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Shoo J, Msilanga D, Mngumi J, Valentine G, Kidunda P, Nyello M, Buma D, Furia F. Clinical profile and outcome of kidney transplantation at Muhimbili National Hospital, Tanzania. BMC Nephrol 2024; 25:323. [PMID: 39342167 PMCID: PMC11439196 DOI: 10.1186/s12882-024-03765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 09/19/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Kidney transplantation is the definitive treatment option for chronic kidney failure, offering improved quality of life and extended survival. Access to kidney transplantation is limited in the Sub-Saharan Africa (SSA) region, with only a few countries with established services. Tanzania started its program five years ago, for the sustainability of the program it is important to understand the outcome. Therefore, this study was conducted to determine the clinical outcomes and survival rates of kidney transplant recipients at Muhimbili National Hospital in Tanzania, in the absence of a national transplant registry, since the inception of the program. METHODS This was a retrospective study conducted among kidney transplant recipients from live donors at Muhimbili National Hospital (MNH) between November 2017 and February 2022. Analyses were performed to assess baseline characteristics, post-transplant complications, and patient and graft survival. RESULTS In our study of 68 kidney transplant recipients, the majority of recipients were male (63.2%) with a mean age of 45.8 years and under medical insurance (88.2%). The predominant cause of CKD was hypertension (58.2%) with recipients undergoing dialysis for a mean duration of 14.4 months, and basiliximab being the most commonly used induction medication (57.3%). The majority of donors were males (64.7%) and had first-degree relationships with recipients (76.5%). Haploid HLA mismatch was observed in 36.8% of cases. One-year patient and graft survival rates were 91.2% and 96.7%, respectively, with infection being the primary cause of death (n = 5), and more than half of deceased patients died with a functioning graft (n = 4). CONCLUSION Our study underscores favorable one-year patient and graft outcomes among kidney transplant recipients at Muhimbili National Hospital, Tanzania. However, challenges persist, notably with infections posing ongoing difficulties for this cohort.
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Affiliation(s)
- Jacqueline Shoo
- Renal Unit, Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania.
- School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
- Muhimbili Renal and Rheumatology Research Group, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Daniel Msilanga
- Renal Unit, Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
- School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jonathan Mngumi
- Renal Unit, Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
- School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Muhimbili Renal and Rheumatology Research Group, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gudila Valentine
- Renal Unit, Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
- School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Muhimbili Renal and Rheumatology Research Group, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Pilly Kidunda
- Renal Unit, Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Mahmoud Nyello
- Renal Unit, Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Deus Buma
- Directorate of Research and Training, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Francis Furia
- Renal Unit, Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
- School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Muhimbili Renal and Rheumatology Research Group, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mkumbi GG, Boaz M. Prevalence of poor glycemic control and the monitoring utility of glycated albumin among diabetic patients attending clinic in tertiary hospitals in Dodoma, Tanzania: A cross-sectional study protocol. PLoS One 2024; 19:e0289388. [PMID: 39231139 PMCID: PMC11373853 DOI: 10.1371/journal.pone.0289388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 06/16/2024] [Indexed: 09/06/2024] Open
Abstract
The burden of diabetes is rising in developing countries, and this is significantly linked to the increasing prevalence of poor glycemic control. The cost of glycated haemoglobin (HbA1c) testing is a barrier to timely glycemic assessments, but newer tests such as glycated albumin may be cheaper and tempting alternatives. Additional research must ascertain if glycated albumin (GA) can act as a viable supplement or alternative to conventional HbA1c measurements for glycemic control in diabetic individuals. GA as a biomarker is an emerging area of interest, particularly for those who display unreliable HbA1c levels or cannot afford the test. This study aims to investigate the prevalence of poor glycemic control in outpatient diabetic patients and the utility of glycated albumin in this population's monitoring of glycemic control. Method. A cross-sectional study of 203 diabetic patients will be conducted at the Dodoma Regional Referral Hospital and Benjamin Mkapa Hospital from August 1st, 2023, to August 31st, 2024. Patients diagnosed with diabetes mellitus for over six months will be screened for eligibility. Informed consent, history, clinical examination, and voluntary blood sample collection will be obtained from all eligible patients. Glycated Albumin levels will be obtained from the same blood samples collected. The glycemic status of all patients will be defined as per HbA1c, and a level of greater than 7% will considered as a poor control. The analysis will be computed with SPSS version 28.0, and a predictor variable, P<0.05, will be regarded as statistically significant, with the utility of GA determined by plotting the area under the ROC curve and the confusion matrix.
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Affiliation(s)
- George Gabriel Mkumbi
- Department of Internal Medicine, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania
- Department of Internal Medicine, Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Matobogolo Boaz
- Department of Internal Medicine, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania
- Department of Internal Medicine, Benjamin Mkapa Hospital, Dodoma, Tanzania
- Department of Internal Medicine, University of Dodoma Hospital, Dodoma, Tanzania
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Furia FF. Progress in CKD Care and Integration of Adult and Childhood Nephrology Services in Tanzania. KIDNEY360 2024; 5:1037-1040. [PMID: 39254462 PMCID: PMC11296552 DOI: 10.34067/kid.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Affiliation(s)
- Francis F Furia
- School of Clinical Medicine and Muhimbili Renal and Rheumatology Research Group, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Fiseha T, Ekong NE, Osborne NJ. Chronic kidney disease of unknown aetiology in Africa: A review of the literature. Nephrology (Carlton) 2024; 29:177-187. [PMID: 38122827 DOI: 10.1111/nep.14264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
During the last two decades, an epidemic of a severe form of chronic kidney disease (CKD) unrelated to traditional risk factors (diabetes and hypertension) has been recognized in low- to middle-income countries. CKD of unknown aetiology (CKDu) mainly affects young working-age adults, and has become as an important and devastating public health issue. CKDu is a multifactorial disease with associated genetic and environmental risk factors. This review summarizes the current epidemiological evidence on the burden of CKDu and its probable environmental risk factors contributing to CKD in Africa. PubMed/Medline and the African Journals Online databases were searched to identify relevant population-based studies published in the last two decades. In the general population, the burden of CKD attributable to CKDu varied from 19.4% to 79%. Epidemiologic studies have established that environmental factors, including genetics, infectious agents, rural residence, low socioeconomic status, malnutrition, agricultural practise and exposure to agrochemicals, heavy metals, use of traditional herbs, and contaminated water sources or food contribute to the burden of CKD in the region. There is a great need for epidemiological studies exploring the true burden of CKDu and unique geographical distribution, and the role of environmental factors in the development of CKD/CKDu.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Nicholas J Osborne
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
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Mbwambo SH, Mbago MC, Rao GS. Socio-environmental predictors of diabetes incidence disparities in Tanzania mainland: a comparison of regression models for count data. BMC Med Res Methodol 2024; 24:75. [PMID: 38532325 PMCID: PMC11340067 DOI: 10.1186/s12874-024-02166-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/30/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Diabetes is one of the top four non-communicable diseases that cause death and illness to many people around the world. This study aims to use an efficient count data model to estimate socio-environmental factors associated with diabetes incidences in Tanzania mainland, addressing lack of evidence on the efficient count data model for estimating factors associated with disease incidences disparities. METHODS This study analyzed diabetes counts in 184 Tanzania mainland councils collected in 2020. The study applied generalized Poisson, negative binomial, and Poisson count data models and evaluated their adequacy using information criteria and Pearson chi-square values. RESULTS The data were over-dispersed, as evidenced by the mean and variance values and the positively skewed histograms. The results revealed uneven distribution of diabetes incidence across geographical locations, with northern and urban councils having more cases. Factors like population, GDP, and hospital numbers were associated with diabetes counts. The GP model performed better than NB and Poisson models. CONCLUSION The occurrence of diabetes can be attributed to geographical locations. To address this public health issue, environmental interventions can be implemented. Additionally, the generalized Poisson model is an effective tool for analyzing health information system count data across different population subgroups.
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Affiliation(s)
- Sauda Hatibu Mbwambo
- Department of Statistics, Dar es Salaam, University of Dar es Salaam, P.O. Box 35047, Dar es Salaam, Tanzania.
- Department of Mathematics and Statistics, The University of Dodoma, P.O. Box 338, Dodoma, Tanzania.
| | - Maurice C Mbago
- Department of Statistics, Dar es Salaam, University of Dar es Salaam, P.O. Box 35047, Dar es Salaam, Tanzania
| | - Gadde Srinivasa Rao
- Department of Mathematics and Statistics, The University of Dodoma, P.O. Box 338, Dodoma, Tanzania
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Katatwire DD, Meremo A. Prevalence of and factors associated with uncontrolled hypertension among patients with early chronic kidney disease attending tertiary hospitals in Dodoma, Tanzania: a cross-sectional study. BMJ Open 2023; 13:e074441. [PMID: 38086591 PMCID: PMC10729198 DOI: 10.1136/bmjopen-2023-074441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To determine the prevalence of uncontrolled hypertension and its associated factors among patients with early chronic kidney disease (CKD) attending medical outpatient clinics at tertiary hospitals in Dodoma, Tanzania. DESIGN Cross-sectional study. SETTING Two tertiary hospitals in Dodoma, Tanzania. PARTICIPANTS The participants in this study were adult patients (≥18 years) with early CKD stages (1, 2 and 3) who were attending nephrology and medical outpatient clinics from November 2020 to March 2021. Patients who had been attending the clinic for at least 3 months, had baseline clinical data on their files, had estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2 and who provided written informed consent were eligible. A total of 352 patients were enrolled, of whom 182 were men and 170 were women. OUTCOME MEASURE The dependent variable was uncontrolled hypertension among patients with early CKD, based on blood pressure measurements. RESULTS The prevalence of hypertension was 58.5% (206 of 352) and the prevalence of uncontrolled hypertension was 58.3% (120 of 206). Among patients with uncontrolled hypertension, 88.3% (106 of 120) had CKD stage 3, 80.2% (96 of 120) reported non-adherence to antihypertensives, 76.7% (92 of 120) were overweight or obese, 72.5% (87 of 120) reported current alcohol use and 26.7% (32 of 120) had diabetes mellitus. Factors that contributed to higher odds of uncontrolled hypertension were: age ≥50 years (OR=5.17, 95 % CI 2.37 to 13.33, p=0.001), alcohol use (OR=11.21, 95% CI 3.83 to 32.84, p=0.001), non-adherence to antihypertensives (OR=10.19, 95% CI 4.22 to 24.61, p=0.001), overweight/obesity (OR=6.28, 95% CI 2.54 to 15.53, p=0.001) and CKD stage 3 (OR=3.52, 95% CI 1.32 to 9.42, p=0.012). CONCLUSION Uncontrolled hypertension was highly prevalent among patients with early CKD in this setting and was associated with age, current alcohol use, non-adherence to antihypertensives, overweight/obesity and declining eGFR.
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Affiliation(s)
- Denis D Katatwire
- Department of Internal Medicine, University of Dodoma, Dodoma, Tanzania, United Republic of
- Department of Internal Medicine, Benjamin Mkapa Hospital, Dodoma, Tanzania, United Republic of
- Department of Internal Medicine, Dodoma Regional Referral Hospital, Dodoma, Tanzania, United Republic of
| | - Alfred Meremo
- Department of Internal Medicine, University of Dodoma, Dodoma, Tanzania, United Republic of
- Department of Internal Medicine, Benjamin Mkapa Hospital, Dodoma, Tanzania, United Republic of
- Department of Internal Medicine, Dodoma Regional Referral Hospital, Dodoma, Tanzania, United Republic of
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Asmelash D, Mesfin Bambo G, Sahile S, Asmelash Y. Prevalence and associated factors of prediabetes in adult East African population: A systematic review and meta-analysis. Heliyon 2023; 9:e21286. [PMID: 37928032 PMCID: PMC10623273 DOI: 10.1016/j.heliyon.2023.e21286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Diabetes mellitus is a major public health problem with serious consequences, and more than three-fourths of diabetes live in low- and middle-income countries. According to a recent study, people with prediabetes have nearly six times the risk of developing diabetes than those with normal glucose levels. However, due to the inconsistency and absence of representative data, this study aimed to estimate the prevalence of prediabetes and its associated factors in the adult East African population. Methods Databases were systematically searched for articles published between January 1, 2013, and December 30, 2022. All observational community-based studies that reported prediabetes prevalence and/or associated factors in adult East African populations were included in the meta-analyses. Three authors independently extracted all required data using the Excel data extraction format and analyzed using Stata™ Version 11. An I2 test was conducted to determine significant heterogeneity. Finally, a random effects model was used to determine the overall prevalence of prediabetes and its associated factors. The study was registered with Prospero number CRD42023389745. Results The search strategy identified 267 articles. After screening for full-text review, twenty-one articles were included in the final analysis. The overall prevalence of prediabetes was 12.58 % (95 % CI:10.30, 14.86 %) in the adult East African population. Furthermore, the subgroup analysis revealed that prediabetes in the urban population 20 % (95 % CI: 1.60, 38.37) was twice as prevalent as in rural 10.0 % (95 % CI: 5.52, 14.48) populations. The prevalence of prediabetes by the ADA diagnostic criteria was 21.45 % (95 % CI: 15.54, 27.35) three times higher than the WHO 7.20 % (95 % CI: 5.70, 8.69). Moreover, prediabetes was significantly associated with old age (OR = 1.64, 95 %, CI: 1.07, 2.53), hypertension (OR = 2.43, 95 %, CI: 1.02-5.79), obesity and overweight (OR = 1.70, 95 %, CI: 1.09,2.65). Conclusion This study showed a high prevalence of prediabetes, which was significantly associated with old age, hypertension, and high BMI. This study suggests that health policymakers should pay attention to the prevention and control strategies that is targeted at those with obesity, hypertension, and old age.
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Affiliation(s)
- Daniel Asmelash
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Getachew Mesfin Bambo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Samuel Sahile
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Yemane Asmelash
- Department of Statistics, College of Natural and Computational Science, Aksum University, Aksum, Ethiopia
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Mboera LEG, Kishamawe C, Rumisha SF, Chiduo MG, Kimario E, Bwana VM. Patterns and trends of in-hospital mortality due to non-communicable diseases and injuries in Tanzania, 2006-2015. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000281. [PMID: 37410764 DOI: 10.1371/journal.pgph.0000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/10/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Globally, non-communicable diseases (NCD) kill about 40 million people annually, with about three-quarters of the deaths occurring in low- and middle-income countries. This study was carried out to determine the patterns, trends, and causes of in-hospital non-communicable disease (NCD) and injury deaths in Tanzania from 2006-2015. METHODS This retrospective study involved primary, secondary, tertiary, and specialized hospitals. Death statistics were extracted from inpatient department registers, death registers, and International Classification of Diseases (ICD) report forms. The ICD-10 coding system was used to assign each death to its underlying cause. The analysis determined leading causes by age, sex, annual trend and calculate hospital-based mortality rates. RESULTS Thirty-nine hospitals were involved in this study. A total of 247,976 deaths (all causes) were reported during the 10-year period. Of the total deaths, 67,711 (27.3%) were due to NCD and injuries. The most (53.4%) affected age group was 15-59 years. Cardio-circulatory diseases (31.9%), cancers (18.6%), chronic respiratory diseases (18.4%), and injuries (17.9%) accounted for the largest proportion (86.8%) of NCD and injuries deaths. The overall 10-year hospital-based age-standardized mortality rate (ASMR) for all NCDs and injuries was 559.9 per 100,000 population. It was higher for males (638.8/100,000) than for females (444.6/100,000). The hospital-based annual ASMR significantly increased from 11.0 in 2006 to 62.8 per 100,000 populations in 2015. CONCLUSIONS There was a substantial increase in hospital-based ASMR due to NCDs and injuries in Tanzania from 2006 to 2015. Most of the deaths affected the productive young adult group. This burden indicates that families, communities, and the nation at large suffer from premature deaths. The government of Tanzania should invest in early detection and timely management of NCDs and injuries to reduce premature deaths. This should go hand-in-hand with continuous efforts to improve the quality of health data and its utilization.
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Affiliation(s)
- Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
- Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, West Perth, Western Australia
| | - Mercy G Chiduo
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Evord Kimario
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Veneranda M Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzanian
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Mhundwa W, Joubert G, Mofokeng TR. The prevalence of chronic kidney disease among type 2 diabetes mellitus patients in central South Africa. S Afr Fam Pract (2004) 2023; 65:e1-e6. [PMID: 37265141 DOI: 10.4102/safp.v65i1.5663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD). The prevalence of CKD among T2DM patients in Africa is 22.0%. The cut-off age for dialysing diabetic patients in the resource-limited state sector in South Africa is 50 years. Type 2 diabetes mellitus patients who develop CKD are likely to be excluded from chronic dialysis and rely on control of risk factors, including blood pressure and blood glucose levels, to prevent CKD progression. We aimed to determine the prevalence of CKD among T2DM patients attending the diabetes clinic at Pelonomi Academic Hospital, Bloemfontein. METHODS In this retrospective cross-sectional study, medical records of patients (January 2016 and December 2018) were reviewed to collect demographic and clinical information. RESULTS In total, 244 records were reviewed. Sixty-one (25.0%, 95% confidence interval [CI]: 20% - 30.8%) T2DM patients had CKD. The rate of CKD was slightly higher in males (n = 24/81; 29.6%) compared with females (n = 37/163; 22.7%). Most patients with CKD (n = 58; 95.1%) were 50 years of age. Only 17.8% of patients achieved a glycosylated haemoglobin (HbA1c) of 7.0%. Blood pressure was controlled in 14.3% of hypertensive patients. Renin-angiotensin-aldosterone system inhibitors were used by 78.6% of patients. CONCLUSION A high prevalence of clinically significant CKD among T2DM patients with poor prospects of chronic dialysis in a resource-limited setting was observed. The risk factors for CKD development and progression should be adequately managed in T2DM patients.Contribution: This study emphasises the need for further research and innovation to improve outcomes of T2DM patients with CKD in resource-constrained settings.
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Affiliation(s)
- William Mhundwa
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein.
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Osetinsky B, Mhalu G, Mtenga S, Tediosi F. Care cascades for hypertension and diabetes: Cross-sectional evaluation of rural districts in Tanzania. PLoS Med 2022; 19:e1004140. [PMID: 36469527 PMCID: PMC9762578 DOI: 10.1371/journal.pmed.1004140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/19/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs), especially hypertension and diabetes, are rapidly rising in sub-Saharan Africa, necessitating health systems transformations. In Tanzania, current policies aim to improve control of hypertension and diabetes, but information is still needed to assess the gaps in treatment. METHODS AND FINDINGS We conducted a cross-sectional household survey of 784 adults in two districts in Tanzania from December 2020 to January 2021, capturing the cascade-of-care for hypertension and diabetes. The ages of the respondents ranged from 18 to 89 years. Of those screened positive for these conditions, we measured the proportion in each step of the cascades: awareness, care engagement, treatment, and control. We conducted multivariable logistic regression analyses for all four steps along the hypertension care cascade with the independent variables of social health protection schemes, and prior diagnosis of comorbid diabetes, and demographic information. In our sample, of the 771 who had their blood pressure measured, 41% (95% confidence interval (CI): 38% to 44%) were screened positive for hypertension, and of the 707 who had their blood sugar measured, 6% (95% CI: 4% to 8%) were screened positive for diabetes. Of those with hypertension, 43% (95% CI: 38% to 49%) had a prior diagnosis, 25% (95% CI: 21% to 31%) were engaged in care, 21% (95% CI: 3% to 25%) were on treatment, and 11% (95% CI: 8% to 15%) were controlled. Of the 42 respondents with diabetes, 80% (95% CI: 69% to 93%) had a prior diagnosis. The diabetes care cascade had much less drop-off, so 66% of those with diabetes (95% CI: 52% to 82%) were engaged in care and on treatment, and 48% (95% CI: 32% to 63%) had their diabetes controlled at the point of testing. Healthcare fee exemptions were independently associated with higher odds of being previously diagnosed (OR 5.81; 95% CI [1.98 to 17.10] p < 0.005), engaged in care (OR 4.71; 95% CI [1.59 to 13.90] p 0.005), and retained in treatment (OR 2.93; 95% CI [1.03 to 8.35] p < 0.05). Prior diagnosis of comorbid diabetes was highly associated with higher odds of being engaged in care for hypertension (OR 3.26; 95% CI [1.39 to 7.63] p < 0.005). The two primary limitations of this study were reliance on screening at a single time point only of people available at the village at the time of the sample and dependence on self-report for to inform the three cascade steps of prior diagnosis, healthcare visits for engagement in care, and treatment use. CONCLUSIONS The high burden of hypertension and low levels of control in our study underscores the importance of improving the awareness and treatment of hypertension. The differences in the care cascades for hypertension and diabetes demonstrates that chronic NCD treatment is possible in this setting, but efforts will be needed across the entire care cascade to improve hypertension control.
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Affiliation(s)
- Brianna Osetinsky
- Swiss Tropical and Public Health Institute, Allschwill, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Sally Mtenga
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Allschwill, Switzerland
- University of Basel, Basel, Switzerland
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Sarpong E, Acheampong DO, Fordjour GNR, Anyanful A, Aninagyei E, Tuoyire DA, Blackhurst D, Kyei GB, Ekor M, Thomford NE. Zero malaria: a mirage or reality for populations of sub-Saharan Africa in health transition. Malar J 2022; 21:314. [PMID: 36333802 PMCID: PMC9636766 DOI: 10.1186/s12936-022-04340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
The global burden of malaria continues to be a significant public health concern. Despite advances made in therapeutics for malaria, there continues to be high morbidity and mortality associated with this infectious disease. Sub-Saharan Africa continues to be the most affected by the disease, but unfortunately the region is burdened with indigent health systems. With the recent increase in lifestyle diseases, the region is currently in a health transition, complicating the situation by posing a double challenge to the already ailing health sector. In answer to the continuous challenge of malaria, the African Union has started a "zero malaria starts with me" campaign that seeks to personalize malaria prevention and bring it down to the grass-root level. This review discusses the contribution of sub-Saharan Africa, whose population is in a health transition, to malaria elimination. In addition, the review explores the challenges that health systems in these countries face, that may hinder the attainment of a zero-malaria goal.
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Affiliation(s)
- Esther Sarpong
- Department of Molecular Biology and Biotechnology, School Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Desmond Omane Acheampong
- Department of Biomedical Sciences, School Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - George Nkansah Rost Fordjour
- Pharmacogenomics and Genomic Medicine Group, Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Akwasi Anyanful
- Pharmacogenomics and Genomic Medicine Group, Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Enoch Aninagyei
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Derek A Tuoyire
- Department of Community Medicine, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Dee Blackhurst
- Division of Chemical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory,, Cape Town, 7925, South Africa
| | - George Boateng Kyei
- Department of Virology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Martins Ekor
- Department of Pharmacology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Nicholas Ekow Thomford
- Pharmacogenomics and Genomic Medicine Group, Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
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12
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Stieglitz LM, Bärnighausen T, Leyna GH, Kazonda P, Killewo J, Rohr JK, Kohler S. Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221076254. [PMID: 35586032 PMCID: PMC9106316 DOI: 10.1177/26335565221076254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/04/2021] [Indexed: 12/11/2022]
Abstract
Background Multimorbidity poses an increasing challenge to health care systems in Sub-Saharan Africa. We studied the extent of multimorbidity and patterns of comorbidity among women aged 40 years or older in a peri-urban area of Dar es Salaam, Tanzania. Methods We assessed 15 chronic conditions in 1528 women who participated in a cross-sectional survey that was conducted within the Dar es Salaam Urban Cohort Study (DUCS) from June 2017 to July 2018. Diagnoses of chronic conditions were based on body measurements, weight, blood testing, screening instruments, and self-report. Results The five most prevalent chronic conditions and most common comorbidities were hypertension (49.8%, 95% CI 47.2 to 52.3), obesity (39.9%, 95% CI 37.3 to 42.4), anemia (36.9%, 95% CI 33.3 to 40.5), signs of depression (32.5%, 95% CI 30.2 to 34.9), and diabetes (30.9%, 95% CI 27.6 to 34.2). The estimated prevalence of multimorbidity (2+ chronic conditions) was 73.8% (95% CI 71.2 to 76.3). Women aged 70 years or older were 4.1 (95% CI 1.5 to 10.9) times mores likely to be affected by multimorbidity and had 0.7 (95% CI 0.3 to 1.2) more chronic conditions than women aged 40 to 44 years. Worse childhood health, being widowed, not working, and higher food insecurity in the household were also associated with a higher multimorbidity risk and level. Conclusion A high prevalence of multimorbidity in the general population of middle-aged and elderly women suggests substantial need for multimorbidity care in Tanzania. Comorbidity patterns can guide multimorbidity screening and help identify health care and prevention needs.
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Affiliation(s)
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Germana H. Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julia K. Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Yu A, Zhao J, Yadav SPS, Molitoris BA, Wagner MC, Mechref Y. Changes in the Expression of Renal Brush Border Membrane N-Glycome in Model Rats with Chronic Kidney Diseases. Biomolecules 2021; 11:1677. [PMID: 34827675 PMCID: PMC8616023 DOI: 10.3390/biom11111677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
Chronic kidney disease (CKD) is defined by a reduced renal function i.e., glomerular filtration rate (GFR), and the presence of kidney damage is determined by measurement of proteinuria or albuminuria. Albuminuria increases with age and can result from glomerular and/or proximal tubule (PT) alterations. Brush-border membranes (BBMs) on PT cells play an important role in maintaining the stability of PT functions. The PT BBM, a highly dynamic, organized, specialized membrane, contains a variety of glycoproteins required for the functions of PT. Since protein glycosylation regulates many protein functions, the alteration of glycosylation due to the glycan changes has attracted more interests for a variety of disease studies recently. In this work, liquid chromatography-tandem mass spectrometry was utilized to analyze the abundances of permethylated glycans from rats under control to mild CKD, severe CKD, and diabetic conditions. The most significant differences were observed in sialylation level with the highest present in the severe CKD and diabetic groups. Moreover, high mannose N-glycans was enriched in the CKD BBMs. Characterization of all the BBM N-glycan changes supports that these changes are likely to impact the functional properties of the dynamic PT BBM. Further, these changes may lead to the potential discovery of glycan biomarkers for improved CKD diagnosis and new avenues for therapeutic treatments.
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Affiliation(s)
- Aiying Yu
- Department of Chemistry and Biochemistry, Texas Tech University, Texas City, TX 79409, USA; (A.Y.); (J.Z.)
| | - Jingfu Zhao
- Department of Chemistry and Biochemistry, Texas Tech University, Texas City, TX 79409, USA; (A.Y.); (J.Z.)
| | - Shiv Pratap S. Yadav
- Nephrology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (S.P.S.Y.); (B.A.M.); (M.C.W.)
| | - Bruce A. Molitoris
- Nephrology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (S.P.S.Y.); (B.A.M.); (M.C.W.)
| | - Mark C. Wagner
- Nephrology Division, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA; (S.P.S.Y.); (B.A.M.); (M.C.W.)
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Texas City, TX 79409, USA; (A.Y.); (J.Z.)
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Tran Ngoc C, Barango P, Harrison R, Jones A, Shongwe SV, Tuyishime A, Uwinkindi F, Xu H, Shoop-Worrall S. Risk factors associated with albuminuria in Rwanda: results from a STEPS survey. BMC Nephrol 2021; 22:361. [PMID: 34724916 PMCID: PMC8561895 DOI: 10.1186/s12882-021-02574-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are a growing burden which affects every part of the world, including developing countries. Chronic kidney disease (CKD) has varied etiology which can result from or complicate other NCDs such as diabetes and cardiovascular diseases. The growing prevalence of NCDs coupled with the increasing age in most developing countries, has seen a marked increase of CKD in these settings. CKD has been described as "the most neglected NCD" and greatly affects the quality of life of patients. It also places a huge economic burden on societies. However, few epidemiological data exist, particularly in sub-Saharan Africa. Assessment of the prevalence of albuminuria as a marker of kidney damage and CKD progression and its main risk factors was thus needed in Rwanda. METHODS This study analyzed data collected during the first STEPwise approach to NCD risk factor Surveillance (STEPS) survey in Rwanda, conducted from 2012 to 2013, to assess the prevalence of albuminuria. A multistage cluster sampling allowed to select a representative sample of the general population. Furthermore, descriptive, as well as univariable analyses and multiple logistic regression were performed to respond to the research question. RESULTS This survey brought a representative sample of 6,998 participants, among which 4,384 (62.65%) were female. Median age was 33 years (interquartile range, IQR 26-44), and over three quarters (78.45%) lived in rural areas. The albuminuria prevalence was 105.9 per 1,000 population. Overall, semi-urban and urban residency were associated with lower odds of CKD (odds ratio, OR 0.36, CI 0.23-0.56, p<0.001 and OR 0.34, CI 0.23-0.50, p<0.001, respectively) than rural status. Being married or living with a partner had higher odds (OR 1.44 (CI 1.03-2.02, p=0.031) and OR 1.62 (CI 1.06-2.48, p=0.026), respectively) of CKD than being single. Odds of positive albuminuria were also greater among participants living with human immunodeficiency virus (HIV) (OR 1.64, CI 1.09- 2.47, p=0.018). Gender, age group, smoking status and vegetable consumption, body mass index (BMI) and hypertension were not associated with albuminuria. CONCLUSION The albuminuria prevalence was estimated at 105.9 per 1,000 in Rwanda. Rural residence, partnered status and HIV positivity were identified as main risk factors for albuminuria. Increased early screening of albuminuria to prevent CKD among high-risk groups, especially HIV patients, is therefore recommended.
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Affiliation(s)
- Candide Tran Ngoc
- World Health Organization, Country Office for Rwanda, Kigali, Rwanda.
| | - Prebo Barango
- World Health Organization, Inter Country Support Team, Eastern and Southern Africa, Harare, Zimbabwe
| | - Roger Harrison
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Andrew Jones
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Steven Velabo Shongwe
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | | | - Hongyi Xu
- World Health Organization, Headquarters, Geneva, Switzerland
| | - Stephanie Shoop-Worrall
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
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Prevalence of Chronic Kidney Disease as a Marker of Hypertension Target Organ Damage in Africa: A Systematic Review and Meta-Analysis. Int J Hypertens 2021; 2021:7243523. [PMID: 34671490 PMCID: PMC8523261 DOI: 10.1155/2021/7243523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/21/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Hypertension is a major global cause of cardiovascular disease and death with rising worldwide prevalence, particularly in low-income countries. With low awareness, poor treatment, and low control of hypertension in Africans, there is an increased number of patients with target organ damage (TOD), especially chronic kidney disease (CKD), as a consequence of hypertension. The aim of our study is to assess the prevalence of CKD from studies in Africa reporting TOD related to hypertension. Methods We performed a search of PubMed/MEDLINE, Web of Science, EBSCOhost, and African Journals Online (AJOL) for studies reporting on CKD as TOD in patients with hypertension. The pooled estimate of CKD was then presented by subregions, age group, eGFR equations, and urban or rural location. Results We identified 1,334 articles from which 12 studies were included for quantitative analysis. The studies included 5297 participants from 6 countries (Ghana, Nigeria, Uganda, Tanzania, Democratic Republic of Congo, and South Africa). The pooled prevalence of CKD was 17.8% (95% CI 13.0-23.3%), and CKD was significantly more prevalent in West Africa (21.3% (95% CI: 16.1-27.0); p < 0.0001) and in studies conducted in urban settings (p < 0.001). CKD prevalence was not significantly different by type of GFR equation or age. Conclusion This study reports a high prevalence of CKD related to hypertension with a higher prevalence in urban than rural areas. This emphasizes the role of hypertension in causing kidney damage, and the need for strategies to improve awareness, treatment, and control of hypertension in Africans. This study is registered with PROSPERO registration number CRD42018089263.
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Yu A, Zhao J, Zhong J, Wang J, Yadav SPS, Molitoris BA, Wagner MC, Mechref Y. Altered O-glycomes of Renal Brush-Border Membrane in Model Rats with Chronic Kidney Diseases. Biomolecules 2021; 11:1560. [PMID: 34827558 PMCID: PMC8615448 DOI: 10.3390/biom11111560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) is defined as a decrease in renal function or glomerular filtration rate (GFR), and proteinuria is often present. Proteinuria increases with age and can be caused by glomerular and/or proximal tubule (PT) alterations. PT cells have an apical brush border membrane (BBM), which is a highly dynamic, organized, and specialized membrane region containing multiple glycoproteins required for its functions including regulating uptake, secretion, and signaling dependent upon the physiologic state. PT disorders contribute to the dysfunction observed in CKD. Many glycoprotein functions have been attributed to their N- and O-glycans, which are highly regulated and complex. In this study, the O-glycans present in rat BBMs from animals with different levels of kidney disease and proteinuria were characterized and analyzed using liquid chromatography tandem mass spectrometry (LC-MS/MS). A principal component analysis (PCA) documented that each group has distinct O-glycan distributions. Higher fucosylation levels were observed in the CKD and diabetic groups, which may contribute to PT dysfunction by altering physiologic glycoprotein interactions. Fucosylated O-glycans such as 1-1-1-0 exhibited higher abundance in the severe proteinuric groups. These glycomic results revealed that differential O-glycan expressions in CKD progressions has the potential to define the mechanism of proteinuria in kidney disease and to identify potential therapeutic interventions.
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Affiliation(s)
- Aiying Yu
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, USA; (A.Y.); (J.Z.); (J.Z.); (J.W.)
| | - Jingfu Zhao
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, USA; (A.Y.); (J.Z.); (J.Z.); (J.W.)
| | - Jieqiang Zhong
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, USA; (A.Y.); (J.Z.); (J.Z.); (J.W.)
| | - Junyao Wang
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, USA; (A.Y.); (J.Z.); (J.Z.); (J.W.)
| | - Shiv Pratap S. Yadav
- Department of Medicine, Nephrology Division, Indiana University, Indianapolis, IN 46202, USA; (S.P.S.Y.); (B.A.M.); (M.C.W.)
| | - Bruce A. Molitoris
- Department of Medicine, Nephrology Division, Indiana University, Indianapolis, IN 46202, USA; (S.P.S.Y.); (B.A.M.); (M.C.W.)
| | - Mark C. Wagner
- Department of Medicine, Nephrology Division, Indiana University, Indianapolis, IN 46202, USA; (S.P.S.Y.); (B.A.M.); (M.C.W.)
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, USA; (A.Y.); (J.Z.); (J.Z.); (J.W.)
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Al Kathiry DA, Al Slail F, Al-Surimi K, Abusaris R. The Impact of Financial Incentives on Behavior and Self-Management of Uncontrolled Type 2 Diabetes: Pre- and Post-Quasiexperimental Study. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2021; 4:88-95. [PMID: 37261064 PMCID: PMC10228991 DOI: 10.36401/jqsh-20-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/25/2021] [Accepted: 04/12/2021] [Indexed: 06/02/2023]
Abstract
Introduction Noncommunicable diseases are one of the main challenges that affect health worldwide and have been found to be increasing in both low- and middle-income countries compared with high-income countries. The aim of this study was to assess the impact of financial incentives and a comprehensive care program focusing on patients' behavior and self-management of uncontrolled type 2 diabetes (glycosylated hemoglobin [HbA1c] ≥ 7), as well as modifiable risk factors for disease complications in a Saudi Arabian population. Methods This quasiexperimental study, using a pre- and postevaluation approach, was used to compare the level of HbA1c among patients with uncontrolled diabetes before and after the financial incentives and comprehensive care program were implemented. Financial awards were given to patients who achieved a significantly greater decrease in HbA1c levels with his/her responsible physician. The study population included 702 Saudi Arabian patients with type 2 diabetes from 14 regions and 34 primary healthcare centers in the Kingdom of Saudi Arabia. All of these patients (≥ 15 years old) with uncontrolled type 2 diabetes who attended local primary healthcare centers in Saudi Arabia for a follow-up visit from February to October 2018. Results The mean age, in years, of the sample was 56.14 (± SD = 9.909); slightly more than half of the patients 401 (57.1%) were females. Most of the participants 645 (91.9%) were married, and 381(54.3%) patients were housewives. Linear mixed modeling revealed that all groups showed improvements over time in the primary outcome of HbA1c levels (p = 0.009), Including the secondary outcomes of body mass index and systolic and diastolic blood pressure (p = 0.04, < 0.001, 0.019 respectively). Conclusions Patient behavior was improved, which was reflected by decreases in HbA1c, body mass index, and blood pressure levels. A comprehensive care program is recommended by healthcare providers to increase awareness among patients with diabetes to reduce other risk factors. These kinds of interventions positively motivate patients with diabetes to control their health measurements and to adopt a healthy lifestyle.
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Affiliation(s)
- Dalal Abdulaziz Al Kathiry
- Ministry of Health, Directorate General of Health Programs and Non-Communicable Disease, Riyadh, Saudi Arabia
| | - Fatima Al Slail
- Ministry of Health, Directorate General of Health Programs and Non-Communicable Disease, Riyadh, Saudi Arabia
| | - Khaled Al-Surimi
- Department of Health Systems and Management, College of Public Health and Health Informatics King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raghib Abusaris
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Nutritional Status of Patients on Maintenance Hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania: A Cross-Sectional Study. J Nutr Metab 2021; 2021:6672185. [PMID: 34123420 PMCID: PMC8166490 DOI: 10.1155/2021/6672185] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/14/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Patients on hemodialysis therapy are at high risk of malnutrition which is attributed to multiple factors. Protein-energy malnutrition in these patients confers poor clinical outcomes. This study investigated the nutritional status of patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods A cross-sectional descriptive study was done among 160 adult patients on maintenance hemodialysis therapy. Data concerning patients' personal, medical, dietary, and hemodialysis-related information were collected. Patients' anthropometric and laboratory tests (complete blood count, albumin, total cholesterol, creatinine, and urea) were measured. The quantitative Subjective Global Assessment (SGA) dialysis malnutrition score (DMS) was used to assess their nutritional status. Data analysis was done using the SPSS software version 20. Results Among the 160 hemodialysis patients, 49 (30.6%) were female. Patients' mean age was 52.2 ± 13.3 years. The median duration on hemodialysis was 18 (8.25–29.75) months. Malnutrition was present in 98 (61.2%) of the patients. Severe malnutrition was found in only 3 (1.9%) patients and 16.9% were underweight. The longer duration on hemodialysis, having diabetes mellitus, and being single were associated with increased risk for malnutrition in multivariate logistic regression. Malnourished patients had significantly lower dry weight, body mass index, mid-upper arm circumference, waist circumference, albumin, total cholesterol, and creatinine levels. Conclusion Malnutrition is very common among hemodialysis patients at Muhimbili National Hospital, especially those on longer duration of hemodialysis, and diabetic patients. We recommend that hemodialysis patients should be regularly assessed for malnutrition and appropriately treated which if left unattended heralds worse outcomes.
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Wei H, Wang J, Liang Z. STAT1-p53-p21axis-dependent stress-induced progression of chronic nephrosis in adriamycin-induced mouse model. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1002. [PMID: 32953802 PMCID: PMC7475511 DOI: 10.21037/atm-20-5167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Chronic nephrosis (CN) is an aging-related disease with high mortality. Signal transduction and transcriptional activator 1 (STAT1) protein promotes senescence in human glomerular mesangial cells (HMCs), but whether it affects the progression of adriamycin (ADR)-induced CN in vivo remains unclear. Methods We established an ADR-induced CN mouse model that was completed in wild-type (wt) mice by a single intravenous injection of 10 mg/kg ADR for 2 or 4 weeks. Clinical indexes in each group were determined. Hematoxylin and eosin staining (H&E) was employed to determine renal histopathological damage, SA-β-gal staining was used to evaluate cell senescence phenotype. TUNEL and immunohistochemistry (IHC) staining were used to detect renal apoptosis. Protein levels of Bcl-2, Bax, STAT1, p53 and p21 were measured by Western Blot. Results STAT1 intervention ameliorated renal function. H&E staining indicated that STAT1-deficient (stat1−/−) improved the renal tubular injury, and stat1−/− obviously inhibited the apoptosis and Caspase-3+ number in kidney tissues. Besides, stat1−/− decreased proteinuria, and the levels of urea nitrogen and creatinine as well as that of reactive oxygen species induced by ADR. Also, stat1−/− resulted in the reduced expression of p53 and p21. Conclusions Our current study strongly demonstrated the involvement of the STAT1-p53-p21 axis in the regulation of CN and is a potential target for the nephrosis treatment.
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Affiliation(s)
- Hua Wei
- Nephrology Department, Xinxiang Central Hospital, Xinxiang, China
| | - Jiali Wang
- Nephrology Department, Xinxiang Central Hospital, Xinxiang, China
| | - Zhaozhi Liang
- Nephrology Department, Xinxiang Central Hospital, Xinxiang, China
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20
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Comini LDO, de Oliveira LC, Borges LD, Dias HH, Batistelli CRS, Ferreira EDS, da Silva LS, Moreira TR, da Costa GD, da Silva RG, Cotta RMM. Prevalence of chronic kidney disease in Brazilians with arterial hypertension and/or diabetes mellitus. J Clin Hypertens (Greenwich) 2020; 22:1666-1673. [PMID: 33460313 PMCID: PMC8029734 DOI: 10.1111/jch.13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/27/2022]
Abstract
The present study aimed to evaluate the prevalence of chronic kidney disease (CKD) in individuals with arterial hypertension (AH) and/or diabetes mellitus (DM) accompanied by Primary Health Care (PHC) in Brazil. The estimated glomerular filtration rate (eGFR) based on creatinine, and urinary albumin-to-creatinine ratio (ACR) were measured in 841 subjects with AH and/or DM, followed by PHC in the city of Viçosa. The CKD was diagnosed according to KDIGO criteria. Sociodemographic, clinical, and anthropometric factors related to the prevalence of CKD were investigated through multiple logistic regression. The prevalence of hidden CKD was 15.4%. Of these, 7.5% were identified by albuminuria (ACR ≥30 mg/g) with slightly decreased eGFR. Age, baseline disease, waist circumference (WC), and systolic blood pressure remained associated with CKD after multivariate analysis. The two major risk factors for hidden CKD were the presence of AH in association with DM and an increase in age. Hidden CKD was more common within people with AH and DM, and with high WC, glycosylated hemoglobin, and serum phosphorus as well as male gender and decreased serum albumin. This knowledge of risk associations can help avoid progression to CKD.
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Affiliation(s)
- Luma de Oliveira Comini
- Department of Nutrition and HealthFederal University of ViçosaGraduate Program in Nutrition and HealthViçosaMGBrazil
| | - Laura Camargo de Oliveira
- Department of Nutrition and HealthFederal University of ViçosaGraduate Program in Nutrition and HealthViçosaMGBrazil
| | - Luiza Delazari Borges
- Department of Nutrition and HealthFederal University of ViçosaGraduate Program in Nutrition and HealthViçosaMGBrazil
| | - Heloísa Helena Dias
- Department of Nutrition and HealthFederal University of ViçosaGraduate Program in Nutrition and HealthViçosaMGBrazil
| | | | - Emily de Souza Ferreira
- Department of Nutrition and HealthFederal University of ViçosaGraduate Program in Nutrition and HealthViçosaMGBrazil
| | | | | | - Glauce Dias da Costa
- Department of Nutrition and HealthFederal University of ViçosaGraduate Program in Nutrition and HealthViçosaMGBrazil
| | - Rodrigo Gomes da Silva
- Clinical Director of the Nephrology Service of Hospital São João BatistaSão João Batista HospitalViçosaMGBrazil
| | - Rosângela Minardi Mitre Cotta
- Department of Nutrition and HealthFederal University of ViçosaGraduate Program in Nutrition and HealthViçosaMGBrazil
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Prevalence and Risk Factors of CKD in South Kivu, Democratic Republic of Congo: A Large-Scale Population Study. Kidney Int Rep 2020; 5:1251-1260. [PMID: 32775824 PMCID: PMC7403549 DOI: 10.1016/j.ekir.2020.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/29/2020] [Accepted: 05/25/2020] [Indexed: 12/26/2022] Open
Abstract
Background The prevalence of chronic kidney disease (CKD) in African American individuals is high but whether this applies to native populations in sub-Saharan Africa is unclear. Methods In a cross-sectional study, we assessed the prevalence and risk factors of CKD in rural and urban adults in South Kivu, Democratic Republic of Congo. Glomerular filtration rate (GFR) was estimated using the CKD–Epidemiology Collaboration (CKD-EPI) equations based on serum creatinine (eGFRcr), cystatin C (eGFRcys), or both markers (eGFRcr-cys), without ethnic correction factor. CKD was defined as an eGFR <60 ml/min per 1.73 m2 and/or albuminuria (albumin-to-creatinine ratio ≥30 mg/g). Results A total of 1317 participants aged 41.1 ± 17.1 years (730 rural, 587 urban) were enrolled. The prevalence of hypertension (20.2%; 95% confidence interval [CI], 18–22.3), diabetes mellitus (4.3%; 95% CI, 3.2–5.4) and obesity (8.9%; 95% CI, 7.4–10.5) was higher in urban than rural participants (all P < 0.05). HIV infection prevalence was 0.41% (95% CI, 0.05–0.78). The prevalence of eGFRcr <60 ml/min per 1.73 m2 was 5.4% (95% CI, 4.2–6.7). The prevalence of albuminuria was 6.6% (95 % CI, 5.1–8.1). The overall prevalence of CKD was 12.2% (95% CI, 10.2–14.2) according to CKD-EPIcr. Factors independently associated with CKD-EPIcr were older age (adjusted odds ratio [aOR], 1.05 [1.04–1.07]), urban residence (aOR 1.86 [1.18–2.95]), female sex (aOR 1.66 [1.04–2.66]), hypertension (aOR 1.90 [1.15–3.12]), diabetes (aOR 2.03 [1.02–4.06]), and HIV infection (10.21 [2.75–37.85]). The results based on eGFRcys or eGFRcr-cys were largely consistent with the preceding. Conclusion Overall, the burden of CKD is substantial (>11%), predominantly in the urban area, and largely driven by classic risk factors (gender, aging, HIV, hypertension, and diabetes).
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Comorbilidad afectiva en personas con hipertensión arterial: un estudio de caso-control en adultos dominicanos. ACTA COLOMBIANA DE PSICOLOGIA 2020. [DOI: 10.14718/acp.2020.23.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
En la literatura científica se encuentra un gran número de controversias y resultados dispares a la hora de explicar la relación entre la hipertensión arterial y algunas variables vinculadas a la afectividad negativa, como la depresión, la ansiedad y la ira. Teniendo esto en cuenta, en la presente investigación se planteó como objetivo principal analizar medidas de ansiedad, depresión e ira en personas adultas que padecen de hipertensión arterial (HTA). A partir de un diseño de caso-control, se contrastaron dos grupos, uno conformado por personas con HTA (n = 50) y otro de control equiparado en número de casos, edad y sexo. A nivel general, el grupo de HTA mostró mayores niveles de depresión ¾en su dimensión somática¾ y de ira-rasgo ¾en su dimensión de temperamento¾. Asimismo, las personas con HTA presentaron síntomas de irritabilidad y pérdida de energía ¾síntomas depresivo-somáticos¾, además de que tendían a enojarse con facilidad o rápidamente —sín- tomas de temperamento de ira¾. El abordaje de estos factores psicológicos comórbidos resulta de relevancia dado que en estudios precedentes ha demostrado aumentar la adherencia al tratamiento médico en pacientes que han sido diagnosticados con hipertensión o patologías similares.
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Furia FF, Shoo J, Ruggajo PJ, Kilonzo K, Basu G, Yeates K, Varughese S, Svarstad E, Kisanga O. Developing nephrology services in low income countries: a case of Tanzania. BMC Nephrol 2019; 20:378. [PMID: 31623570 PMCID: PMC6798480 DOI: 10.1186/s12882-019-1568-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of kidney diseases is reported to be higher in lower- and middle-income countries as compared to developed countries, and countries in sub-Saharan Africa are reported to be most affected. Health systems in most sub-Sahara African countries have limited capacity in the form of trained and skilled health care providers, diagnostic support, equipment and policies to provide nephrology services. Several initiatives have been implemented to support establishment of these services. METHODS This is a situation analysis to examine the nephrology services in Tanzania. It was conducted by interviewing key personnel in institutions providing nephrology services aiming at describing available services and international collaborators supporting nephrology services. RESULTS Tanzania is a low-income country in Sub-Saharan Africa with a population of more than 55 million that has seen remarkable improvement in the provision of nephrology services and these include increase in the number of nephrologists to 14 in 2018 from one in 2006, increase in number of dialysis units from one unit (0.03 unit per million) before 2007 to 28 units (0.5 units per million) in 2018 and improved diagnostic services with introduction of nephropathology services. Government of Tanzania has been providing kidney transplantation services by funding referral of donor and recipients abroad and has now introduced local transplantation services in two hospitals. There have been strong international collaborators who have supported nephrology services and establishment of nephrology training in Tanzania. CONCLUSION Tanzania has seen remarkable achievement in provision of nephrology services and provides an interesting model to be used in supporting nephrology services in low income countries.
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Affiliation(s)
- Francis F. Furia
- School of Medicine, Muhimbili University of Health Sciences (MUHAS), P. O. Box 65001, Dar es Salaam, Tanzania
- Renal Unit, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Jacqueline Shoo
- School of Medicine, Muhimbili University of Health Sciences (MUHAS), P. O. Box 65001, Dar es Salaam, Tanzania
- Renal Unit, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Paschal J. Ruggajo
- School of Medicine, Muhimbili University of Health Sciences (MUHAS), P. O. Box 65001, Dar es Salaam, Tanzania
- Renal Unit, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Kajiru Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Gopal Basu
- Department of Renal Medicine, The Alfred Hospital, Melbourne, Australia
- Previously Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu India
| | - Karen Yeates
- Department of Medicine, Division of Nephrology, Queen’s University, Kingston, Ontario Canada
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College-Vellore, Vellore, Tamil Nadu India
| | - Einar Svarstad
- Department of Medicine, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Onesmo Kisanga
- School of Medicine, Muhimbili University of Health Sciences (MUHAS), P. O. Box 65001, Dar es Salaam, Tanzania
- Renal Unit, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
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Eghan BA, Agyemang-Yeboah F, Togbe E, Annani-Akollor ME, Donkor S, Afranie BO. Waist circumference and hip circumference as potential predictors of visceral fat estimate among type 2 diabetic patients at the Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1080/20905068.2019.1658340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Benjamin Ackon Eghan
- Medicine Department, KNUST School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Francis Agyemang-Yeboah
- Department of Molecular Medicine, KNUST School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Eliezer Togbe
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Max Efui Annani-Akollor
- Department of Molecular Medicine, KNUST School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Sampson Donkor
- Department of Molecular Medicine, KNUST School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Bright Oppong Afranie
- Department of Molecular Medicine, KNUST School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Ortiz A. Burden, access and disparities in kidney disease: chronic kidney disease hotspots and progress one step at a time. Clin Kidney J 2019; 12:157-159. [PMID: 30976390 PMCID: PMC6452190 DOI: 10.1093/ckj/sfz026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Indexed: 01/24/2023] Open
Abstract
The 2019 International Society of Nephrology World Kidney Day theme is Kidney Health for Everyone Everywhere. It focuses on the uneven burden of acute kidney injury and chronic kidney disease (CKD) in different communities, identifies disparities and challenges in access to care and calls for universal health coverage for prevention and early treatment of kidney disease. This topic is fully in line with the Clinical Kidney Journal (ckj) editorial strategy for improving worldwide kidney care without leaving any community behind. Indeed, the first PubMed-recorded use of the term CKD hotspot was in ckj, where it was defined as 'countries, region[s], communities or ethnicities with higher than average incidence of CKD'. This issue of ckj contains the World Kidney Day editorial as well as contributions that illustrate two concepts: the need to validate biochemical thresholds generated in developed countries in other populations, as exemplified by Kidney Disease: Improving Global Outcomes CKD-mineral and bone disorder parameters in an African population, and the fact that some disease associations characteristic of developing countries may be described initially in developed countries, as exemplified by the association of APOL1 variants with CKD or by minimal change disease secondary to malaria, but have to be validated locally.
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Affiliation(s)
- Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid; Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN, Madrid, Spain
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Omar SM, Musa IR, ElSouli A, Adam I. Prevalence, risk factors, and glycaemic control of type 2 diabetes mellitus in eastern Sudan: a community-based study. Ther Adv Endocrinol Metab 2019; 10:2042018819860071. [PMID: 31275546 PMCID: PMC6598316 DOI: 10.1177/2042018819860071] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/03/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) constitutes a global health threat and burden, especially in developing countries. We conducted a cross-sectional study in Gadarif in eastern Sudan to evaluate the prevalence and glycaemic control of patients with type 2 diabetes mellitus (T2DM). METHODS We performed a cross-sectional community-based study. Data on blood glucose levels, and anthropometric, demographic and clinical history data were obtained. RESULTS Six hundred Sudanese adults with a mean (SD) age of 44.9 (16.5) years were enrolled. More than two-thirds (70.3%) of the study participants were women. The prevalence of T2DM, newly diagnosed T2DM and uncontrolled T2DM was 20.8%, 10.0% and 80.0%, respectively. Logistic regression analysis showed no significant association between education, marital status, body mass index, waist circumference and DM. However older age (AOR = 4.88, 95% CI = 3.09-7.70) and a family history of DM (AOR = 2.58, 95% CI = 1.59-4.20) were associated with T2DM. CONCLUSION The prevalence of T2DM is high among the Sudanese population, especially in older people and those with a family history of DM. The high prevalence of uncontrolled DM in this setting is another hidden burden.
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Affiliation(s)
- Saeed M. Omar
- Faculty of Medicine, Gadarif University, Gadarif, Sudan
| | - Imad R. Musa
- King Abdu Aziz Armed Forces Hospital at Air Base, Dhahran, Kingdom of Saudi Arabia
| | - Amir ElSouli
- Unaizah College of Medicine, Qassim University, Unaizah, Kingdom of Saudi Arabia
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Valdivia-Rivera S, Martínez-Cano AK, Aguirre-García G, Lizardi-Jiménez MA. Hydrocarbon water-pollution related to chronic kidney disease in Tierra Blanca, a perfect storm. ENVIRONMENT INTERNATIONAL 2018; 121:1204-1209. [PMID: 30366661 DOI: 10.1016/j.envint.2018.10.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/14/2018] [Accepted: 10/18/2018] [Indexed: 06/08/2023]
Abstract
Chronic kidney disease (CKD) affects the kidneys, and in severe cases is considered as end-stage renal disease which can only be treated by dialysis and transplantation. Tierra Blanca city has a higher CKD rate compared to other Mexican cities, but its principal cause has not been found yet. Main factors related to CKD are carbonated beverage consumption, diabetes, obesity, hypertension, heat stress, dehydration, and intoxication by pesticides, heavy metals, and/or hydrocarbons. The aim of this work was to evaluate hydrocarbon pollution in Tierra Blanca domestic fresh-water related to CKD and to integrate this information with other main factors in order to suggest precautionary actions taking account of key actors. We found hydrocarbons in the water wells of the city and the presence of other risk factors, which creates a perfect storm for CKD. Additionally, key actors were identified in order to follow precautionary principles related to CKD cases in Tierra Blanca.
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Affiliation(s)
- S Valdivia-Rivera
- Instituto Tecnológico Superior de Tierra Blanca, Av. Veracruz s/n, Tierra Blanca, Ver. 95110, Mexico
| | - A K Martínez-Cano
- Instituto Tecnológico Superior de Tierra Blanca, Av. Veracruz s/n, Tierra Blanca, Ver. 95110, Mexico
| | - G Aguirre-García
- Universidad Autónoma Metropolitana-Xochimilco, Prol. Canal de Miramontes 3855, Ex de San Juan de Dios, 14387 Ciudad de México, CDMX, Mexico
| | - M A Lizardi-Jiménez
- CONACYT-Instituto Tecnológico Superior de Tierra Blanca, Av. Veracruz s/n, Tierra Blanca, Ver. 95110, Mexico.
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