A Chijioke

Mortality patterns among type 2 diabetes mellitus patients in Ilorin, Nigeria

Abstract Objective: People living with diabetes mellitus (DM) are prone to varied forms of complications which often lead to their premature death. The vulnerability has the greatest impact in type 2 DM because of larger numerical strength, insidious onset and late recognition especially in resource-poor nations like Nigeria. This study is designed to provide information on current trends in mortality among type 2 DM patients. Design: The study was a 10-year retrospective analysis of causes of death and contributing factors in type 2 DM patients. Information was obtained from case files and the hospital death register. Setting: It was carried out in adult medical wards and the accident/emergency unit of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Subjects: The study subjects were type 2 DM patients who were admitted from the diabetic clinic and/or accident and emergency units of the hospital. Data analysis was done using SPSS, version 16. Outcome measures: The study is an attempt to provide insight into preventive measures against complications that culminate in the premature death of Nigerians with type 2 DM. The findings may form a basis for future research on characteristics of type 2 DM in our environment Results: The overall mortality rate was 32.5% with mean age at diagnosis and death being 53.43 + 15.07 and 57.07 + 14.29 respectively. Systemic hypertension was present in 50% of the study population with male and female rate of 55% and 43% respectively. The highest number of admissions were due to diabetic hyperglycaemic emergencies, septicaemia and diabetic foot syndrome (DFS). Mortality rates were highest in those that presented with hypoglycaemia, stroke and diabetic foot syndrome. There was gender disparity in the first three major causes as more males died from DFS and stroke while females accounted for the majority of deaths from diabetic ketoacidosis (DKA). Conclusion: Type 2 DM is a common cause of morbidity and mortality in Nigeria. The contributory factors to high mortality were ignorance, poor hygiene, infections, lack of foot care and inadequate glycaemic/blood pressure control. There is a need to improve hygiene and provide education programmes targeted at DM patients on proper foot care and good glycaemic and blood pressure control. We should emphasise the importance of early diagnosis of diabetes and proper management.

Hemodialysis performance and outcomes among end stage renal disease patients from Sokoto, North‑Western Nigeria

The cost of managing end stage renal disease (ESRD) is prohibitive in Nigeria and the burden is solely borne by patients and their relatives. Despite increasing number of dialysis centers in urban areas, actual utilization of such facilities is very low. It is unclear if the outcomes of these patients have improved in recent times. We evaluated pattern of hemodialysis (HD) performance and outcome among ESRD patients. A 5-year prospective cross-sectional study of all ESRD patients on HD was undertaken. The final outcomes included duration on maintenance dialysis, death from inability to sustain dialysis, absconded, confirmed deaths within or outside health facility or referral for kidney transplant. A total of 540 (54%) of 976 cases of ESRD commenced HD, out of which 7 (1.3%) eventually had live-related kidney transplant in India. The male to female ratio was 2:1 with male and female mean ages of 43 ± 17 and 36 ± 16 years respectively. There was a progressive annual increase in the number of ESRD patients. The commonest underlying renal disorder was chronic glomerulonephritis. The mean HD session duration was 8.11 ± 5.4 hours, while the mean duration of stay on HD was 8.72 ± 1.0 weeks. In conclusion, ESRD is common and is being increasingly recognized. Financial constraint and late presentation are major contributory factors to poor outcomes despite the widespread availability of HD facilities. Therefore, effort should be geared towards aggressive strategies for early detection and treatment. Government commitment in terms of funding and/or subsidy for patient with ESRD is advocated.

Electrocardiographic abnormalities among dialysis naïve chronic kidney disease patients in Ilorin Nigeria

BACKGROUND Chronic kidney disease (CKD) has an increased risk of not only end-stage renal disease (ESRD), but majority of moderate CKD patients do die from cardiovascular disease (CVD) before reaching ESRD. The prognosis of these patients is very poor in most developing countries because of late presentation, inadequate diagnostic facilities, and inability to pay for treatment. Knowledge about CVD in CKD is crucial because of unpredictable progressive nature of the disease and increased risk of premature death from cardiovascular events. We sought to determine prevalence and pattern of electrocardiographic abnormalities in dialysis naïve CKD patients. MATERIALS AND METHODS This is a 10-year prospective cross-sectional study carried out at the University of Ilorin Teaching Hospital, Ilorin. Patients were recruited from the nephrology clinic and renal wards and all who met diagnostic criteria for stages 4 and 5 CKD were included. All had their standard 12-lead electrocardiogram (ECG) recorded and various findings were critically studied and interpreted independently by two consultant physician including a cardiologist. Data analysis was done using SPSS version 16. RESULTS Overall, 86% of the patients had at least one form of ECG abnormality, with hypertension (HTN) and anemia being the main contributory factors. These include left ventricular hypertrophy (LVH) (27.6%), left atrial enlargement (LAE) (21.6%), combination of LVH and LAE (17.2%), and ventricular premature contractions (6%). Etiology of CKD appears to have influence on ECG changes as prevalence of LVH and LAE were high among hypertensive renal disease, chronic glomerulonephritis (CGN), and diabetic nephropathy patients. CONCLUSION LVH and LAE were very common ECG abnormalities in our dialysis naïve CKD patients. HTN, CGN, anemia, late presentation, and male gender appear to be the main risk factors for the ECG abnormalities. There is need for gender-specific intervention strategies directed at early detection and treatment of HTN, anemia, and underlying kidney disease, especially in resource poor nations where the burden of CKD is assuming epidemic proportion.

Usefulness of renal length and volume by ultrasound in determining severity of chronic kidney disease

To determine the correlation of renal ultrasonic parameters and degree of kidney function among chronic kidney disease patients seen at the Nephrology unit of the University of Ilorin Teaching Hospital (UITH) Ilorin, we studied 322 patients. The results were analyzed with specific reference to socio-demography and correlating renal length and volume with estimated glomerular filtration rate. The male to female ratio was 2:1, with an age range from 20 to 80 years and mean age of 45.06 (±13.0) years. The serum creatinine levels ranged from 201 to 1205 μmol/L, with a mean of 388 ± 168 μmol/L, while the estimated glomerular filtration rate (eGFR) ranged from 3.77 to 44.32 mL/min, with a mean of 18.2 ± 7.19 mL/min. The right and left renal lengths ranged from 6.9 to 13.0 cm, with a mean of 9.11 ± 1.06, and 6.5-13.4 cm, with a mean of 9.23 ± 1.07 cm, respectively. The mean volumes of the right and left kidneys were 98.6 ± 41.9 cm 3 and 105 ± 46.2 cm 3 , respectively. The Pearson correlation of the right and left kidneys length to eGFR were -0.197 and -0.137 respectively, while that of the right and left kidney volume to eGFR were -0.122 and -0.043, respectively. Our study showed that there is a positive correlation between ultrasonic renal measurements and degree of kidney function.

Clinical pattern and outcome of acute kidney injury patients from a Tertiary Health Institution in Northwestern Nigeria

Background: Acute kidney injury (AKI) is a common cause of hospitalization associated with high mortality, especially in developing countries. Despite better understanding of the pathophysiology, mortality from AKI remains source of concern worldwide. AKI varies between countries and even within the same environment due to diverse diagnostic criteria. Studies from developing nations have alluded to the high incidence of AKI from preventable and potentially reversible causes affecting predominantly children and young adults. The growing concern as to whether the pattern and outcome have changed in recent times prompted this study. Materials and Methods: All the patients that met RIFLE criteria for the diagnosis of AKI were audited with specific reference to clinical pattern and outcome in Northwestern Nigeria. Results: A total of 318 patients (198 males and 120 females) that met RIFLE criteria for AKI were seen with age range and mean of 20–80 years and 42.0 ± 12.0 years, respectively. Severe gastroenteritis, septicemia, obstetric complications, and toxic nephropathies were leading causes of AKI. Main clinical features in order of magnitude were oliguria, fever, body swelling, unusual weakness, and vomiting. Sixty-eight percent had hemodialysis while 32% were managed conservatively. Overall, mortality was 26.4%, and conservative management was associated with higher mortality than those that had hemodialysis. Factors associated with high mortality were late presentation, severe anemia, and sepsis. Conclusion: AKI is common in our setting and causes are largely preventable and treatable. Identification and prompt correction of reversible causes and timely referral of severe cases to nephrologists are of immense importance.

Hemodialysis among pregnancy related acute kidney injury patients: A single center experience in North-Western Nigeria

Pregnancy related acute kidney injury (PRAKI) patients that underwent hemodialysis (HD) between May 2007 and April 2015 were studied with specific reference to clinical features, laboratory values, duration of pregnancy at the diagnosis of acute kidney injury and outcome. It involved 38 patients aged between 15 and 30 years. The main clinical features were fever, edema and oliguria. The leading etiological factors included ante/postpartum hemorrhage, septic abortion, and toxemia of pregnancy. The majority of cases occurred during the third trimester. PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. HD improved patient survival in our study.

Factors influencing attitude towards kidney donation for transplantation in Ilorin.

Background : Chronic renal failure (CRF) is a major cause of premature death and morbidity in Nigeria. Majority of patients with end stage renal disease (ESRD) are in the productive age bracket. Haemodialysis is the most commonly available mode of renal replacement therapy. The quality of life of the few that can afford the cost of haemodialysis is poor when compared to the transplanted patients. A survey is carried out to assess factors affecting attitudes towards kidney donation in Ilorin, Nigeria. Methods : A total of 600 self administered, semi-structured questionnaires were distributed amongst asymptomatic adults (aged > 17years) with a response rate of 88%. Data analysis was done using statistical package for social studies (SPSS) version 14. Results : There were 282 males (53.4%) and 246 females (46.6%) with age range of 17-65years and a mean of 34.76+14.9. Two hundred and ninety two (55%) were willing to donate a kidney (165 males, 127 females). Majority of the willing donors (86%) were between 30 and 50 years of age. Though educational level positively influenced the knowledge about the kidney failure, it did not influence willingness to donation of a kidney. There was religion related gender disparity in the willingness to donate a kidney as more male Christians and Muslims were willing to donation than their females. Conclusions : The main constraints to kidney donation were fear of surgical pains, belief in life after death and uncertainty of donor outcome. This calls for awareness programmes on the safety of kidney donation for transplantation.