Correlation between Albuminuria and Ankle Brachial Index among Nigerians with Chronic Kidney Disease

Background: Peripheral arterial disease (PAD), the most common manifestation of atherosclerosis and chronic kidney disease (CKD), has been described as an independent risk factor for its development. The combination of CKD and PAD multiplies the risk of cardiovascular disease. Ankle-brachial pressure index (ABPI) is a good marker of atherosclerosis and is useful for the diagnosis of PAD. The study aimed to determine the prevalence, pattern and predictors of PAD in patients with CKD. Materials and Methods: This was a cross-sectional study of patients with CKD with age and gender-matched controls. Medical history relating to CKD and PAD was obtained using a pre-tested questionnaire. The ABPI was measured using handheld Doppler ultrasound equipment. Blood samples were drawn for serum creatinine and spot urine for Urinary Albumin Creatinine Ratio (UACR). Results: One hundred and thirty-two subjects participated in the study, 66 cases and 66 controls. The mean ages were 47.5±15.9 years in cases and 41.6±11.6 years in controls. The mean ABPI (0.9±0.2 vs 1.0±0.1, p-0.01), eGFR (62.8±28.2 vs 98±23.1ml/min/1.73m2 , p-0.01) were lower in the cases compared to the controls while UACR was higher in the cases (3.1±1.1 vs 1.2±0.1, p-0.01. The prevalence of PAD was 36 (54.5%) and 15 (22.7%) among cases and controls, respectively (p < 0.01) while low eGFR OR, 3.9 (1.86-10.41), elevated Systolic blood pressure (SBP) OR, 1.83 (1.40-5.78) and UACR (t-3.663, p-0.023) were associated with PAD in CKD. Conclusion: This study demonstrated that high prevalence of PAD among individuals with CKD while low eGFR, elevated SBP and microalbuminuria were clinical correlates of PAD in CKD

Effects of gender on patient's satisfaction with physician care and communication skills in a tertiary hospital in Nigeria

Patient satisfaction is an important indicator of quality of care. Satisfied patients tend to be more adherent to medical recommendations and are less likely to disenroll from healthcare plans. The study set out to empirically investigate the influence of patient and physician gender on patient’s satisfaction with the clinical care and physician’s communication skills. The study is a cross sectional survey of 300 patient-physician pairs at 5 adult outpatient clinics of a tertiary hospital in Nigeria. Satisfaction to the clinical care received and communication skills of the physician were assessed by the patients using the adapted Patients Satisfaction Questionnaire Form 18 (PSF-18). Three hundred patient-physician pairs were examined, and they made up of 300 patients and 150 physicians. Two hundred and eleven (70.3%) and 249 (83%) respondents were satisfied with the clinical care and physician’s communication skills respectively. Respondents attended to by female physicians were more likely to be satisfied with the clinical care [female 72.8% vs male 62.8%, p < 0.01] and communication skills [female 88.8% vs male 77%, p < 0.01] than those attended to by male physicians. Respondent’s gender had no influence on both the clinical care [male 49.7% vs female 50.3%, p - 0.90] and physician’s communication skills [male 49.0% vs female 51.0%, p - 0.44]. Physician’s gender [Odd Ratio (OR), 2.4] and cadre (OR, 3.8) independently predict patient’s satisfaction to the clinical care received, while only physician’s gender (OR, 1.7) predicts patient’s satisfaction to communication skills. This study showed that physician’s gender influenced patient’s satisfaction to both the clinical care and physician’s communication skills during medical consultation.Keywords: Communication, Clinical care, Gender, Physician, Satisfaction

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

Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria

Introduction:&nbsp;vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis. There continues to be a challenge with the creation of AV fistula, due to shortage of vascular surgeons skilled in the AV fistula creation particularly in source limited setting. We described the outcomes of the tunneled internal jugular venous catheters amongst our patients at the University College Hospital (UCH) Ibadan. Methods:&nbsp;a retrospective study of patients on maintenance haemodialysis at the UCH, Ibadan, we reviewed the records of all patients on chronic dialysis over a period of 5 years. Information obtained include demographics, types and aetiology of renal failure, types of vascular access, observed complications and outcomes. Results:&nbsp;a total number of 147 catheters were inserted during the period under review, 94 were in males while 53 were females. The age range was 18-85 years while the mean age was 46.3 ± 17.2 years. The range and mean duration for Tunneled Dialysis Catheter (TDC) carriage were (30 - 1,440) and 220±185 days respectively. The observed immediate complications of TDCs were failed first attempt 7(4.7%), reactionary haemorrhage 5(3.4%), arrhythmia 3(2.0%), haemothorax 2(1.4%) while death during catheter placement was recorded in 2(1.4%) cases. Catheter related infection was the commonest long-term complications and occurred in 15 cases (10.1%), while being diabetic increased the risk of developing catheter related complications. One tenth of our patients with End Stage Renal Disease on TDC had kidney transplantation while catheter related mortality was 16.3%. Conclusion:&nbsp;internal jugular tunneled dialysis catheters despite its shortcomings, has been a safe procedure with good outcomes among our patients on maintenance haemodialysis

Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery

Abstract Background It is necessary to define the problem of acute kidney injury (AKI) after non-cardiac surgery in order to design interventions to prevent AKI. The study aimed to evaluate the occurrence, determinants and outcome of AKI among children undergoing general (non-cardiac) surgery. Methods This was a prospective cohort study of patients aged ≤ 15 years who had general surgery over 18 months period at a tertiary hospital in Nigeria. AKI was evaluated at 6 and 24 h and within 7 days of surgery. Data were analysed using SPSS version 21. Results A total of 93 patients were studied with age ranging from 3 days to 15 years (median = 4 years). AKI occurred within 24 h of surgery in 32 (34.4%) and cumulatively over 7 days in 33 (35.5%). Patients who had sepsis were nearly four times as likely as others to develop perioperative AKI (OR = 3.52, 95% CI 1.21, 10.20, p = 0.021). Crude mortality rate was 12.1% (4/33); no mortality was recorded among those without AKI, p = 0.014. Conclusion Perioperative AKI occurred in 35.5% of children who underwent general (non-cardiac) surgery. Patients who had sepsis were four times more likely than others to develop AKI. Mortality was documented only in patients who had AKI