Haemodialysis practice in a resource–limited setting in the tropics

Background: Objective: To provide information on the challenges of haemodialysis in a resource limited setting in South-Western Nigeria.Methods: This is a 5 year audit of all haemodialysis sessions carried out at the renal unit of the Ladoke Akintola University Teaching Hospital  (LAUTECH), Osogbo, Nigeria.Results: A total of 225 patients were offered haemodialysis (HD) during this period with age range of 10 to 85 years (mean age of 49  years±16.25). There were 155 males and 70 females (male to female  ratio of 2.2:1). Chronic kidney failure accounted for 180 (80%) of the cases while acute kidney injury (AKI) constituted 45 (20%) of the cases offered haemodialysis. The sessions of HD in both cases ranged from 1 to 27 with an average of 3 sessions. Hypotension is still the commonest intradialytic complication at our setting while diabetic nephropathy is rapidly emerging as a major cause of end stage renal disease at our setting  requiring HD. As seen in other parts of the tropics sepsis, nephrotoxinsand pregnancy related cases still accounted for a large percentage of AKI cases requiring haemodialysis. Only three patients were able to afford haemodialysis support for more than three months.Conclusion: Haemodialysis still remains a veritable option in renal  replacement therapy. Problems encountered were similar to many other settings in the tropics. Intensive efforts should still be geared at preventing the risk factors for both acute kidney injury and chronickidney disease in our environment.Keywords: Haemodialysis, practice, tropics, Resource limite

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Public knowledge of chronic kidney disease evaluated using a validated questionnaire: a cross-sectional study

Background: Screening programs may help to address the burden of chronic kidney disease (CKD) in Australia. Public awareness is an important determinant of the uptake of screening programs. However, data on the public knowledge of CKD in Australia is lacking. The aim of this study was to develop a validated questionnaire and assess the Australian public knowledge of CKD. Methods: A CKD knowledge questionnaire was developed after reviewing the literature and discussions with nephrology experts. Content validity was performed by nephrologists (n = 3), renal nurses (n = 3) and research personnel (n = 4). The questionnaire was piloted in 121 public participants. Next, discriminant validation was performed by recruiting two additional groups of participants: final year undergraduate pharmacy students (n = 28) and nephrologists (n = 27). Reliability of the questionnaire was assessed by calculating Cronbach’s alpha. Next, a cross-sectional survey of the Australian public (n = 943) was conducted by using the validated questionnaire. It was administered using an online Omnibus survey. Quota sampling was used for participant selection and to ensure that the final sample would match the key characteristics of the Australian population. Finally, a standard multiple regression analysis was performed to identify predictors of the public knowledge. Results: The median CKD knowledge scores of the public, students and nephrologists were 12, 19 and 23 (maximum score of 24), respectively, with statistically significant differences in the scores across the three groups (p < 0.001; Kruskal-Wallis test). The Cronbach’s alpha was 0.88 (95% CI: 0.86–0.91), indicating that the questionnaire had good internal consistency. In the cross-sectional survey of the Australian public, the participants’ mean (SD) age was 47.6 (±16.6) years and 51.2% were female. The mean (SD) knowledge score was 10.3 (± 5.0). The multivariate analysis showed that participants with a higher level of education; with a family history of kidney failure; with a personal history of diabetes; and currently or previously living in a relationship had significantly higher knowledge scores. Conclusion: The Australian public knowledge of CKD was relatively poor. Improving public knowledge may assist in increasing early detection and subsequent management of CKD in Australia

Awareness, knowledge and perception of chronic kidney disease in a rural community of South‑West Nigeria

Background: Awareness and education on kidney disease impact on its effective management and will reduce the significant economic and public health burden. Knowledge of CKD and risk factors increases the perception of being at high risk and increasing health seeking behavior. We conducted a cross‑sectional descriptive study to assess the level of awareness, knowledge and conventional risk factors of CKD in the community to strategize on preventive modalities using the information gathered from this population.Methods: We used a pretested structured questionnaire to draw information on sociodemography, knowledge and risk factors of CKD from 563 residents aged &gt;18 years.Results: A total of 454 residents completed this study, mainly farmers, with a mean age of 45.8 ± 19.0 years and male: female ratio of 0.8:1. Only 33.7% had heard of kidney disease with 59.3% from the media and 35.3% from health workers; the level of knowledge of CKD was good in 27.1%. The majority (67.0%) do not know the correct location of the kidneys. Only 10.6% could mention at least one function of the kidneys with only 24.5% agreeing that NSAIDs can cause kidney disease. A laboratory test for kidney function was known by 4.4%; 45.9% and 47.8% believe that CKD can be cured by spiritual means and herbal concoctions respectively. Only 11.1% agreed that CKD can be hereditary. Abdominal obesity and cigarette smoking were seen in 14.6% and 16.6% respectively. Hypertension was seen in 26.5% while 17.8% actually knew they were hypertensive. Diabetes mellitus was found in 3.4%. None of the patients with CKD who had diabetes or hypertension was aware of kidney disease.Conclusion: There are a misconception and low level of awareness and knowledge of CKD, including those with risk factors, in the community. Efforts should be made to create awareness and educate people on CKD and prevention of its risk factors.Key words: Awareness, chronic kidney disease, knowledge, perceptio

The effect of a membrane dialyzer during hemodialysis on the antioxidant status and lipid peroxidation of patients with end-stage renal disease

Renal failure is accompanied by oxidative stress, which is caused by enhanced production of reactive oxygen species (ROS) and an impaired antioxidant defense. We studied 73 hemodialysis (HD) patients (39 males and 34 females) aged 24-75 years; the patients were randomized into two subgroups according to the type of hemodialysis membrane (35 patients were dialyzed on cellulose and 38 patients on polysulfone F7/F9 membrane dialyzers) and we assessed their antioxidant and lipid peroxidation status levels. The total antioxidant status (TAS) levels including whole blood levels of malondialdehyde (MDA) and glutathione (GSH); glutathione peroxidase (GSH-Px) , superoxide dismutase (SOD), and catalase (CAT) activities were measured, before and after hemodialysis. The MDA levels significantly increased 52.0% and 16.9% post dialysis among the cellulose and the polysulfone dialyzer users, respectively, (P <0.05). The TAS levels significantly decreased, 22.0 and 16.5% in the cellulose and polysulfone dialyzer users, respectively, (P <0.05). The erythrocyte SOD activity decreased 25.1 and 19.1% in the cellulose and the polysulfone dialyzer users, respectively, (P <0.05). The GSH concentrations, post dialysis, decreased 49.9 and 6.8% in the cellulose and polysulfone dialyzer users, respec-tively, (P <0.05). In contrast, the erythrocyte activity of CAT, post dialysis, increased 15.0 and 37.3% in the polysulfone and the cellulose dialyzer users, respectively, (P <0.05). We conclude that the type of the dialysis membrane affects the oxidative status after HD with possible consequences on patient morbidity and mortality

Pulmonary stenosis in pregnancy: A case report

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