Burden, psychological well-being and quality of life of caregivers of end stage renal disease patients

BACKGROUND: Caregivers of chronic kidney disease (CKD) patients play an important role in the management of the patients. Their psychological needs are often overlooked and unmet by the managing team. This study assessed the psychosocial well-being and quality of life (QoL) of caregivers of CKD patients in two hospitals in Southern Nigeria.METHODS: Burden of caregiving, QoL, depression, and anxiety were assessed using standardized instruments; modified Zarit questionnaire, modified SF-12 questionnaire and Hospital Anxiety and Depression Scale (HADS) respectively among caregivers of CKD patients on maintenance haemodialysis and controls.RESULTS: Fifty-seven caregivers of CKD patients and aged and sex-matched controls participated in the study.Anxiety was significantly higher in caregivers compared to control (31.6% vs 5.3%, p = 0.004). Also, depression was significantly higher in caregivers (31.6% vs 3.5%, p= <0.001). Twenty-eight (49.1%) of the caregivers had mild to moderate burden and 19 (33.3%) had a high burden. The mean Zarit burden score was higher in female caregivers compared to male caregivers (18.30±8.11 vs 14.83±6.70, p = 0.09). The mean depression score was higher in female caregivers compared to male caregivers (8.58±3.83 vs 6.75±3.80, p= 0.08). There was significant positive correlation between Zarit burden and hospital anxiety score (r = 0.539, p= < 0.001) and depression score (r = 0.472, p = 0.005).CONCLUSION: Depression, anxiety and burden were common among caregivers of CKD patients especially females compared to controls. Supportive interventions for these caregivers should be included in treatment guidelines in order to improve overall patients’ outcome.Keywords: caregiver, chronic kidney disease, burden, anxiety, depressionFunding: Self-funde

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

Assessment of iron status in predialysis chronic kidney disease patients in a Nigerian Tertiary Hospital

Anemia in chronic kidney disease (CKD) is associated with poor overall outcome if not promptly managed with erythropoietin when indicated. This study assessed iron status and associated factors in predialysis CKD patients in Southern Nigeria. This was a cross-sectional study that assessed and compared iron status in 100 predialysis CKD patients and 90 healthy controls. Mean age of the CKD patients was 49.39 ± 14.84 years. Iron deficiency was present in 14% of CKD patients compared to 3% of the controls (P = 0.021). Among CKD patients with ID, 11 (85.7%) had functional iron deficiency while three (14.3%) had absolute iron deficiency. Serum ferritin was significantly higher in the predialysis CKD patients (P = 0.001). There was no significant gender difference in iron indices among the CKD patients. Functional iron deficiency was present in 11 (11%) of the CKD patients compared to none among the control group (P = 0.003). There was no significant association between iron deficiency and age, gender, etiology, and stage of CKD. Functional iron deficiency was the predominant form of iron deficiency in our predialysis CKD patients, and there was no significant association with age, gender, stage, or etiology of CKD