Ak Soyibo

Prevalence of Chronic Kidney Disease among Patients Attending a Specialist Diabetes Clinic in Jamaica.

OBJECTIVE To estimate the prevalence of chronic kidney disease (CKD) among patients attending the University Hospital of the West Indies (UHWI) Diabetes Clinic and to determine the proportion of patients at high risk for adverse outcomes. METHODS We conducted a cross-sectional study among patients attending the UHWI Diabetes Clinic between 2009 and 2010. Trained nurses administered a questionnaire, reviewed dockets, and performed urinalyses. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Albuminuria was assessed using urine test strips for protein and microalbumin. Chronic kidney disease was defined as an eGFR < 60 ml/min/1.73m2 or albuminuria ≥ 30 mg/g creatinine. Risk of adverse outcome (all-cause mortality, cardiovascular disease and kidney failure) was determined using the Kidney Disease: Improving Global Outcome (KDIGO) 2012 prognosis grid. RESULTS Participants included 100 women and 32 men (mean age, 55.4 ± 12.9 years, mean duration of diabetes, 16.7 ± 11.7 years). Twenty-two per cent of participants had eGFR < 60 ml/min/1.73m2. Moderate albuminuria (30-300 mg/g) was present in 20.5% of participants and severe albuminuria (> 300 mg/g) in 62.1%. Overall prevalence of CKD was 86.3% (95%CI 80.4%, 92.2%). Based on KDIGO risk categories, 50.8% were at high risk and 17.4% at very high risk of adverse outcomes. CONCLUSION Most patients at the UHWI Diabetes Clinic had CKD and were at high or very high risk of adverse outcomes. Further studies to determine the burden of CKD in other clinical settings and to identify the best strategies for preventing adverse outcomes in developing countries need to be conducted.

Acute renal failure post coronary artery bypass grafting at the University Hospital of the West Indies

OBJECTIVES The purpose of the study was to determine the period prevalence of acute renal failure (ARF) after coronary bypass surgery (CABG) at the University Hospital of the West Indies and to identify risk factors. METHOD A retrospective analysis of patients who underwent CABG during the period 1994-2004 was done. Data collected included; age, gender, weight, the presence of hypertension (HTN), diabetes mellitus (DM), hypercholesterolaemia, previous myocardial infarction (MI), blood pressure on admission, urea and creatinine one year prior to surgery, on admission for surgery and post-surgery, duration of intra-operative hypotension, duration of cardiopulmonary bypass, perfusion pressure and the perioperative medications. RESULTS The case notes of 62 patients (68.9%) were obtained for analysis. There were 47 (75.8%) males and 15 females (24.2%)--a 3:1 ratio. The prevalence of HTN and DM in the study sample was 78% and 72% respectively, hypercholesterolaemia was 31% and a previous MI was 29%. There were no differences based on gender. Post CABG complications were: persistent postoperative hypotension (6.8%), congestive cardiac failure (CCF) (6.8%), arrhythmia (6.8%), sepsis (6.8%), lower respiratory tract infection (LRTI) and pleural effusion (5.1%), heart block (3.4%), pulmonary embolism (1.7%), cellulitis and haematoma formation were 1.7%. Three patients had increases in postoperative creatinine values > 89 micromol/L over the postoperative value resulting in a prevalence of ARF of 5%. One of the three patients died and none received dialysis. There were no statistical difference in pre-operative clinical and biochemical characteristics based on the presence or absence of ARE. The presence of diabetes and increased length of stay were significant predictors of increasing postoperative creatinine values adjusting for pre-operative creatinine values. In addition, the presence of diabetes mellitus and male gender were significant predictors of increasing postoperative urea values. CONCLUSION DM is a significant risk factor for the development of ARF post CABG.

The prevalence of sexual dysfunction among patients with end stage renal disease in Jamaica

BACKGROUND Sexual performance and gratification impact quality of life. Although recognized in the literature as a problem, sexual dysfunction among patients with end stage renal disease (ESRD) has never been studied in Jamaica. SUBJECTS AND METHOD The prevalence of sexual dysfunction was determined among 268 adult Jamaican patients (166 males, 102 females) with ESRD who had been on haemodialysis for at least three months. Erectile dysfunction (ED) was assessed using the International Index of Erectile Function (IIEF). Female sexual dysfunction (FSD) was determined using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and International Classification of Diseases (ICD)-10 classifications of sexual disorders. Prevalence, severity of sexual dysfunctions and relationships with the primary aetiology of ESRD and anaemia were assessed. RESULTS Erectile dysfunction, desire and orgasmic disorderS were found in 91.4%, 88.3%, and 81.6% of male subjects, respectively. The majority of male patients were dissatisfied with their performance at intercourse after progressing to ESRD. Hypoactive sexual disorder, sexual arousal and orgasmic disorders, and aversion sexual disorder were prevalent, found in 96%, 88.1% and 87.1% of female patients. All diabetic patients with ESRD reported hypoactive sexual disorder and orgasmic dysfunction; arousal disorder was found in 94.7%. Aversion sexual disorder was found more among patients with underlying chronic glomerulonephritis. All patients with severe anaemia were found to have hypoactive sexual disorder and among these, 87.5% and 97.8% had severe arousal and orgasmic disorders, respectively. CONCLUSION Sexual dysfunction among patients with ESRD in Jamaica was prevalent in males and females. Associations exist between sexual dysfunction and diabetes mellitus, chronic glomerulonephritis and anaemia.

Chronic Kidney Disease in the Caribbean Island of Antigua: Causes, Morbidity and Mortality Factors

Background: Chronic kidney disease (CKD) and its associated high morbidity and mortality cause a significant economic burden and decreased quality of life in affected patients in Antigua, the rest of the Caribbean and globally. The causes of CKD in Antigua, morbidity and mortality factors affecting the sampled patients were evaluated with a view to formulating interventions to minimize the occurrence and the impact of these factors. Objective: To determine the causes of CKD over a nine-year period and the causes of morbidity and mortality among patients with CKD at the two main hospitals in Antigua. Methods: A retrospective review was done of the medical records of patients with CKD who were diagnosed between January 1, 2005 and December 1, 2013. Chronic kidney disease was defined as a glomerular filtration rate of less than 60 mL/minute/1.73 m2. The causes of CKD, the patients’ admission diagnoses, the causes of death and laboratory investigations were evaluated. Results: The documented causes of CKD in these patients were diabetes mellitus (51% of the patients), hypertension (26%), glomerulonephritis (5%) and lupus nephritis (4%). The causes of morbidity among the patients with CKD were myocardial infarction (5.1%), unstable angina (12.7%) and ischaemic stroke (12%). Contributing significantly to the patients’ morbidity were catheter-associated sepsis (8.1%, p < 0.001) and lower respiratory tract infections (5.4%). The main factors contributing to the patients’ mortality were myocardial infarction (16.7%) and catheter-associated sepsis (16.7%). Conclusion: This study documented that the most common causes of CKD among the sampled patients in Antigua were diabetes mellitus and hypertension. Ischaemic heart disease and infections were the major causes of morbidity and mortality among the patients. Early recognition and aggressive management of CKD and its risk factors and complications are important in reducing the clinical and economic burden associated with CKD.

Quality of life and its correlates in chronic dialysis patients

Background: Quality of Life (QOL) is an independent risk factor for mortality in End Stage Renal Disease (ESRD). Traditional parameters such as haemoglobin concentration > 11.1 g/dl, higher socioeconomic status, educational level >10 years of study, Kt/V > 1.2 or urea reduction ratio (URR) > 65%, show a positive correlation with quality of life. Others such as age > 65 years, comorbidity, diabetes mellitus, female gender, poor socioeconomic and educational status (< 10 years duration) are risk factors for poor quality of life. Black populations within the United States of America have recorded higher QOL scores than their matched Caucasian population despite having negative predictive clinical parameters. Quality of life and its correlates in chronic dialysis patients have not been previously documented in the Englishspeaking Caribbean. We therefore undertook a QOL survey in a tertiary care hospital outpatient haemodialysis and peritoneal dialysis units. Methods: The Kidney Disease Quality of Life Short Form Questionnaire was completed by 60 haemodialysis and 10 peritoneal dialysis patients. This represented ninety per cent of both dialysis populations. Mean haemoglobin (Hb) concentration was 10.0 ± 1.8 g/dl, mean serum albumin 41± 6.4 g/dl and URR 75% ± 9 %. Results: Mean QOL scores were equivalent to the means of the sample population except in Sleep function (p = 0.03), Burden of Kidney Disease (p = 0.002) and Dialysis Staff Satisfaction (p = 0.045) which were significantly lower. Positive correlates were noted with Hb > 10g/dL (p = 0.02), URR > 65% (p = 0.01), serum albumin > 35 g/dL (p = 0.024) and high socioeconomic status (p = 0.045) but not with age > 65 years, comorbidity eg DM, nor educational level (p > 0.05). Female gender was associated with higher Quality of Social Interaction scores (p = 0.045) and Sexual Function scores (p = 0.008) while males reported higher Physical Functioning scores (p = 0.024). Higher socioeconomic status patients reported higher Quality of Social Interaction scores (p = 0.05) and Energy scores (p = 0.007) with positive correlation with Hb concentration (p = 0.02) and URR (p = 0.024). Lower income groups had worse Pain scores (p = 0.021) and Burden of Kidney Disease scores (p = 0.02). Married patients reported worse Pain (p = 0.01), Emotional wellbeing (p = 0.024) and Energy scores (p = 0.05). Higher Patient Satisfaction (p = 0.04) and Dialysis Staff Encouragement (p = 0.048) were seen among those with health insurance coverage. Age < 60 years was associated with higher Physical Functioning (p = 0.048) and Emotional Role (p = 0.002) with age > 65 years reporting lower Energy scores (p = 0.03). Multivariate analysis showed these to be independent associations. Conclusion: Overall, QOL among the chronic dialysis patients in this study is good. Positive predictive correlates were age < 65 years, Hb > 10g/dL, URR > 65%, serum albumin > 35g/dL and higher socioeconomic status.