Hearing impairment among chronic kidney disease patients on haemodialysis at a tertiary hospital in Ghana

Background: Chronic kidney disease is a major public health challenge, globally. Inadequate excretion of metabolic waste products by the kidneys results in circulation of these toxic materials in the body. This can cause damage to tissues and organ systems including the auditory system which can lead to hearing loss.Aim: The study was aimed at determining the prevalence, degrees and types of hearing impairment among Chronic kidney disease patients on haemodialysis in Ghana.Methods: A case-control study involving 50 Chronic Kidney disease patients and 50 age and gender-matched control group was carried out at the Korle Bu Teaching Hospital (KBTH). A structured questionnaire was administered to obtain basic socio-demographic data and case history of the participants. Audiological assessment was performed using a test battery comprising otoscopy, tympanometry and pure tone audiometry in a soundproof booth.Results: Higher hearing thresholds were recorded across all the frequencies tested among the case group than the control group (p < 0.05) in both ears. Only sensorineural hearing loss was identified among the cases. The prevalence of hearing loss was 32% among the case group and 12% among the control group. No significant association was observed between hearing loss and duration of Chronic kidney disease (p = 0.16), gender of Chronic kidney disease patient and hearing loss (p = 0.88), and duration of Chronic kidney disease and degree of hearing loss (p=0.31).Conclusion: Our study showed that Chronic Kidney disease patients on haemodialysis are at higher risk of experiencing hearing loss.Keywords: Hearing loss, chronic kidney disease, prevalence, haemodialysis, hearing thresholdFunding: None declare

Identification of the Dietary Protein Sources and Their Association with Serum Phosphorus Levels among Patients with Kidney Failure

Background: Major dietary protein sources double as major sources of phosphorus with implications on serum phosphorus in kidney failure (KF) patients. Objectives: To identify the dietary protein sources of kidney failure patients and its association with their serum phosphorus (SP).Methods: Cross-sectional design involving 22 patients with kidney failure ≥ 18 years, recruited from the Renal and Dialysis Unit of the Korle-Bu Teaching Hospital. Sources and amount of protein and phosphorus were determined using quantitative food frequency questionnaire. Serum phosphorus was obtained from patients’ hospital records. Correlation between dietary and serum phosphorus was determined. Data were analyzed using SPSS version 21 at a 95% CI at p ≤ 0.05.Results: Mean age was 46.2 ± 2.5 years. Sources of protein and phosphorus were cereals, animal protein (AP) and legumes and nuts (L&N). The highest contribution for both protein and phosphorus was from cereals (65.7% and 63.4%) respectively. There was no significant correlation between all sources of phosphorus with SP (AP r2 = 0.120, p = 0.595; L&N r2 = -0.045, p= 0.843; cereals r2 = 0.117, p = 0.604) howbeit, legumes and nuts showed a negative correlation.Conclusion; Main dietary source of both protein and phosphorus was cereals. There was no significant correlation between all sources of phosphorus with serum phosphorus levels. Appropriate medical nutrition therapy by qualified nutritionist/dietitians is recommended for this group to prevent protein energy wasting. Keywords: kidney failure, protein, phosphorous, protein energy wasting, serum phosphorous. DOI: 10.7176/JBAH/12-16-04 Publication date:August 31st 202

Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review

Background The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received. Methods We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis. Findings Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis Interpretation Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa

The Ghana Renal Registry – a first annual report

There are few data on the treatment of kidney disease in sub-Saharan Africa and no formal reports of kidney replacement therapy (KRT) in Ghana. We report data from the newly established Ghana Renal Registry on the prevalence, causes, and modality of treatment of kidney disease in Ghana. Using the web-based data capture system of the African Renal Registry, data were obtained for patients who had KRT in Ghana between January and December 2017. A total of 201 patients started KRT, giving an incidence rate of 6.9 per million population (pmp). There were 687 patients on KRT, a prevalence rate of 23.6 pmp. The median age of prevalent patients was 45.5 years and 63.6% were male. Hypertensive kidney disease was the most common primary kidney disease, reported in 39.9%. The overwhelming majority of patients (96.2%) were treated with haemodialysis, 3.5% had a kidney transplant, and only two were on continuous ambulatory peritoneal dialysis. The incidence and prevalence of KRTtreated kidney failure in Ghana is low, and the patients are younger than those on KRT in high- and upper-middleincome countries. The major cause of kidney failure is hypertensive kidney disease and the vast majority of the patients are treated with haemodialysis

Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review

Background Access to diagnosis and dialysis for acute kidney injury can be life-saving, but can be prohibitively expensive in low-income settings. The burden of acute kidney injury in sub-Saharan Africa is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care. Methods We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles published between Jan 1, 1990, and Nov 30, 2014. We scored studies, and all were of medium-to-low quality. We made a pragmatic decision to include all studies to best refl ect reality, and did a descriptive analysis of extracted data. This study is registered with PROSPERO, number CRD42015015690. Findings We identifi ed 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex. Interpretation Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa

Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review.

BACKGROUND: Access to diagnosis and dialysis for acute kidney injury can be life-saving, but can be prohibitively expensive in low-income settings. The burden of acute kidney injury in sub-Saharan Africa is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care. METHODS: We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles published between Jan 1, 1990, and Nov 30, 2014. We scored studies, and all were of medium-to-low quality. We made a pragmatic decision to include all studies to best reflect reality, and did a descriptive analysis of extracted data. This study is registered with PROSPERO, number CRD42015015690. FINDINGS: We identified 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex. INTERPRETATION: Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa. FUNDING: None

Implementation of Antimicrobial Stewardship in a District Hospital in the Ashanti Region of Ghana Using a Health Partnership Model

Commonwealth Partnerships for Antimicrobial Stewardship (AMS) uses a health partnership model to establish AMS in Commonwealth countries. The University Hospital of Kwame Nkrumah University of Science and Technology in partnership with Ulster University, in Northern Ireland undertook an AMS project from November 2021 to May 2022. We report on the implementation and its effect on antibiotic use and infections management at the University Hospital. The Global-Point Prevalence Survey (PPS) protocol was used to assess antibiotics use at the hospital at the beginning, midpoint and end of the project. Feedback on each PPS was given to staff to inform behaviour change and improve antibiotic prescribing. Antibiotic use reduced from 65% at baseline to 59.7% at the end of the project. The rate of health-associated infections also reduced from 17.5% at baseline to 6.5%. In addition, the use of antibiotics belonging to the WHO Access group at the hospital was 40% initially but increased to 50% at the project endpoint. Culture and antibiotic susceptibility requests increased from the beginning of the project from 111 total requests to 330 requests over 7 months. The AMS model implemented improved antibiotic use as well as requests for culture and susceptibility test which must be sustained

A roadmap for kidney care in Africa: An analysis of International Society of Nephrology–Global Kidney Health Atlas Africa data describing current gaps and opportunities

Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. Forty two African countries participated in the survey conducted in 2018. North Africa had the highest proportions of nephrologists [12.53 per million population (pmp)], nephrology trainees (2.19 pmp) and haemodialysis (HD) centres (8.58 pmp); whereas southern Africa had the highest proportions of peritoneal dialysis (PD) centres (0.89 pmp) and kidney transplant (KT) centres (0.29 pmp); West Africa had the greatest nephrology workforce shortages. The annual median costs of HD (US$22,731 [interquartile range (IQR): US$1,560–43,902]) and PD (US$34,165 [US$34,165–34,165]) were highest in Central Africa and only Algeria, Egypt and South Africa reported zero co-payment for all modalities of kidney replacement therapy in the public sector. Policies on chronic kidney disease and non-communicable diseases were scarcely available across all African sub-regions. The ISN–GKHA African data highlight a stark difference in kidney care measures between North and sub-Saharan Africa and also suggest the need for a more cohesive approach to policy formulations that support and protect patients with kidney disease in the continent, especially from the excessive costs associated with care. Using the World Health Organization (WHO) Global Action Plan for noncommunicable diseases, this paper proposes an African roadmap for optimal kidney care

Cardiovascular Risk Factor Burden and Association With CKD in Ghana and Nigeria

INTRODUCTION: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD); however, the burden of cardiovascular risk factors in patients with CKD in Africa is not well characterized. We determined the prevalence of selected cardiovascular risk factors, and association with CKD in the Human Heredity for Health in Africa Kidney Disease Research Network study. METHODS: We recruited patients with and without CKD in Ghana and Nigeria. CKD was defined as estimated glomerular filtration rate of 50 years, and body mass index (BMI) <18.5 kg/m 2 were independently associated with CKD. The association of diabetes and smoking with CKD was modified by other risk factors. CONCLUSION: Cardiovascular risk factors are prevalent in middle-aged adult patients with CKD in Ghana and Nigeria, with higher proportions in Ghana than in Nigeria. Hypertension, elevated cholesterol, and underweight were independently associated with CKD