M. Wainstein, S. Shrapnel, C. Clark, W. Hoy, H. Healy, I. Katz
With a prevalence of approximately 10–15% in Africa and a close relationship with other non-communicable diseases, chronic kidney disease (CKD) can result in a significant comorbidity burden and impact on quality of life. The complex spectrum of precipitants and drivers of progression present a challenge for early diagnosis and effective interventions. Predicting this progression can provide clinicians with guidance on the need and frequency of monitoring in specialist clinics, the degree to which interventions such as kidney biopsies and aggressive risk factor modification may be of use, and to plan, in a timely manner, the various elements of dialysis initiation and transplantation. For patients, such predictions have the potential to contextualise the recommended therapies and monitoring regimes prescribed, allowing them to engage better with decision making and planning if, and when, kidney replacement therapies are needed. This paper explores the use of machine learning to facilitate such predictions and improve our understanding of CKD as well as to provide a platform for future studies to examine their clinical utility and value to both clinicians and patients.
{"title":"Machine learning and chronic kidney disease risk prediction","authors":"M. Wainstein, S. Shrapnel, C. Clark, W. Hoy, H. Healy, I. Katz","doi":"10.21804/24-1-4748","DOIUrl":"https://doi.org/10.21804/24-1-4748","url":null,"abstract":"With a prevalence of approximately 10–15% in Africa and a close relationship with other non-communicable diseases, chronic kidney disease (CKD) can result in a significant comorbidity burden and impact on quality of life. The complex spectrum of precipitants and drivers of progression present a challenge for early diagnosis and effective interventions. Predicting this progression can provide clinicians with guidance on the need and frequency of monitoring in specialist clinics, the degree to which interventions such as kidney biopsies and aggressive risk factor modification may be of use, and to plan, in a timely manner, the various elements of dialysis initiation and transplantation. For patients, such predictions have the potential to contextualise the recommended therapies and monitoring regimes prescribed, allowing them to engage better with decision making and planning if, and when, kidney replacement therapies are needed. This paper explores the use of machine learning to facilitate such predictions and improve our understanding of CKD as well as to provide a platform for future studies to examine their clinical utility and value to both clinicians and patients.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365066","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}
Background: Patients on haemodialysis experience various challenges associated with their disease as well as complications related to therapy. Intradialytic events, such as cramping, hypotension and shivering, are major stressors for persons on haemodialysis. In an attempt to cope with stress associated with dialysis, most patients tend to adopt emotion-orientated coping strategies. This study aimed at evaluating the coping strategies used by patients at Kenyatta National Hospital, to deal with stress related to intradialytic events. Methods: A cross-sectional study was conducted among 96 participants undergoing maintenance haemodialysis. They were selected through convenience sampling. Data were collected using a researcher-administered questionnaire for demographic data, a visual analogue scale to assess stress, and the Jaloweic coping scale. Data were analysed using SPSS version 23. Results: The majority (62%) of the participants were male. Muscle cramps (55%), headaches (54%) and hypertension (47%) were the most commonly experienced intradialytic events. The mean level of stress on the Jaloweic scale was 5.1 ± 2.1. The commonly used coping strategies were confrontational (45%), fatalistic (46%) and supportive (48%). The level of stress explained 66% of the variance associated with the use of a coping style (P = 0.01). Conclusions: Intradialytic events were common among our participants and the majority used confrontational, fatalistic and supportive coping strategies. Tailored counselling services are recommended to reinforce effective coping.
背景:血液透析患者经历与疾病相关的各种挑战以及与治疗相关的并发症。透析内事件，如痉挛、低血压和颤抖，是血液透析患者的主要压力源。在试图应对与透析有关的压力，大多数患者倾向于采取情绪导向的应对策略。本研究旨在评估在肯雅塔国家医院的患者使用的应对策略，以处理与分析事件有关的压力。方法:对96名接受维持性血液透析的参与者进行横断面研究。他们是通过方便抽样选择的。数据收集使用研究者管理的人口调查问卷、评估压力的视觉模拟量表和Jaloweic应对量表。数据分析采用SPSS version 23。结果:大多数(62%)参与者为男性。肌肉痉挛(55%)、头痛(54%)和高血压(47%)是最常见的溶栓内事件。Jaloweic量表的平均应激水平为5.1±2.1。常用的应对策略是对抗(45%)、宿命论(46%)和支持(48%)。压力水平解释了66%与应对方式使用相关的方差(P = 0.01)。结论:分析内事件在我们的参与者中很常见，大多数人使用对抗性，宿命论和支持性应对策略。建议提供量身定制的辅导服务，以加强有效应对。
{"title":"Strategies used by Kenyan patients on maintenance haemodialysis for coping with stress related to intradialytic events","authors":"Lydia Muthoka, D. Maina, S. Kimani","doi":"10.21804/24-1-4529","DOIUrl":"https://doi.org/10.21804/24-1-4529","url":null,"abstract":"Background: Patients on haemodialysis experience various challenges associated with their disease as well as complications related to therapy. Intradialytic events, such as cramping, hypotension and shivering, are major stressors for persons on haemodialysis. In an attempt to cope with stress associated with dialysis, most patients tend to adopt emotion-orientated coping strategies. This study aimed at evaluating the coping strategies used by patients at Kenyatta National Hospital, to deal with stress related to intradialytic events. Methods: A cross-sectional study was conducted among 96 participants undergoing maintenance haemodialysis. They were selected through convenience sampling. Data were collected using a researcher-administered questionnaire for demographic data, a visual analogue scale to assess stress, and the Jaloweic coping scale. Data were analysed using SPSS version 23. Results: The majority (62%) of the participants were male. Muscle cramps (55%), headaches (54%) and hypertension (47%) were the most commonly experienced intradialytic events. The mean level of stress on the Jaloweic scale was 5.1 ± 2.1. The commonly used coping strategies were confrontational (45%), fatalistic (46%) and supportive (48%). The level of stress explained 66% of the variance associated with the use of a coping style (P = 0.01). Conclusions: Intradialytic events were common among our participants and the majority used confrontational, fatalistic and supportive coping strategies. Tailored counselling services are recommended to reinforce effective coping.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68364440","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}
Objectives: To report the prevalence of metabolic abnormalities found in an urban South African population of stone formers and thereby determine whether international guidelines on 24-hour urine collection should be recommended for South African stone formers.Methods: A retrospective folder review was conducted on patients who were admitted with renal stones or who had renal stone procedures between 1 November 2014 and 31 March 2020, with a confirmed history of renal calculi and who had 24-hour urine collection at a tertiary centre renal stone clinic. All confirmed stone formers were offered 24-hour urine collection once they were infection-free and stone-free. Demographics, 24-hour urine collection findings and stone analysis results (if available) were recorded. A 24-hour urine collection was performed once patients were stone-free while on their regular diet and routine lifestyle.Results: 175 patients with metabolic studies were included (65 females and 110 males). The mean age was 53.8 ±13.6 years. The commonest metabolic risk factors were hypocitraturia (61.0%), hypomagnesiuria (41.1%), mild hypercalciuria (22.0%), and hyperuricosuria (20.2%). Hyperuricaemia, high urinary sodium excretion, mild hypercalciuria and hyperuricosuria were more common in men. A total of 102 patients had both 24-hour urine collection and stone analysis for comparison. There were no differences between different stone types in the prevalence of metabolic risk factors except for hyperuricaemia and high urinary sodium excretion, which were both higher in uric acid predominant stone formers.Conclusion: The prevalence of risk factors was high and seemed similar to that of other populations, except for a higher prevalence of hypocitraturia. Internationally recommended guidelines for 24-hour urine studies are therefore applicable and appropriate for this population. Risk factors seem similar across stone types; however, a larger study is necessary to clarify whether metabolic risk factors are useful to predict stone composition.
{"title":"Twenty four-hour urine collection is appropriate in a cohort of South African renal stone formers","authors":"L. Kaestner, J. Lazarus, E. Muller","doi":"10.21804/24-1-4543","DOIUrl":"https://doi.org/10.21804/24-1-4543","url":null,"abstract":"Objectives: To report the prevalence of metabolic abnormalities found in an urban South African population of stone formers and thereby determine whether international guidelines on 24-hour urine collection should be recommended for South African stone formers.Methods: A retrospective folder review was conducted on patients who were admitted with renal stones or who had renal stone procedures between 1 November 2014 and 31 March 2020, with a confirmed history of renal calculi and who had 24-hour urine collection at a tertiary centre renal stone clinic. All confirmed stone formers were offered 24-hour urine collection once they were infection-free and stone-free. Demographics, 24-hour urine collection findings and stone analysis results (if available) were recorded. A 24-hour urine collection was performed once patients were stone-free while on their regular diet and routine lifestyle.Results: 175 patients with metabolic studies were included (65 females and 110 males). The mean age was 53.8 ±13.6 years. The commonest metabolic risk factors were hypocitraturia (61.0%), hypomagnesiuria (41.1%), mild hypercalciuria (22.0%), and hyperuricosuria (20.2%). Hyperuricaemia, high urinary sodium excretion, mild hypercalciuria and hyperuricosuria were more common in men. A total of 102 patients had both 24-hour urine collection and stone analysis for comparison. There were no differences between different stone types in the prevalence of metabolic risk factors except for hyperuricaemia and high urinary sodium excretion, which were both higher in uric acid predominant stone formers.Conclusion: The prevalence of risk factors was high and seemed similar to that of other populations, except for a higher prevalence of hypocitraturia. Internationally recommended guidelines for 24-hour urine studies are therefore applicable and appropriate for this population. Risk factors seem similar across stone types; however, a larger study is necessary to clarify whether metabolic risk factors are useful to predict stone composition.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68364947","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}
W. van Hougenhouck-Tulleken, M. Hussain, C. do Vale
Introduction: Acute kidney injury (AKI) in hospitalized patients infected with COVID-19 is associated with an elevated mortality rate compared to non-infected patients (39% versus 24%). This is despite a lower prevalence of AKI in COVID-19-infected patients (17 vs 22%). The reasons are multifactorial and have been well documented in developed countries, whereas in developing countries there are scant data. Methods: This study aimed to document the mortality in COVID-19-infected South African patients who required dialysis for AKI. Exclusion criteria included any chronic kidney replacement therapy (transplantation or dialysis). A REDCap survey of South African nephrologists and nephrology fellows registered with the South African Nephrology Society was conducted. The primary outcome was all-cause in-hospital mortality, while additional points of interest included comorbidities, dialysis modality and intervention required. Univariate analysis of mortality predictors was performed. Results: The COVID-19-related AKI mortality rate was 58.9%. Significant predictors included continuous veno-venous haemodialysis therapy, invasive ventilation, use of inotropes and the presence of shock. Ischaemic heart disease, heart failure and admission to a private healthcare facility were associated with lower mortality. No significant associations were found with ethnicity, sex, hypertension, diabetes, HIV infection or the use of other modes of dialysis. Conclusions: In South African patients, we report similar outcomes in critically ill patients requiring dialysis for AKI, relative to international data. The predictors of mortality most likely reflect the severity of the illness in our patients. The data suggest that continuous veno-venous haemodiafiltration or slow low efficiency dialysis may be the preferred dialysis modalities in these patients.
{"title":"COVID-19-related acute kidney injury and dialysis: What are the outcomes in South Africa?","authors":"W. van Hougenhouck-Tulleken, M. Hussain, C. do Vale","doi":"10.21804/24-1-4577","DOIUrl":"https://doi.org/10.21804/24-1-4577","url":null,"abstract":"Introduction: Acute kidney injury (AKI) in hospitalized patients infected with COVID-19 is associated with an elevated mortality rate compared to non-infected patients (39% versus 24%). This is despite a lower prevalence of AKI in COVID-19-infected patients (17 vs 22%). The reasons are multifactorial and have been well documented in developed countries, whereas in developing countries there are scant data. Methods: This study aimed to document the mortality in COVID-19-infected South African patients who required dialysis for AKI. Exclusion criteria included any chronic kidney replacement therapy (transplantation or dialysis). A REDCap survey of South African nephrologists and nephrology fellows registered with the South African Nephrology Society was conducted. The primary outcome was all-cause in-hospital mortality, while additional points of interest included comorbidities, dialysis modality and intervention required. Univariate analysis of mortality predictors was performed. Results: The COVID-19-related AKI mortality rate was 58.9%. Significant predictors included continuous veno-venous haemodialysis therapy, invasive ventilation, use of inotropes and the presence of shock. Ischaemic heart disease, heart failure and admission to a private healthcare facility were associated with lower mortality. No significant associations were found with ethnicity, sex, hypertension, diabetes, HIV infection or the use of other modes of dialysis. Conclusions: In South African patients, we report similar outcomes in critically ill patients requiring dialysis for AKI, relative to international data. The predictors of mortality most likely reflect the severity of the illness in our patients. The data suggest that continuous veno-venous haemodiafiltration or slow low efficiency dialysis may be the preferred dialysis modalities in these patients.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365001","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}
Groote Schuur Hospital in Cape Town, South Africa, offers a PD-First policy as a result of haemodialysis (HD) restrictions and resource limitations. This study aimed to compare health-related quality of life (HRQOL) between HD and peritoneal dialysis (PD) patients, given the lack of autonomy in modality choice and the socio-economic challenges. This single-centre, cross-sectional study was performed between July 2015 and December 2016. Demographic, socio-economic variables and perceptions of safety were collected. HRQOL was assessed using the Kidney Disease Quality of Life-Short Form (KDQOL-SFTM) version 1.3. All data were compared between the two dialysis modalities; 77 HD and 33 PD patients were included in the study and there were no significant differences in demographics. Median age was 42.5 years (IQR: 32.4–48.6) and 57.3% were female. HD patients had less pain (P = 0.036), better emotional well-being (P = 0.020) and a better energy/fatigue score (P = 0.015). Both cohorts experienced role-limitations due to physical health with PD being more affected overall (P = 0.05). The only significant symptom in the kidney domain was that PD patients experienced more shortness of breath (P < 0.001). Patients in both groups had very poor socio-economic circumstances, and safety within their communities was a major concern. The patients in our dialysis service have very challenging social circumstances. Those on PD scored worse in four HRQOL domains, possibly due to a lack of autonomy in dialysis modality choice and less frequent contact with dialysis staff. Additional psychological and social support needs to be instituted to help improve our patients’ well-being on PD.
{"title":"Health-related quality of life in a PD-First programme in South Africa","authors":"B. Davidson, Waldo Welgemoed, E. Jones, Z. Barday","doi":"10.21804/23-1-4151","DOIUrl":"https://doi.org/10.21804/23-1-4151","url":null,"abstract":"Groote Schuur Hospital in Cape Town, South Africa, offers a PD-First policy as a result of haemodialysis (HD) restrictions and resource limitations. This study aimed to compare health-related quality of life (HRQOL) between HD and peritoneal dialysis (PD) patients, given the lack of autonomy in modality choice and the socio-economic challenges. This single-centre, cross-sectional study was performed between July 2015 and December 2016. Demographic, socio-economic variables and perceptions of safety were collected. HRQOL was assessed using the Kidney Disease Quality of Life-Short Form (KDQOL-SFTM) version 1.3. All data were compared between the two dialysis modalities; 77 HD and 33 PD patients were included in the study and there were no significant differences in demographics. Median age was 42.5 years (IQR: 32.4–48.6) and 57.3% were female. HD patients had less pain (P = 0.036), better emotional well-being (P = 0.020) and a better energy/fatigue score (P = 0.015). Both cohorts experienced role-limitations due to physical health with PD being more affected overall (P = 0.05). The only significant symptom in the kidney domain was that PD patients experienced more shortness of breath (P < 0.001). Patients in both groups had very poor socio-economic circumstances, and safety within their communities was a major concern. The patients in our dialysis service have very challenging social circumstances. Those on PD scored worse in four HRQOL domains, possibly due to a lack of autonomy in dialysis modality choice and less frequent contact with dialysis staff. Additional psychological and social support needs to be instituted to help improve our patients’ well-being on PD.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49471872","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}
Dr Anthony Were, a stalwart of the Kenyan and African nephrology communities, died on 21 November 2020 at the age of 64.
Anthony Were博士是肯尼亚和非洲肾脏病界的坚定支持者，于2020年11月21日去世，享年64岁。
{"title":"In memoriam: Anthony Jude Omolo Were","authors":"A. Twahir","doi":"10.21804/23-1-4433","DOIUrl":"https://doi.org/10.21804/23-1-4433","url":null,"abstract":"Dr Anthony Were, a stalwart of the Kenyan and African nephrology communities, died on 21 November 2020 at the age of 64.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49337403","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}
Osmotic demyelination syndrome is a rare complication following treatment of chronic hyponatraemia. We describe a case of a middle-aged man known with hypertension and hypothyroidism who presented with a reduced level of consciousness and a generalised convulsion. Laboratory results revealed severe hyponatraemia and hypokalaemia. Following rapid overcorrection of the serum sodium concentration, his level of consciousness remained unchanged, and he developed quadriplegia. Magnetic resonance imaging of the brain revealed central pontine myelinolysis (CPM). The patient died 3 weeks after hospitalisation. Other than rapid overcorrection of chronic hyponatraemia, this case also highlights the important role of potassium in the pathogenesis of CPM. Therefore, when severe chronic hyponatraemia is accompanied by hypokalaemia, the latter should be corrected first to further reduce the risk of CPM.
{"title":"Central pontine myelinolysis: not just a low sodium issue","authors":"G. Titus, L. Vazi, Tholakele Sabela, M. Chothia","doi":"10.21804/23-1-4233","DOIUrl":"https://doi.org/10.21804/23-1-4233","url":null,"abstract":"Osmotic demyelination syndrome is a rare complication following treatment of chronic hyponatraemia. We describe a case of a middle-aged man known with hypertension and hypothyroidism who presented with a reduced level of consciousness and a generalised convulsion. Laboratory results revealed severe hyponatraemia and hypokalaemia. Following rapid overcorrection of the serum sodium concentration, his level of consciousness remained unchanged, and he developed quadriplegia. Magnetic resonance imaging of the brain revealed central pontine myelinolysis (CPM). The patient died 3 weeks after hospitalisation. Other than rapid overcorrection of chronic hyponatraemia, this case also highlights the important role of potassium in the pathogenesis of CPM. Therefore, when severe chronic hyponatraemia is accompanied by hypokalaemia, the latter should be corrected first to further reduce the risk of CPM.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46477062","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}
Amirah Parak, R. Daya, S. Bulbulia, F. Seedat, Z. Bayat
Hyperprolactinaemia is a common endocrine abnormality in patients with kidney failure. A 43-year-old female, known with kidney failure on maintenance haemodialysis, was referred with symptomatic hyperprolactinaemia. Biochemical investigations revealed a markedly elevated serum prolactin level. Magnetic resonance imaging of the brain (without gadolinium) demonstrated a pituitary macroadenoma. The patient was started on cabergoline therapy. This case discusses hyperprolactinaemia in kidney failure and highlights the importance of investigating markedly elevated prolactin levels. In cases where patients have galactorrhoea, headaches and/or visual disturbances, clinicians should be alert to the possibility of a prolactin-secreting pituitary tumour.
{"title":"Hyperprolactinaemia in a patient with kidney failure","authors":"Amirah Parak, R. Daya, S. Bulbulia, F. Seedat, Z. Bayat","doi":"10.21804/23-1-4266","DOIUrl":"https://doi.org/10.21804/23-1-4266","url":null,"abstract":"Hyperprolactinaemia is a common endocrine abnormality in patients with kidney failure. A 43-year-old female, known with kidney failure on maintenance haemodialysis, was referred with symptomatic hyperprolactinaemia. Biochemical investigations revealed a markedly elevated serum prolactin level. Magnetic resonance imaging of the brain (without gadolinium) demonstrated a pituitary macroadenoma. The patient was started on cabergoline therapy. This case discusses hyperprolactinaemia in kidney failure and highlights the importance of investigating markedly elevated prolactin levels. In cases where patients have galactorrhoea, headaches and/or visual disturbances, clinicians should be alert to the possibility of a prolactin-secreting pituitary tumour.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41622179","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}
Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease (CVD), such that the risk of cardiovascular mortality is greater than the risk of progression to end-stage kidney disease. Despite the increased prevalence of traditional and non-traditional cardiovascular risk factors, patients with kidney disease have been mostly under-represented in previous cardiovascular outcome studies, thereby resulting in a paucity of data on the evidence-based management of CVD in CKD. In this review, we explore the evidence on the burden of CVD and its risk factors in patients with CKD, highlight various inflammatory biomarkers for predicting CVD and provide an overview on novel biomarkers for CVD.
{"title":"Cardiovascular disease in chronic kidney disease – a review of risk factors","authors":"M. Hassan, S. Oguntola, R. Duarte, S. Naicker","doi":"10.21804/23-1-3960","DOIUrl":"https://doi.org/10.21804/23-1-3960","url":null,"abstract":"Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease (CVD), such that the risk of cardiovascular mortality is greater than the risk of progression to end-stage kidney disease. Despite the increased prevalence of traditional and non-traditional cardiovascular risk factors, patients with kidney disease have been mostly under-represented in previous cardiovascular outcome studies, thereby resulting in a paucity of data on the evidence-based management of CVD in CKD. In this review, we explore the evidence on the burden of CVD and its risk factors in patients with CKD, highlight various inflammatory biomarkers for predicting CVD and provide an overview on novel biomarkers for CVD.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46996768","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}
Background: Cardiovascular disease is the most common cause of morbidity and premature mortality in patients on chronic haemodialysis. There are limited data on cardiac abnormalities among these patients in sub-Saharan Africa, including Uganda. We determined the prevalence and patterns of echocardiographic (echo) abnormalities among patients with end-stage renal disease (ESRD) on haemodialysis at Mulago National Referral Hospital, Kampala, Uganda. Methods: Eighty patients with ESRD on chronic haemodialysis were enrolled in the study over a period of five months from November 2017 to March 2018. We collected data on demographic and baseline clinical characteristics by reviewing charts and conducting patient interviews. Participants had blood pressure measurements performed and blood samples taken for laboratory investigations. We then conducted a cardiac evaluation using standard transthoracic echo protocols. Bivariable and multivariable analysis was performed to study associations with left ventricular hypertrophy and diastolic dysfunction. Results: Fifty-three of the 80 patients (66%) were male, mean age was 49 ± 16 years and the median duration on dialysis was 9.5 months (interquartile range 4–24 months). Twenty-eight (35%) had to travel >50 km to access dialysis. Seventy-four patients (93%) had at least one cardiac echo abnormality and 30% had at least three abnormalities. Left ventricular hypertrophy (68%) and diastolic dysfunction (64%) were the most common abnormalities. There was a high prevalence of factors that have previously been associated with left ventricular hypertrophy and diastolic dysfunction including anaemia (79%), poorly controlled hypertension (79%) and dyslipidaemia (56%) but none of these was statistically significantly associated in this study. Conclusions: Our study confirmed a high prevalence of cardiac abnormalities among a young population of African patients with ESRD on chronic dialysis. We recommend that echocardiography be part of the routine care to help plan early intervention for those at high risk of cardiovascular events.
{"title":"Prevalence and pattern of echocardiographic abnormalities among patients on haemodialysis at an urban hospital in Central Uganda","authors":"G. Kansiime, R. Kalyesubula, E. Okello, P. Ocama","doi":"10.21804/23-1-3947","DOIUrl":"https://doi.org/10.21804/23-1-3947","url":null,"abstract":"Background: Cardiovascular disease is the most common cause of morbidity and premature mortality in patients on chronic haemodialysis. There are limited data on cardiac abnormalities among these patients in sub-Saharan Africa, including Uganda. We determined the prevalence and patterns of echocardiographic (echo) abnormalities among patients with end-stage renal disease (ESRD) on haemodialysis at Mulago National Referral Hospital, Kampala, Uganda. Methods: Eighty patients with ESRD on chronic haemodialysis were enrolled in the study over a period of five months from November 2017 to March 2018. We collected data on demographic and baseline clinical characteristics by reviewing charts and conducting patient interviews. Participants had blood pressure measurements performed and blood samples taken for laboratory investigations. We then conducted a cardiac evaluation using standard transthoracic echo protocols. Bivariable and multivariable analysis was performed to study associations with left ventricular hypertrophy and diastolic dysfunction. Results: Fifty-three of the 80 patients (66%) were male, mean age was 49 ± 16 years and the median duration on dialysis was 9.5 months (interquartile range 4–24 months). Twenty-eight (35%) had to travel >50 km to access dialysis. Seventy-four patients (93%) had at least one cardiac echo abnormality and 30% had at least three abnormalities. Left ventricular hypertrophy (68%) and diastolic dysfunction (64%) were the most common abnormalities. There was a high prevalence of factors that have previously been associated with left ventricular hypertrophy and diastolic dysfunction including anaemia (79%), poorly controlled hypertension (79%) and dyslipidaemia (56%) but none of these was statistically significantly associated in this study. Conclusions: Our study confirmed a high prevalence of cardiac abnormalities among a young population of African patients with ESRD on chronic dialysis. We recommend that echocardiography be part of the routine care to help plan early intervention for those at high risk of cardiovascular events.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21804/23-1-3947","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44384168","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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