Risk factors for atherosclerosis in black South African patients on Haemodialysis

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Medicine Johannesburg, 2005ABSTRACT INTRODUCTION The risk of cardiovascular disease in patients with end stage renal disease (ESRD) is far greater than in the general population. Amongst patients with ESRD, the prevalence of coronary artery disease (CAD) and congestive heart failure is approximately 40% compared with 5-12% in the general population. The excess risk is caused by multiple traditional and non-traditional risk factors for ischaemic heart disease present in these patients. There is little information on CAD and its risk factors in black haemodialysis patients as most of these studies were carried out in the white population. This study is therefore aimed at determining the risk factors for atherosclerosis in Black and non-black (White and Indian) South African patients on haemodialysis. METHODS Fifty-eight black patients and twenty-six non-black patients on haemodialysis were recruited. Sixty-three age and sex matched controls (staff, students and kidney donors) were also recruited. Fasting venous blood samples were drawn for measurement of Creactive protein, homocysteine, Lp (a), serum lipids and adiponectin. Carotid intima-media thickness and plaque occurrence was measured by B-mode ultrasonography. Echocardiography was used to determine LVH. vi RESULTS Haemodialysis (HD) patients had significantly lower total cholesterol, LDL cholesterol and triglycerides compared with controls (p<0.001; p= 0.042). Hs-CRP, adiponectin and homocysteine levels were significantly higher in patients compared with controls (p< 0.001). The prevalence of plaques was significantly higher among HD patients (32%) compared with controls (7%) X2 = 60.72 p< 0.001. LVMI was significantly higher among HD patients (194.25± 7.69gm/m2) compared with controls (93.21 ± 3.27 gm/m2) p < 0.001. No significant difference between patients (Black or Asian/White) and controls with respect to CIMT was found. CVD risk factors in black haemodialysis patients and black controls showed a similar pattern to the whole study population combined. Risk factors associated with CIMT on regression analysis were total cholesterol, LDL-cholesterol, age, Hs-CRP, family history of CKD. Risk factors associated with plaque occurrence on logistic regression analysis were age, systolic blood pressure, male gender, smoking, calcium phosphate product and serum phosphate. CONCLUSION HD patients have a high prevalence of traditional and non-traditional risk factors for atherosclerosis and this is independent of race. Traditional risk factors like lipids were much lower in ESRD patients. HD patients showed a high prevalence of atherosclerosis as measured by increased carotid intima-media thickness and plaque occurrence in carotid arteries. Hs-CRP correlated significantly with a surrogate marker of atherosclerosis (CIMT)

Pattern of skin disorders in a rural community in Lagos State, Nigeria

Background: Skin disorders are commonly found in the community. In most circumstances, they are easily treatable and preventable. Social and environmental factors play a key role in the epidemiology of skin disease. It is important to assess the dermatological needs of a community as this will help address specific needs. The objective of this study was to identify the skin disorders in a rural community.Methods: This was a cross-sectional study carried out in Epeme, a rural community in Lagos state, South west Nigeria. All consenting adults and children with parental consent that presented for the screening programme were recruited. A self-reported questionnaire was administered by face-to face interview. Socio-demographic data were collected. All those with a skin disease or complaint were further questioned and a clinical examination carried out and findings recorded.Results: There were 263 individuals screened; 156 adults and 107 children. Mean age of adults was 38.04 ± 13.04 years and children 9.50 ± 4.67 years. Thirty adults (19.2%) and 27 (25.2%) children had a skin disorder identified clinically. Among the adults the following categories of skin disorders were found: infection 12 (7.6%), disorders of sebaceous glands 5 (3.2%), pigmentary disorders 2 (1.2%) and pruritus 1 (0.6%). Among children, 21 (19.6%) had skin infections, 2 (1.8%) each with eczema and sebaceous gland disorder. Majority of the infections in children were of fungal aetiology.Conclusion: Infections still remain the major skin disorders in rural communities in Nigeria where dermatologic healthcare is not readily available and accessible.Keywords: pattern, skin disorders, skin infection, rural, community, Nigeri

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.&nbsp;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

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