Haemodialysis vascular access function in dialysis patients at the Kenyatta National Hospital

Background: The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise. Vascular access is the lifeline for these patients when haemodialysis (HD) is the treatment of choice. Access-related morbidity is a leading cause of hospitalization so that the function and patency of access are essential for the optimal management of patients. There is a need to recognize when a vascular access is dysfunctional because intervention must maintain function as well as preserve future vascular access sites.Methods: This was a cross-sectional study that evaluated the haemodialysis vascular access function in patients undergoing chronic haemodialysis at the Kenyatta National Hospital, Nairobi, Kenya. Peak access blood flow rates, urea reduction ratio (URR) and Kt/V were analysed in 150 patients.Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48% achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88% and for tunnelled dialysis catheters 82%. One-quarter of the patients had a URR < 65%. Higher mean blood flow rates were associated with higher URR (P = 0.004) and Kt/V (P = 0.009) values. AVF stenosis was present in 12.5% and thrombosis in 3% of patients. Aneurysms were the commonest AVF complication (47%) but were not haemodynamically significant.Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis dose. Greater blood flow rates were associated with a higher delivered dialysis dose. There is a need for routine surveillance and affordable interventional procedures to prevent loss of vascular access

Living-Related Kidney Graft Donors Sociodemographic Characteristics and Recipients Clinical Characteristics in Kenya: A Single Centre Experience Kenyatta National Hospital 2010-2015 Audit

This article provides summary of sociodemographic and clinical characteristics of the kidney transplant donors and recipients from 2010-2015 from Kenyatta national hospital, Nairobi, Kenya, East Africa. Only living-related organ donation is practiced in Kenya. Accelerated kidney transplantation activities picked up in Kenyatta national hospital from the 2010. The duration from 2010-2015 has seen more kidney transplantations undertaken in the hospital than the ones done in the same hospital from 1984 when first transplantation was performed in Kenya to 2009. The data were extracted from manual medical records. There were about 120 kidney transplantations performed during this period but only 113 complete records were traceable. There were 113 medical records for both kidney graft donors and recipients from 2010-2015. Demographic characteristics for donors and recipients captured included age, sex, and donor-recipient relationships. The mean donor age was 32.9

Human Leucocyte Antigens (DRB1*03, DRB1*04 and DQB1*02) Associated with Type 1 Diabetes Mellitus Among 269 Kidney Graft Donors and Recipients in Kenya

This was a descriptive study which utilized the medical records for the kidney donors and recipients who had been followed up in the kidney transplantation programme in Kenyatta National Hospital, Nairobi, Kenya. Tissue typing is rarely performed routinely among our patients partially due to cost. It is with this in mind that we engaged in extraction of more information from the tissue typing data which have been used in kidney transplantation programme in Kenyatta National Hospital, Nairobi Kenya

Factors Associated with Uncontrolled Hypertension among Renal Transplant Recipients Attending Nephrology Clinics in Nairobi, Kenya

Objective. To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting. Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5, p=0.006), higher levels of proteinuria (p=0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2–65.7, p<0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1–19.0, p=0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6–73.0, p<0.001) were independently associated with uncontrolled hypertension. Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population