In September 2019, a two-day workshop ahead of the Southern African Transplantation Society congress brought together South African champions for organ donation and leaders from the International Society of Organ Donation and Procurement (ISODP) at a high-level workshop focused on creating a national strategy roadmap to improve organ donation in South Africa. The full report is available via the supplementary materials on the African Journal of Nephrology website.
{"title":"Reviving a national strategy roadmap for organ and tissue donation in South Africa","authors":"D. Thomson","doi":"10.21804/26-1-5811","DOIUrl":"https://doi.org/10.21804/26-1-5811","url":null,"abstract":"In September 2019, a two-day workshop ahead of the Southern African Transplantation Society congress brought together South African champions for organ donation and leaders from the International Society of Organ Donation and Procurement (ISODP) at a high-level workshop focused on creating a national strategy roadmap to improve organ donation in South Africa. The full report is available via the supplementary materials on the African Journal of Nephrology website.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Okpechi, A. Niang, M. Hafez, G. Ashuntantang, D. Zaidi, F. Ye, A. Abdu, A. Asinobi, R. Balogun, I. Chukwuonye, H. Diongolé, E. Effa, Udeme Ekrikpo, Z. Gouda, Jibrin Hussaini, F. Kaze, K. Kilonzo, R. Kalyesubula, Amna Kununa, M. Makusidi, I. Mbah, Mignon McCullough, Y. Mengistu, M. Moloi, George Moturi, Kwazi C Z Ndlovu, J. Ngigi, Yannick Nklandu, J. Ntarindwa, Julius Okel, T. Olanrewaju, C. Osafo, Ugochi Samuel-Okpechi, M. Shigidi, E. Sumaili, Ifeoma Ulasi, T. Umeizudike, N. Wearne, V. Jha, A. Levin, David W. Johnson, A. Bello
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.
{"title":"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","authors":"I. Okpechi, A. Niang, M. Hafez, G. Ashuntantang, D. Zaidi, F. Ye, A. Abdu, A. Asinobi, R. Balogun, I. Chukwuonye, H. Diongolé, E. Effa, Udeme Ekrikpo, Z. Gouda, Jibrin Hussaini, F. Kaze, K. Kilonzo, R. Kalyesubula, Amna Kununa, M. Makusidi, I. Mbah, Mignon McCullough, Y. Mengistu, M. Moloi, George Moturi, Kwazi C Z Ndlovu, J. Ngigi, Yannick Nklandu, J. Ntarindwa, Julius Okel, T. Olanrewaju, C. Osafo, Ugochi Samuel-Okpechi, M. Shigidi, E. Sumaili, Ifeoma Ulasi, T. Umeizudike, N. Wearne, V. Jha, A. Levin, David W. Johnson, A. Bello","doi":"10.21804/25-1-5100","DOIUrl":"https://doi.org/10.21804/25-1-5100","url":null,"abstract":"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.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43063651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Holness, D. J. van der Westhuizen, M. R. Davids, J. Warwick
Glomerular filtration rate (GFR) is usually estimated rather than measured as this only requires measurement of an endogenous filtration marker. In certain clinical settings a more accurate measure of GFR is essential. The most commonly used endogenous filtration marker is creatinine. Exogenous filtration markers include nonradiopharmaceuticals such as inulin, iohexol and unlabelled iothalamate, or radiopharmaceuticals such as 51Crethylenediaminetetraacetic acid (51Cr-EDTA) and 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA). Inulin is considered an ideal filtration marker but the clearance of iothalamate, 99mTc-DTPA, 51Cr-EDTA and iohexol have all been shown to have sufficient accuracy for measuring GFR. For radiopharmaceuticals, a well counter is required to measure the amount of activity in patient samples. Iohexol or unlabelled iothalamate require samples to be measured using high performance liquid chromatography with ultraviolet detection (HPLC-UV), liquid chromatography-tandem mass spectrometry (LC-MS/MS) or x-ray fluorescence (XRF). Due to the practical challenges of measuring urinary clearance, measurement of GFR in clinical settings is almost exclusively based on plasma clearance of a filtration marker. This can follow a long-established approach based on the ratio of the tracer administered to the area under the plasma concentration curve. Alternatively, a single plasma sample giving an apparent volume of distribution at a given time point can be used to accurately measure GFR. While techniques exist for the measurement of GFR in a number of African countries, preliminary evidence suggests that facilities are very limited. There is a need for support for both equipment and training to establish GFR measurement facilities in several centres on the continent. Keywords: measured glomerular filtration rate;, mGFR;, Africa
{"title":"Measurement of glomerular filtration rate and its current status in African countries GFR measurement and its status in Africa","authors":"J. Holness, D. J. van der Westhuizen, M. R. Davids, J. Warwick","doi":"10.21804/25-1-5110","DOIUrl":"https://doi.org/10.21804/25-1-5110","url":null,"abstract":"Glomerular filtration rate (GFR) is usually estimated rather than measured as this only requires measurement of an endogenous filtration marker. In certain clinical settings a more accurate measure of GFR is essential. The most commonly used endogenous filtration marker is creatinine. Exogenous filtration markers include nonradiopharmaceuticals such as inulin, iohexol and unlabelled iothalamate, or radiopharmaceuticals such as 51Crethylenediaminetetraacetic acid (51Cr-EDTA) and 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA). Inulin is considered an ideal filtration marker but the clearance of iothalamate, 99mTc-DTPA, 51Cr-EDTA and iohexol have all been shown to have sufficient accuracy for measuring GFR. For radiopharmaceuticals, a well counter is required to measure the amount of activity in patient samples. Iohexol or unlabelled iothalamate require samples to be measured using high performance liquid chromatography with ultraviolet detection (HPLC-UV), liquid chromatography-tandem mass spectrometry (LC-MS/MS) or x-ray fluorescence (XRF). Due to the practical challenges of measuring urinary clearance, measurement of GFR in clinical settings is almost exclusively based on plasma clearance of a filtration marker. This can follow a long-established approach based on the ratio of the tracer administered to the area under the plasma concentration curve. Alternatively, a single plasma sample giving an apparent volume of distribution at a given time point can be used to accurately measure GFR. While techniques exist for the measurement of GFR in a number of African countries, preliminary evidence suggests that facilities are very limited. There is a need for support for both equipment and training to establish GFR measurement facilities in several centres on the continent. Keywords: measured glomerular filtration rate;, mGFR;, Africa","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julia Morley, M. Rensburg, M. Hoffman, M. Hassan, M. R. Davids
Introduction: Thiazide diuretics can lower urinary calcium excretion, helping to prevent recurrent calcium kidney stones. As dietary intake and urine chemistry varies throughout the day, a 24-h urine collection may not provide sufficient information to guide the optimal management in individual patients. Using multiple timed urine collections, we sought to identify times during the day when stone-forming risk is higher, allowing for therapy to be more accurately targeted. Methods: In a prospective study, healthy adult volunteers took a 4-week course of either hydrochlorothiazide (HCTZ) 25 mg/d or indapamide 2.5 mg/d. They were assessed at baseline, and at days 7, 14 and 28. At each time point, blood samples were taken for analysis and multiple timed urine samples were collected throughout the day, together with one overnight sample. Results: Diuretic treatment was well tolerated. Daily calcium and citrate excretion decreased, while ionized calcium and phosphate excretion were unchanged. Ionized calcium-divalent phosphate and ionized calcium-oxalate products were unchanged. In the timed urine samples, calcium excretion was decreased, particularly by indapamide, in the morning. Indapamide, but not HCTZ, decreased urinary citrate excretion, most obviously in overnight and early morning urines. No changes in ionized calcium were observed. Decreased divalent phosphate excretion was observed at several time points in the indapamide group. The ionized calcium-divalent phosphate product tended to decrease at most time points in both groups but no significant changes were observed in the ionized calcium-oxalate product. Conclusions: Indapamide 2.5 mg/d has a stronger protective effect against forming calcium kidney stones than HCTZ 25 mg/d. Most of the benefits appear to be achieved during the daytime and it may therefore be beneficial to prescribe medication twice daily or in the evening to maximize the protective effects of these agents. The benefits of indapamide treatment were attenuated by a reduction in urinary citrate excretion, an effect which has not been previously described.
{"title":"Effect of diuretics on kidney stone-forming risk – an investigation using multiple timed urine collections","authors":"Julia Morley, M. Rensburg, M. Hoffman, M. Hassan, M. R. Davids","doi":"10.21804/25-1-4842","DOIUrl":"https://doi.org/10.21804/25-1-4842","url":null,"abstract":"Introduction: Thiazide diuretics can lower urinary calcium excretion, helping to prevent recurrent calcium kidney stones. As dietary intake and urine chemistry varies throughout the day, a 24-h urine collection may not provide sufficient information to guide the optimal management in individual patients. Using multiple timed urine collections, we sought to identify times during the day when stone-forming risk is higher, allowing for therapy to be more accurately targeted. Methods: In a prospective study, healthy adult volunteers took a 4-week course of either hydrochlorothiazide (HCTZ) 25 mg/d or indapamide 2.5 mg/d. They were assessed at baseline, and at days 7, 14 and 28. At each time point, blood samples were taken for analysis and multiple timed urine samples were collected throughout the day, together with one overnight sample. Results: Diuretic treatment was well tolerated. Daily calcium and citrate excretion decreased, while ionized calcium and phosphate excretion were unchanged. Ionized calcium-divalent phosphate and ionized calcium-oxalate products were unchanged. In the timed urine samples, calcium excretion was decreased, particularly by indapamide, in the morning. Indapamide, but not HCTZ, decreased urinary citrate excretion, most obviously in overnight and early morning urines. No changes in ionized calcium were observed. Decreased divalent phosphate excretion was observed at several time points in the indapamide group. The ionized calcium-divalent phosphate product tended to decrease at most time points in both groups but no significant changes were observed in the ionized calcium-oxalate product. Conclusions: Indapamide 2.5 mg/d has a stronger protective effect against forming calcium kidney stones than HCTZ 25 mg/d. Most of the benefits appear to be achieved during the daytime and it may therefore be beneficial to prescribe medication twice daily or in the evening to maximize the protective effects of these agents. The benefits of indapamide treatment were attenuated by a reduction in urinary citrate excretion, an effect which has not been previously described.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The perception of death differs by region, culture, religion, and ethnic group in Nigeria. These differences can affect the consent rate for cadaveric transplantation. Understanding the Yoruba concept of death and approaching families for consent in a culturally sensitive manner may increase family consent to deceased donor organ harvesting. This literature review explores the Yoruba concept of death and organ transplantation.Methods: Three research questions were formulated and a search strategy was drafted by creating a SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) logic search grid. Relevant databases were then examined using the search terms, concepts and keywords so generated. The findings of publications retrieved on Yoruba beliefs regarding death were entered into a summary table based on the themes identified in them. These themes served as the basis for the interpretation synthesis.Results: Fifteen of the eighty-five studies identified initially were deemed contextually relevant to the researchquestions and used in the analysis. These sources revealed that death in the Yoruba belief system signifies the dematerialization of the soul and its transformation from earthly existence into a spiritual one. Consequently, the physical body of the deceased is perceived as becoming dust and of little relevance to the afterlife.Conclusion: In the Yoruba worldview, the state of the physical body after death has no relevance to afterlife and reincarnation. However, transplant teams must consider the circumstances of death when asking for consent. When death is viewed positively, success is more likely. Keywords: Yoruba, death, ontology, organ transplantation
在尼日利亚，对死亡的看法因地区、文化、宗教和族裔群体而异。这些差异会影响尸体移植的同意率。了解约鲁巴人的死亡概念，并以文化上敏感的方式征求家属的同意，可能会增加家属对摘取死者供体器官的同意。这篇文献综述探讨了约鲁巴人关于死亡和器官移植的概念。方法:通过构建SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, research type)逻辑搜索网格，制定3个研究问题，并制定搜索策略。然后使用生成的搜索词、概念和关键字检查相关数据库。检索到的关于约鲁巴人关于死亡信仰的出版物的调查结果根据其中确定的主题输入了一个汇总表。这些主题是解释综合的基础。结果:最初确定的85项研究中有15项被认为与研究问题相关并用于分析。这些资料表明，在约鲁巴信仰体系中，死亡意味着灵魂的非物质化，以及灵魂从世俗存在转变为精神存在。因此，死者的身体被认为会变成灰尘，与来世没有什么关系。结论:在约鲁巴人的世界观中，死后的身体状态与来世和转世无关。然而，移植团队在征求同意时必须考虑死亡的情况。当死亡被积极看待时，成功的可能性更大。关键词:约鲁巴人，死亡，本体，器官移植
{"title":"Yoruba ontology: Perception of the physical body of the dead and its implications for cadaveric organ transplantation in south-west Nigeria. Yoruba death ontology: implications for organ transplantation","authors":"J. Awobusuyi","doi":"10.21804/25-1-5088","DOIUrl":"https://doi.org/10.21804/25-1-5088","url":null,"abstract":"Introduction: The perception of death differs by region, culture, religion, and ethnic group in Nigeria. These differences can affect the consent rate for cadaveric transplantation. Understanding the Yoruba concept of death and approaching families for consent in a culturally sensitive manner may increase family consent to deceased donor organ harvesting. This literature review explores the Yoruba concept of death and organ transplantation.Methods: Three research questions were formulated and a search strategy was drafted by creating a SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) logic search grid. Relevant databases were then examined using the search terms, concepts and keywords so generated. The findings of publications retrieved on Yoruba beliefs regarding death were entered into a summary table based on the themes identified in them. These themes served as the basis for the interpretation synthesis.Results: Fifteen of the eighty-five studies identified initially were deemed contextually relevant to the researchquestions and used in the analysis. These sources revealed that death in the Yoruba belief system signifies the dematerialization of the soul and its transformation from earthly existence into a spiritual one. Consequently, the physical body of the deceased is perceived as becoming dust and of little relevance to the afterlife.Conclusion: In the Yoruba worldview, the state of the physical body after death has no relevance to afterlife and reincarnation. However, transplant teams must consider the circumstances of death when asking for consent. When death is viewed positively, success is more likely. Keywords: Yoruba, death, ontology, organ transplantation","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Hyperkalaemia is a common electrolyte disorder in hospitalised patients and may cause life-threatening cardiac arrythmias and death. There is a lack of consensus regarding its optimal management, which may result in wide variations in practice and the guidance provided to junior staff. Methods: We conducted a survey on a Research Electronic Data Capture (REDCap) platform to evaluate the knowledge of medical specialists regarding the diagnosis and management of hyperkalaemia, with a focus on insulinbased therapy. A convenience sample of 70 specialists in nephrology, internal medicine, emergency medicine and critical-care medicine were invited to participate. Comparisons were also made between nephrologists and nonnephrologists. Results: A total of 51 medical specialists responded, of whom 47% were nephrologists. They were more likely to initiate therapy at a potassium concentration ([K]) of 6 mmol/L, whereas non-nephrologists tended to start at a lower concentration (P < 0.01). Half the respondents regarded blood gas machine measurements as providing an accurate measure of [K]. Non-nephrologists were more likely to perform an ECG before starting treatment (P = 0.02). All respondents regarded insulin and dextrose as the most effective and reliable means for shifting K. Only 22% monitored the serum glucose concentration beyond 2 hours following insulin-based therapy, and 22% thought that hypoglycaemia was an uncommon complication if dextrose also was administered. Conclusions: This is the first comprehensive survey to report on the knowledge of specialists regarding the emergency management of hyperkalaemia. There is a need to address knowledge gaps, particularly around the optimal and safe use of insulin-based therapies. Our findings and recommendations should be useful in informing the development of consensus guidelines and educational resources on hyperkalaemia.
{"title":"Knowledge of medical specialists on the emergency management of hyperkalaemia with a focus on insulin-based therapy","authors":"M. Chothia, U. Chikte, R. Davids","doi":"10.21804/25-1-5002","DOIUrl":"https://doi.org/10.21804/25-1-5002","url":null,"abstract":"Introduction: Hyperkalaemia is a common electrolyte disorder in hospitalised patients and may cause life-threatening cardiac arrythmias and death. There is a lack of consensus regarding its optimal management, which may result in wide variations in practice and the guidance provided to junior staff. Methods: We conducted a survey on a Research Electronic Data Capture (REDCap) platform to evaluate the knowledge of medical specialists regarding the diagnosis and management of hyperkalaemia, with a focus on insulinbased therapy. A convenience sample of 70 specialists in nephrology, internal medicine, emergency medicine and critical-care medicine were invited to participate. Comparisons were also made between nephrologists and nonnephrologists. Results: A total of 51 medical specialists responded, of whom 47% were nephrologists. They were more likely to initiate therapy at a potassium concentration ([K]) of 6 mmol/L, whereas non-nephrologists tended to start at a lower concentration (P < 0.01). Half the respondents regarded blood gas machine measurements as providing an accurate measure of [K]. Non-nephrologists were more likely to perform an ECG before starting treatment (P = 0.02). All respondents regarded insulin and dextrose as the most effective and reliable means for shifting K. Only 22% monitored the serum glucose concentration beyond 2 hours following insulin-based therapy, and 22% thought that hypoglycaemia was an uncommon complication if dextrose also was administered. Conclusions: This is the first comprehensive survey to report on the knowledge of specialists regarding the emergency management of hyperkalaemia. There is a need to address knowledge gaps, particularly around the optimal and safe use of insulin-based therapies. Our findings and recommendations should be useful in informing the development of consensus guidelines and educational resources on hyperkalaemia.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Tannor, Y. Nlandu, Mohammed E Elrggal, O. Chika, V. Nzana
Introduction: The prevalence of chronic kidney disease (CKD) in Africa is generally higher than global averages. Moreover, the management of patients with CKD suffers huge disparities compared to the rest of the world. We reviewed the literature on the major challenges in the management of kidney disease in Africa and suggest ways to bridge the gap for better kidney care on the African continent. Results and recommendations: The prevalence of CKD in Africa is 15.8%. Kidney failure is associated with increased morbidity and mortality as a result of limited infrastructure and out-of-pocket payment for renal replacement therapy in most parts of the continent. The increasing prevalence of CKD results from epidemiological transition with increasing non-communicable diseases (NCDs) and established communicable diseases. Furthermore, Africa has unique risk factors and causes of kidney disease such as sickle cell disease, APOL1 risk alleles, and chronic infections such HIV, and hepatitis B and C. Challenges facing kidney care in Africa include poverty, weak health systems, inadequate primary health care, misplaced priorities by political leaders, a relatively low nephrology workforce, poor identification of acute kidney injury (AKI), low transplantation rates as well as a lack of sustainable prevention policies and renal registries. To bridge the gap to better kidney care, there should be more community engagement, advocacy for increased government support into kidney care, comprehensive renal registries, training of a greater nephrology workforce, task shifting of nephrology services to non-nephrologists, expanded access to renal replacement therapy and promotion of organ donation. Conclusion: Africa needs greater investment in kidney health. Keywords: chronic kidney disease, Africa, sub-saharan Africa, Kidney failure, kidney health
{"title":"Kidney Health for All – Bridging the gap to better kidney care in Africa","authors":"E. Tannor, Y. Nlandu, Mohammed E Elrggal, O. Chika, V. Nzana","doi":"10.21804/25-1-5051","DOIUrl":"https://doi.org/10.21804/25-1-5051","url":null,"abstract":"Introduction: The prevalence of chronic kidney disease (CKD) in Africa is generally higher than global averages. Moreover, the management of patients with CKD suffers huge disparities compared to the rest of the world. We reviewed the literature on the major challenges in the management of kidney disease in Africa and suggest ways to bridge the gap for better kidney care on the African continent. Results and recommendations: The prevalence of CKD in Africa is 15.8%. Kidney failure is associated with increased morbidity and mortality as a result of limited infrastructure and out-of-pocket payment for renal replacement therapy in most parts of the continent. The increasing prevalence of CKD results from epidemiological transition with increasing non-communicable diseases (NCDs) and established communicable diseases. Furthermore, Africa has unique risk factors and causes of kidney disease such as sickle cell disease, APOL1 risk alleles, and chronic infections such HIV, and hepatitis B and C. Challenges facing kidney care in Africa include poverty, weak health systems, inadequate primary health care, misplaced priorities by political leaders, a relatively low nephrology workforce, poor identification of acute kidney injury (AKI), low transplantation rates as well as a lack of sustainable prevention policies and renal registries. To bridge the gap to better kidney care, there should be more community engagement, advocacy for increased government support into kidney care, comprehensive renal registries, training of a greater nephrology workforce, task shifting of nephrology services to non-nephrologists, expanded access to renal replacement therapy and promotion of organ donation. Conclusion: Africa needs greater investment in kidney health. Keywords: chronic kidney disease, Africa, sub-saharan Africa, Kidney failure, kidney health","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Justor Banda, T. Bulaya, A. Mweemba, M. Mweene, N. Suwilanji, C. Natasha, S. Siziya
Introduction: Dialysis is the primary kidney replacement therapy for patients with kidney failure in sub-Saharan Africa. We assessed the rates and predictors of early mortality in Zambian patients starting chronic dialysis. Methods: This retrospective study included all patients who started chronic haemodialysis (HD) or peritonealdialysis (PD) between 1 January 2017 and 31 August 2020 at the three largest public dialysis centres in Zambia. Data on clinical, laboratory and dialysis characteristics were extracted from medical records. The primary outcome of interest was the mortality rate at 90 days. Results: A total of 154 patients were included in the study; 43.5% were female and 32% were 50 years or older.The main causes of kidney failure were hypertension (59%), glomerulonephritis (10%), HIV/AIDS (10%) andunknown (8%). The mortality rate at 90 days was 12.3%. Of these, 42% were cardiovascular-related mortalities and 32% died of infection related to central venous catheters. The lymphocyte percentage of total white blood cells was lower in patients who died compared to survivors (12.7 vs 20.8%) and was an independent predictor of early mortality (OR 0.914, 95% CI 0.850–0.983; P = 0.015). Conclusions: Early mortality was high in Zambian patients starting dialysis, and a low lymphocyte percentage was a predictor of mortality.
导读:透析是撒哈拉以南非洲肾衰竭患者的主要肾脏替代疗法。我们评估了开始慢性透析的赞比亚患者的早期死亡率和预测因素。方法:本回顾性研究纳入了2017年1月1日至2020年8月31日在赞比亚三个最大的公共透析中心开始慢性血液透析(HD)或腹膜透析(PD)的所有患者。从医疗记录中提取临床、实验室和透析特征数据。主要观察指标为90天死亡率。结果:共纳入154例患者;43.5%为女性，32%为50岁或以上。肾衰竭的主要原因是高血压(59%)、肾小球肾炎(10%)、HIV/AIDS(10%)和未知(8%)。90天死亡率为12.3%。其中，42%是心血管相关死亡，32%死于中心静脉导管相关感染。与幸存者相比，死亡患者的淋巴细胞占总白细胞的比例较低(12.7% vs 20.8%)，并且是早期死亡率的独立预测因子(OR 0.914, 95% CI 0.850-0.983;P = 0.015)。结论:赞比亚开始透析的患者早期死亡率很高，低淋巴细胞百分比是死亡率的预测因子。
{"title":"Early mortality in patients with kidney failure starting chronic dialysis in Zambia: A retrospective cohort analysis","authors":"Justor Banda, T. Bulaya, A. Mweemba, M. Mweene, N. Suwilanji, C. Natasha, S. Siziya","doi":"10.21804/25-1-4733","DOIUrl":"https://doi.org/10.21804/25-1-4733","url":null,"abstract":"Introduction: Dialysis is the primary kidney replacement therapy for patients with kidney failure in sub-Saharan Africa. We assessed the rates and predictors of early mortality in Zambian patients starting chronic dialysis. Methods: This retrospective study included all patients who started chronic haemodialysis (HD) or peritonealdialysis (PD) between 1 January 2017 and 31 August 2020 at the three largest public dialysis centres in Zambia. Data on clinical, laboratory and dialysis characteristics were extracted from medical records. The primary outcome of interest was the mortality rate at 90 days. Results: A total of 154 patients were included in the study; 43.5% were female and 32% were 50 years or older.The main causes of kidney failure were hypertension (59%), glomerulonephritis (10%), HIV/AIDS (10%) andunknown (8%). The mortality rate at 90 days was 12.3%. Of these, 42% were cardiovascular-related mortalities and 32% died of infection related to central venous catheters. The lymphocyte percentage of total white blood cells was lower in patients who died compared to survivors (12.7 vs 20.8%) and was an independent predictor of early mortality (OR 0.914, 95% CI 0.850–0.983; P = 0.015). Conclusions: Early mortality was high in Zambian patients starting dialysis, and a low lymphocyte percentage was a predictor of mortality.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68364697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Bagasha, R. Naitala, E. Namukwaya, M. Leng, E. Katabira, E. Namisango
Background: Chronic kidney disease is on the rise in sub-Saharan African countries such as Uganda, and patients often present with advanced disease requiring kidney replacement therapies. Health-related quality of life is a key outcome in chronic kidney disease management but, in Uganda, no tools have been validated to measure this. The aim of this study was to culturally adapt and validate the Kidney Disease Quality of Life-Short Form version 1.3 (KDQOL-SF™) questionnaire for use in the Ugandan setting. Methods: We conducted a four-phase, mixed-methods study which included translation, cultural adaptation, optimisation of face validity and field testing. Our participants included healthcare workers, and patients aged 18 years with an estimated glomerular filtration rate <15 mL/min/1.73 m2. Results: The tool was culturally adapted and translated into one of the Ugandan languages, Luganda, which, with an English version of the tool, was validated and field tested. Over 80% of the subdomains had less than 10% floor and ceiling effects. For reliability, Cronbach’s α coefficient scores ranged from 0.96 to 0.41, with 10 out of 18 subdomains scoring >0.70, indicating acceptable internal consistency. The tool demonstrated discriminant validity, with patients with comorbidities reporting lower quality of life scores, as postulated. Conclusions: The Luganda and English versions of the KDQOL-SF questionnaire have sufficient face and content validity, reliability and acceptability to assess the quality of life of patients with kidney failure in Uganda. Keywords: quality of life, kidney failure, Uganda, KDQOL-SF, developing countries
{"title":"Cultural adaptation and validation of the Kidney Disease and Quality of Life-Short Form (KDQOL-SF™) version 1.3 questionnaire in Uganda","authors":"P. Bagasha, R. Naitala, E. Namukwaya, M. Leng, E. Katabira, E. Namisango","doi":"10.21804/25-1-4840","DOIUrl":"https://doi.org/10.21804/25-1-4840","url":null,"abstract":"Background: Chronic kidney disease is on the rise in sub-Saharan African countries such as Uganda, and patients often present with advanced disease requiring kidney replacement therapies. Health-related quality of life is a key outcome in chronic kidney disease management but, in Uganda, no tools have been validated to measure this. The aim of this study was to culturally adapt and validate the Kidney Disease Quality of Life-Short Form version 1.3 (KDQOL-SF™) questionnaire for use in the Ugandan setting. Methods: We conducted a four-phase, mixed-methods study which included translation, cultural adaptation, optimisation of face validity and field testing. Our participants included healthcare workers, and patients aged 18 years with an estimated glomerular filtration rate <15 mL/min/1.73 m2. Results: The tool was culturally adapted and translated into one of the Ugandan languages, Luganda, which, with an English version of the tool, was validated and field tested. Over 80% of the subdomains had less than 10% floor and ceiling effects. For reliability, Cronbach’s α coefficient scores ranged from 0.96 to 0.41, with 10 out of 18 subdomains scoring >0.70, indicating acceptable internal consistency. The tool demonstrated discriminant validity, with patients with comorbidities reporting lower quality of life scores, as postulated. Conclusions: The Luganda and English versions of the KDQOL-SF questionnaire have sufficient face and content validity, reliability and acceptability to assess the quality of life of patients with kidney failure in Uganda. Keywords: quality of life, kidney failure, Uganda, KDQOL-SF, developing countries","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68364980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Serum uric acid levels are frequently elevated in patients with chronic kidney disease (CKD). The relatively modest hyperuricaemia in CKD may reflect the reduced efficiency of renal excretion of urate. In the past two decades, basic research has shown that hyperuricaemia plays a causal role in the progression of CKD through direct renal injury. However, clinical studies have reported conflicting results, hence there is much controversy about the scope of treating asymptomatic hyperuricaemia to prevent or reduce the rate of CKD progression. In this review, we highlight the most recent guidelines and clinical trials that tested the use of urate-lowering therapy in the management of asymptomatic hyperuricaemia in CKD patients.
{"title":"Management of asymptomatic hyperuricemia in chronic kidney disease: A proposed stepwise approach","authors":"M. Gawad, Dina Zaki, A. Qasem","doi":"10.21804/25-1-4614","DOIUrl":"https://doi.org/10.21804/25-1-4614","url":null,"abstract":"Serum uric acid levels are frequently elevated in patients with chronic kidney disease (CKD). The relatively modest hyperuricaemia in CKD may reflect the reduced efficiency of renal excretion of urate. In the past two decades, basic research has shown that hyperuricaemia plays a causal role in the progression of CKD through direct renal injury. However, clinical studies have reported conflicting results, hence there is much controversy about the scope of treating asymptomatic hyperuricaemia to prevent or reduce the rate of CKD progression. In this review, we highlight the most recent guidelines and clinical trials that tested the use of urate-lowering therapy in the management of asymptomatic hyperuricaemia in CKD patients.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68364626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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