Enajite I Okaka

Patient-related barriers to hypertension control in a Nigerian population

Background Hypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria. Methods This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication. Results A total of 252 participants were included in the survey, and comprised 143 males (56.7%) and 109 females (43.3%). The mean age of the participants was 56.6±12.7 years, with a diagnosis of hypertension for a mean duration of 6.1±3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%), financial constraints (56.6%), high pill burden (22.5%), side effects of medication (17.3%), and low measured blood pressure (12.1%). Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants. Conclusion Poor knowledge regarding hypertension, unrealistic expectations of treatment, poor adherence with medication, unawareness of lifestyle modification, and failure to apply these were identified as patient-related barriers to blood pressure control in this study.

Hyperuricemia in predialysis chronic kidney disease patients in Southern Nigeria

Background: Cardiovascular disease (CVD) is the leading cause of hospitalization and death in chronic kidney disease (CKD) patients. Hyperuricemia has emerged as one of the nontraditional cardiovascular risk factors. Studies have shown that hyperuricemia plays a major role in the development of CVD and rapid progression of CKD to end-stage renal disease. Objective: The aim was to determine the prevalence and pattern of hyperuricemia in predialysis CKD patients attending a teaching hospital in Southern Nigeria. Methodology: One hundred and twenty consecutive predialysis CKD patients and 40 control subjects with normal renal function were recruited over 2 years. Data obtained from participants included demographics, body mass index, blood pressure reading, and etiology of CKD. Blood sampling was done for the determination of serum uric acid, creatinine, and fasting serum lipids. P < 0.05 were taken as significant. Results: The mean age of the CKD subjects was 48.8 ± 16.6 years with a male:female ratio of 1.7:1. The prevalence of hyperuricemia in the CKD subjects was 47.5% and this was significantly higher than 15% observed in the control group (P ≤ 0.001). The prevalence of hyperuricemia was highest in CKD stage 3b. Hyperuricemia was more prevalent in younger predialysis CKD subjects and those with hypertensive nephropathy. There was no significant association between hyperuricemia, obesity, gender and dyslipidemia in this study. Conclusion: Hyperuricemia is highly prevalent in young predialysis CKD patients even in the early stages. Measures to reduce hyperuricemia should be put in place especially lifestyle and dietary modification.

Chronic kidney disease in Nigeria: Late presentation is still the norm

Background: Chronic kidney disease (CKD) has become a public health problem in Nigeria. Efforts are being geared toward early diagnosis and prevention of CKD. This study involved the evaluation of the referral pattern and mode of presentation of CKD patients at first contact in a tertiary health institution. Patients and Methods: Patients′ records over an 18 month period were retrieved and the following information extracted: Sociodemographic data, referral hospital, mode of presentation, etiology of CKD, packed cell volume, blood pressure, and estimated glomerular filtration rate (GFR) at first presentation. Results: There were 202 CKD patients with a male: female ratio of 1.7:1 and a mean age of 48.15 ± 16.69 years. The median estimated GFR of the patients at presentation was 3.17 ml/min/1.73 m [2] . The common etiologies of CKD were chronic glomerulonephritis, hypertension, diabetes mellitus, obstructive nephropathy in 69 (34.2%), 47 (23.3%), 38 (18.8%), and 21 (10.4%) respectively. Among these patients, 111 (55%) and 98 (48.6%) had moderate to severe hypertension and anemia, respectively, 173 (85.6%) presented in CKD Stage 5, 101 (50%) required urgent hemodialysis whereas 123 (60.9%) required in-hospital admission. Only (18) 9% of these CKD patients presented by self-referral while (103) 51% were referred from secondary and private health facilities. Conclusion: Most Nigerian CKD patients still present very late to nephrologists implying that the present preventive strategies have not yielded desired results. Early diagnosis and referral of CKD patients could be better achieved through regular education of the public and retraining of health workers especially those in primary and secondary health institutions.

Quality of life in patients on continuous ambulatory peritoneal dialysis in an African setting

To determine the quality of life (QOL) of patients on continuous ambulatory peritoneal dialysis (CAPD), we studied all the CAPD patients attending their monthly follow-up care clinics at three tertiary hospitals in Johannesburg by administering the World Health Organization QOL-Bref questionnaire. The patients were grouped according to age, duration of peritoneal dialysis and gender. Data were analyzed to determine the significant differences in the QOL scores among the subgroups. There were 114 patients [64 males (56.1%), with a mean age of 42.4 ± 11.3 years) and 38 healthy control subjects (22 males (57.9%), with a mean age of 42.1 ± 12.4 years]. Twenty-one patients (18.4%) had hemoglobin <10 g/dL, while 16 patients (14%) had serum albumin <3 g/dL. The mean QOL scores in the physical, psychological, social relationships and environment domains of the CAPD patients were 55.7 ± 15.0, 56.6 ± 16.4, 55.3 ± 24.7 and 56.3 ± 16.6, respectively. The CAPD patients had significantly lower QOL scores compared with controls, and those aged <30 years had better scores in the physical and psychological domains, gender and hemoglobin concentration. Serum albumin levels did not have a significant impact on the QOL of the CAPD patients.

Spot assessment of chronic kidney disease risk factors in a market population in Benin City

Background: Chronic kidney disease (CKD) is a public health problem world-wide and its management puts a huge financial burden on persons with the disease and those responsible for their treatment. Early identification of CKD risk factors and prevention of its progression is the best option. Objective: The objective of the following study was to determine the prevalence of some CKD risk factors in a population of traders in Benin City. Materials and Methods: Traders in Oba market Benin City were invited for CKD screening on world Kidney Day 2012. Information obtained from participants included age, sex, weight, height; body mass index and blood pressure. Their urine was tested for protein while capillary blood was tested for glucose. Data obtained were analyzed using SPSS 16.0 (Chicago SPSS Inc). Results: A total of 176 persons comprising 83 men and 93 women participated in the study. Their mean age was 42.6 ± 13 years. The prevalence of hypertension (HTN), obesity, proteinuria and hyperglycemia in the study population were 33.5%, 18.2%, 5.7% and 1.7% respectively. Conclusion: HTN and obesity were the most common CKD risk factors in the study population.

Prevalence and pattern of dyslipidemia in a rural community in Southern Nigeria

Background: Cardiovascular disease is a leading cause of morbidity and mortality world -wide. Dyslipidemia is a major risk factor for cardiovascular diseases, which can be identified and managed appropriately. Objective: The objective of the following study was to determine the prevalence and pattern of dyslipidemia in a rural community in Southern Nigeria. Materials and Methods: A cross -sectional study among members of Udo community in Ovia south -west local government area of Edo State. Questionnaires were administered to willing participants. Data obtained were age, sex, body mass index (BMI), blood pressure (BP). Fasting blood samples were collected to determine blood sugar and serum lipid levels. Results: A total of 161 apparently healthy adults were involved in the study (60 men and 101 women) with a mean age of 48 ± 16.6 years. Hypertension was observed in 31 (19.3%), elevated fasting blood sugar in 7 (4.3%) and 30 (18.6%) were obese. The prevalence of elevated total cholesterol (TC), low density lipoprotein cholesterol (LDL -C), triglycerides (TGs) and low high density lipoprotein cholesterol (HDL -C) was 31.7%, 18.6%, 8.7% and 10.6% respectively. TC and LDL -C correlated positively with age, BMI and BP. Mean TC, LDL -C and TG levels was higher in obese participants compared with those with normal BMI. Hypertensive participants had higher mean TC and LDL -C than those with normal BP. Conclusion: Elevated TC was the most common form of dyslipidemia in this study while high TGs were the least. Low HDL -C was not common in this population of rural dwellers.

Factors associated with blood pressure control in predialysis chronic kidney disease patients: Short-term experience from a single center in Southern Nigeria

Background: Hypertension is a leading cause of kidney disease worldwide, and chronic kidney disease (CKD) is a known cause of secondary hypertension. Blood pressure (BP) control is a main-stay in the management of CKD because it retards the progression of established CKD. Aim: To determine BP control and its associated factors in predialysis CKD patients in a tertiary hospital setting. Methodology: CKD patients who attended the renal outpatient clinic during the period from December 2013 to June 2014 were recruited into the study. Demographic and clinical information were obtained from their case records. The average of the three most recent clinic BPs was calculated for each patient. Good BP control was taken as an average BP of <140/90 mmHg. Results: One hundred and three patients (53 males and 50 females) met inclusion criteria for the study. The mean age of the patients was 40.6 ± 17.4 years. Estimated glomerular filtration rate was <60 ml/min in 49.5% of patients. Good BP control was seen in 57 (55.3%) patients. Poor BP control was associated with middle age, proteinuric CKD, and prescription of 3 or more BP medication. Conclusion: BP control in predialysis CKD patients still needs to be optimized. Special attention should be given to middle-aged patients who have proteinuric CKD and those on multiple BP drugs without optimal BP control.

Blood pressure variation and its correlates among patients undergoing hemodialysis for renal failure in Benin City, Nigeria

Background: Blood pressure (BP) variation is commonly encountered during hemodialysis (HD) procedure. Both intradialysis hypotension and hypertension have implications for outcome of treatment and overall morbidity and mortality of the patients. Methodology: A retrospective study was carried out in the dialysis unit of a tertiary health institution in Benin City among patients who had HD for acute kidney injury (AKI) or chronic kidney disease (CKD) over a 3-year period. Data retrieved included age, gender, type of kidney disease, cause of kidney disease, systolic BP at onset of dialysis and at end of dialysis, and diastolic BP (DBP) at onset of and at end of dialysis. Results: Complete data were available for 217 patients. One hundred and seven patients (49.3%) had no significant change in BP; 30.9% had intradialytic hypertension (IDHT) while 19.8% had intradialytic hypotension (IDH). IDH was more prevalent among patients with diabetic kidney disease while IDHT was more common among patients with hypertensive nephropathy (P = 0.002). Female patients had higher mean BP parameters compared to male patients pre- and post-dialysis, but only changes in DBP were statistically significant (P = 0.029). Patients with CKD had higher mean BP parameters pre- and post-dialysis compared to patients with acute AKI and the differences were statistically significant. Conclusion: Females had higher mean BP parameters than males. Patients with CKD had higher mean BP parameters compared with AKI patients. IDHT is a significant problem among patients on HD in our center. Measures to curtail this trend should be instituted with the goal of reducing morbidity and mortality.

Assessment of some cardiovascular risk factors in predialysis chronic kidney disease patients in Southern Nigeria

Background: Cardiovascular risk factors are responsible for cardiovascular disease and rapid progression of chronic kidney disease (CKD) to end-stage renal disease. Prompt evaluation, modification, and treatment of these factors in predialysis patients will reduce morbidity and mortality. This study assessed some cardiovascular risk factors in predialysis CKD patients in a tertiary hospital in Southern Nigeria. Patients and Methods: This was a case–control study that involved 76 consecutive predialysis CKD patients and 38 age-and sex-matched controls without CKD over 1 year period. Both groups were assessed for cardiovascular risk factors, and comparisons were made. A P value of <0.05 was taken as significant. Results: The mean ages of the CKD versus control group were 48.00 ± 15.28 versus 45.34 ± 15.35 years. The male:female ratio was 1.7:1 for both groups. The common etiologies of CKD in this study were hypertension 30 (39.5%), diabetes mellitus 23 (30.3%), and chronic glomerulonephritis 19 (25%). There were 38 (50%) in CKD stage 3, 31 (40.8%) in CKD stage 4, and 7 (9.2%) in CKD stage 5. The common cardiovascular risk factors found in the CKD versus control were hypertension (96.1% vs. 42.1%), anemia (96.1% vs. 23.7%), left ventricular hypertrophy (77.6% vs. 23.7%), dyslipidemia (67.1% vs. 39.5%), hypocalcemia (60.1% vs. 18.5%), hyperphosphatemia (63.2% vs. 0%), and hyperuricemia (57.9% vs. 15.8%). These risk factors were significantly higher in CKD group. Hyperphosphatemia and hypoalbuminemia significantly increased across CKD stages 3–5. Anemia was significantly more common in males whereas dyslipidemia was more common in female CKD patients. Conclusion: Cardiovascular risk factors were highly prevalent in predialysis CKD subjects even in early stages. Hypoalbuminemia and hyperphosphatemia significantly increased across the CKD stages 3–5 whereas anemia and dyslipidemia showed significant gender differences. Cardiovascular risk factors should be treated early in predialysis CKD patients.