were higher among participants with prehypertension than other BP categories. Conclusions: The study revealed a low level of awareness of BP status and a high prevalence of undiagnosed hypertension and proteinuria in the community. Concerted efforts are needed to improve the awareness of BP and other risk factors for cardiovascular and kidney diseases

Assessment of patient’s satisfaction with healthcare services obtained from a tertiary hospital in southeast Nigeria

Background: Periodic assessment of the services in health facilities will enable health policy makers to identify deficiencies and improve on the quality of health services rendered. Evaluation of patients’ satisfaction is one of the ways of doing this assessment. Only few studies have addressed this issue in sub-Saharan Africa. Materials/Method: A semi-structured pre-tested questionnaire was administered to 406 consenting patients in the medical and surgical wards of Abia Specialist Hospital and Diagnostic Centre, Umuahia, South-East Nigeria. Results: There were more males (210) than females (196). Up to 79.8% of the patients were satisfied with services rendered at the hospital. There was a significant positive correlation between the satisfaction scores and number of times a patient was seen by the doctor or nurse (r = 0.315, p<0.001) and a significant negative correlation between the satisfaction scores and total duration of stay in emergency unit (r = -0.524, p<0.001). Patients who were satisfied had a lower mean pre-intervention waiting time at the accident and emergency or outpatient clinic than patients who were not satisfied (12.4±6.6 vs 15.7±8.0 minutes respectively) and this was statistically significant (t= 3.40, p=0.001). Multivariate logistic regression showed that the educational level of the patients (adjusted odds ratio [AOR]=2.27, p=0.024), number of times seen by the doctors ( AOR = 4.09, p<0.001), pre-intervention waiting time (AOR=2.84, p<0.001) and outcome of treatment (AOR= 5.29, p<0.001) were the determinants of patients’ satisfaction. Conclusion: Most patients were satisfied with services at the medical and surgical wards of this hospital. The determinants of this satisfaction include educational level of the patients, the number of times the patient is seen by doctors or nurses, pre-intervention waiting time and outcome of treatment

Hyperuricemia in predialysis chronic kidney disease patients in Southern Nigeria

Background: Cardiovascular disease (CVD) is the leading cause of hospitalization and death in chronic kidney disease (CKD) patients. Hyperuricemia has emerged as one of the nontraditional cardiovascular risk factors. Studies have shown that hyperuricemia plays a major role in the development of CVD and rapid progression of CKD to end-stage renal disease. Objective: The aim was to determine the prevalence and pattern of hyperuricemia in predialysis CKD patients attending a teaching hospital in Southern Nigeria. Methodology: One hundred and twenty consecutive predialysis CKD patients and 40 control subjects with normal renal function were recruited over 2 years. Data obtained from participants included demographics, body mass index, blood pressure reading, and etiology of CKD. Blood sampling was done for the determination of serum uric acid, creatinine, and fasting serum lipids. P < 0.05 were taken as significant. Results: The mean age of the CKD subjects was 48.8 ± 16.6 years with a male:female ratio of 1.7:1. The prevalence of hyperuricemia in the CKD subjects was 47.5% and this was significantly higher than 15% observed in the control group (P ≤ 0.001). The prevalence of hyperuricemia was highest in CKD stage 3b. Hyperuricemia was more prevalent in younger predialysis CKD subjects and those with hypertensive nephropathy. There was no significant association between hyperuricemia, obesity, gender and dyslipidemia in this study. Conclusion: Hyperuricemia is highly prevalent in young predialysis CKD patients even in the early stages. Measures to reduce hyperuricemia should be put in place especially lifestyle and dietary modification

Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review

Abstract Background Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations. Methods We conducted this scoping review to answer the question: “what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?” Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively. Results Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Conclusion Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined