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Kachimanga C, Williams AJ, Bangura M, Lado M, Kanawa S, Lavallie D, Mhango M, Wurie HI, Rodriguez MP. High Prevalence of Chronic Kidney Disease Among People Living with Hypertension in Rural Sierra Leone: A Cross-Sectional Study. Int J Nephrol Renovasc Dis 2021; 14:459-474. [PMID: 34992425 PMCID: PMC8710521 DOI: 10.2147/ijnrd.s342099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Currently, there are no data on prevalence and associated risk factors of chronic kidney disease (CKD) among patients with hypertension in rural Sierra Leone. PURPOSE To estimate the prevalence and associated risk factors of CKD in rural Sierra Leone. PATIENTS AND METHODS A cross-sectional study of hypertension patients aged between 18 and 75 years attending a non-communicable disease clinic at Koidu Government Hospital, Kono District, Sierra Leone was conducted between February and December 2020. Using systematic random sampling, a structured questionnaire, which comprised of questions on social demographic characteristics and past and current clinical history, was administered followed by measurement of creatinine and urinary protein and glucose. Estimated glomerular filtration rate (eGFR) was estimated using CKD-epidemiology formula without race as a factor. Baseline eGFR between 60-89 min/mL/1.73m2 and <60 min/mL/1.73m2 defined reduced eGFR and renal impairment, respectively. Estimated GFR less than 60 min/mL/1.73m2 measured two times at least 3 months apart was used to define CKD. RESULTS Ninety-six percent (n = 304) patients out of 317 patients were included in the study. Among all included patients, only 3.9% (n = 12) had eGFR of 90 min/mL/1.73m2 and above. The prevalence of renal impairment and CKD was 52% (158/304, CI 46.2-57.7) and 29.9% (91/304, CI 24.8-34.5), respectively. In adjusted logistic regression analysis, currently taking herbal medications as treatment of hypertension (OR 4.11 (CI 1.14-14.80), p = 0.03) and being overweight and/or obese (OR 2.16 (CI 1.24-3.78), p < 0.001) was associated with CKD. Additionally, receiving some education was associated with a 48% (OR 0.52 (CI 0.29-0.91), p = 0.02) reduced likelihood of CKD. CONCLUSION The prevalence of renal impairment and CKD is high among hypertensive patients in rural Sierra Leone. CKD was associated with current history of taking herbal medications and being overweight and/or obese. Additionally, CKD was associated with reduced likelihood in patients who received some education.
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Affiliation(s)
- Chiyembekezo Kachimanga
- Partners in Health Sierra Leone, Koidu City, Sierra Leone
- Partners in Health Malawi, Neno, Malawi
| | - Anu Jegede Williams
- Central Public Health Reference Laboratory, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Musa Bangura
- Partners in Health Sierra Leone, Koidu City, Sierra Leone
| | - Marta Lado
- World Health Organization, Geneva, Switzerland
| | - Sahr Kanawa
- Koidu Government Hospital, Ministry of Health and Sanitation, Koidu City, Sierra Leone
| | - Daniel Lavallie
- Koidu Government Hospital, Ministry of Health and Sanitation, Koidu City, Sierra Leone
| | - Michael Mhango
- Partners in Health Sierra Leone, Koidu City, Sierra Leone
| | - Haja Isatta Wurie
- Laboratory Science Unit, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Lee FY, Islahudin F, Ali Nasiruddin AY, Abdul Gafor AH, Wong HS, Bavanandan S, Mohd Saffian S, Md Redzuan A, Mohd Tahir NA, Makmor-Bakry M. Effects of CYP3A5 Polymorphism on Rapid Progression of Chronic Kidney Disease: A Prospective, Multicentre Study. J Pers Med 2021; 11:252. [PMID: 33808503 PMCID: PMC8066991 DOI: 10.3390/jpm11040252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022] Open
Abstract
Personalised medicine is potentially useful to delay the progression of chronic kidney disease (CKD). The aim of this study was to determine the effects of CYP3A5 polymorphism in rapid CKD progression. This multicentre, observational, prospective cohort study was performed among adult CKD patients (≥18 years) with estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, who had ≥4 outpatient, non-emergency eGFR values during the three-year study period. The blood samples collected were analysed for CYP3A5*3 polymorphism. Rapid CKD progression was defined as eGFR decline of >5 mL/min/1.73 m2/year. Multiple logistic regression was then performed to identify the factors associated with rapid CKD progression. A total of 124 subjects consented to participate. The distribution of the genotypes adhered to the Hardy-Weinberg equilibrium (X2 = 0.237, p = 0.626). After adjusting for potential confounding factors via multiple logistic regression, the factors associated with rapid CKD progression were CYP3A5*3/*3 polymorphism (adjusted Odds Ratio [aOR] 4.190, 95% confidence interval [CI]: 1.268, 13.852), adjustments to antihypertensives, young age, dyslipidaemia, smoking and use of traditional/complementary medicine. CKD patients should be monitored closely for possible factors associated with rapid CKD progression to optimise clinical outcomes. The CYP3A5*3/*3 genotype could potentially be screened among CKD patients to offer more individualised management among these patients.
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Affiliation(s)
- Fei Yee Lee
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (F.Y.L.); (A.Y.A.N.); (S.M.S.); (A.M.R.); (N.A.M.T.); (M.M.-B.)
- Clinical Research Centre, Hospital Selayang, Ministry of Health Malaysia, Batu Caves, Selangor 60800, Malaysia;
| | - Farida Islahudin
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (F.Y.L.); (A.Y.A.N.); (S.M.S.); (A.M.R.); (N.A.M.T.); (M.M.-B.)
| | - Aina Yazrin Ali Nasiruddin
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (F.Y.L.); (A.Y.A.N.); (S.M.S.); (A.M.R.); (N.A.M.T.); (M.M.-B.)
- Faculty of Pharmacy, University of Cyberjaya, Cyberjaya 63000, Malaysia
| | - Abdul Halim Abdul Gafor
- Nephrology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia;
| | - Hin-Seng Wong
- Clinical Research Centre, Hospital Selayang, Ministry of Health Malaysia, Batu Caves, Selangor 60800, Malaysia;
- Nephrology Department, Hospital Selayang, Ministry of Health Malaysia, Batu Caves, Selangor 60800, Malaysia
| | - Sunita Bavanandan
- Nephrology Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur 50586, Malaysia;
| | - Shamin Mohd Saffian
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (F.Y.L.); (A.Y.A.N.); (S.M.S.); (A.M.R.); (N.A.M.T.); (M.M.-B.)
| | - Adyani Md Redzuan
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (F.Y.L.); (A.Y.A.N.); (S.M.S.); (A.M.R.); (N.A.M.T.); (M.M.-B.)
| | - Nurul Ain Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (F.Y.L.); (A.Y.A.N.); (S.M.S.); (A.M.R.); (N.A.M.T.); (M.M.-B.)
| | - Mohd Makmor-Bakry
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (F.Y.L.); (A.Y.A.N.); (S.M.S.); (A.M.R.); (N.A.M.T.); (M.M.-B.)
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Mwenda V, Githuku J, Gathecha G, Wambugu BM, Roka ZG, Ong'or WO. Prevalence and factors associated with chronic kidney disease among medical inpatients at the Kenyatta National Hospital, Kenya, 2018: a cross-sectional study. Pan Afr Med J 2019; 33:321. [PMID: 31692795 PMCID: PMC6815467 DOI: 10.11604/pamj.2019.33.321.18114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The burden of chronic kidney disease (CKD) is increasing worldwide. Few studies in low and low-middle income countries have estimated the prevalence of CKD. We aimed to estimate prevalence and factors associated with CKD among medical inpatients at the largest referral hospital in Kenya. METHODS We conducted a cross-sectional study among medical inpatients at the Kenyatta National Hospital. We used systematic sampling and collected demographic information, behavioural risk factors, medical history, underlying conditions, laboratory and imaging workup using a structured questionnaire. We estimated glomerular filtration rate (GFR) in ml/min/1.73m2 classified into 5 stages; G1 (≥ 90), G2 (60-89), G3a (45-59), G3b (30-44), G4 (15-29) and G5 (<15, or treated by dialysis/renal transplant). Ethical approval was obtained from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (KNH-UoN ERC), approval number P510/09/2017. We estimated prevalence of CKD and used logistic regression to determine factors independently associated with CKD diagnosis. RESULTS We interviewed 306 inpatients; median age 40.0 years (IQR 24.0), 162 (52.9%) were male, 155 (50.7%) rural residents. CKD prevalence was 118 patients (38.6%, 95% CI 33.3-44.1); median age 42.5 years (IQR 28.0), 74 (62.7%) were male, 64 (54.2%) rural residents. Respondents with CKD were older than those without (difference 4.4 years, 95% CI 3.7-8.4 years, P = 0.032). Fifty-six (47.5%) of the patients had either stage G1 or G2, 17 (14.4%) had end-stage renal disease; 64 (54.2%) had haemoglobin below 10g/dl while 33 (28.0%) had sodium levels below 135 mmol/l. ). History of unexplained anaemia (aOR 1.80, 95% CI 1.02-3.19), proteinuria (aOR 5.16, 95% CI 2.09-12.74), hematuria (aOR 7.68, 95% CI 2.37-24.86); hypertension (aOR 2.71, 95% CI 1.53-4.80) and herbal medications use (aOR 1.97, 95% CI 1.07-3.64) were independently associated with CKD. CONCLUSION Burden of CKD was high among this inpatient population. Haematuria and proteinuria can aid CKD diagnosis. Public awareness on health hazards of herbal medication use is necessary.
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Affiliation(s)
- Valerian Mwenda
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
- Division of Non-communicable Diseases, Ministry of Health, Nairobi Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
| | - Gladwell Gathecha
- Division of Non-communicable Diseases, Ministry of Health, Nairobi Kenya
| | | | - Zeinab Gura Roka
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
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Ma X, He L. The intervention effect of zuogui pill on chronic kidney disease-mineral and bone disorder regulatory factor. Biomed Pharmacother 2018; 106:54-60. [PMID: 29957466 DOI: 10.1016/j.biopha.2018.06.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 12/29/2022] Open
Abstract
Chronic kidney disease-mineral and bone disorder (CKD-MBD) play a critical role in the pathogenesis of cardiovascular complications in patients with chronic kidney disease (CKD). Zuogui pill as a traditional Chinese herbal drug has been used for nourish kidney essence improve bone malnutrition of renal bone disease by regulating the metabolism of calcium and phosphorus and participating in osteoblast metabolism. In the present study, 5/6 nephrectomy rat model was used to reveal the mechanism of zuogui pill in treatment of CKD-MBD. Compared with sham rats, the levels of serum phosphorus, PTH, iPTH and creatinine were significantly decreased, while the serum calcium level was significantly increased, and the Cbfa1 protein level was significantly decreased and FGF23 protein level was significantly increased by Zuogui pill treatment. Compared with model rats, the BMD of rat was significantly increased by Zuogui pill treatment. Histological analysis revealed that the kidney injury of rats with CKD was significantly reduced by zuogui pill treatment. Compared with model rats, the CYP27B1 mRNA level was significantly increased, and the PTH mRNA level and NaPiIIa protein level were significantly decreased in the kidney by zuogui pill treatment. We inferred that zuogui pill exhibited potential therapeutic effects on CKD-MBD in the rats by regulating bone metabolism and nourish kidney.
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Affiliation(s)
- Xiaohong Ma
- Chenxinghai Hospital of Zhongshan City, No. 18 Zhuyuan Road, Xiaolan Town, Zhongshan, Guangdong, 528415, China.
| | - Liqun He
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and Pharmacology, No. 185 Pu'an Road, Huangpu District, Shanghai, 200021, China
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Public knowledge of chronic kidney disease evaluated using a validated questionnaire: a cross-sectional study. BMC Public Health 2018; 18:371. [PMID: 29554891 PMCID: PMC5859642 DOI: 10.1186/s12889-018-5301-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 03/12/2018] [Indexed: 12/02/2022] Open
Abstract
Background Screening programs may help to address the burden of chronic kidney disease (CKD) in Australia. Public awareness is an important determinant of the uptake of screening programs. However, data on the public knowledge of CKD in Australia is lacking. The aim of this study was to develop a validated questionnaire and assess the Australian public knowledge of CKD. Methods A CKD knowledge questionnaire was developed after reviewing the literature and discussions with nephrology experts. Content validity was performed by nephrologists (n = 3), renal nurses (n = 3) and research personnel (n = 4). The questionnaire was piloted in 121 public participants. Next, discriminant validation was performed by recruiting two additional groups of participants: final year undergraduate pharmacy students (n = 28) and nephrologists (n = 27). Reliability of the questionnaire was assessed by calculating Cronbach’s alpha. Next, a cross-sectional survey of the Australian public (n = 943) was conducted by using the validated questionnaire. It was administered using an online Omnibus survey. Quota sampling was used for participant selection and to ensure that the final sample would match the key characteristics of the Australian population. Finally, a standard multiple regression analysis was performed to identify predictors of the public knowledge. Results The median CKD knowledge scores of the public, students and nephrologists were 12, 19 and 23 (maximum score of 24), respectively, with statistically significant differences in the scores across the three groups (p < 0.001; Kruskal-Wallis test). The Cronbach’s alpha was 0.88 (95% CI: 0.86–0.91), indicating that the questionnaire had good internal consistency. In the cross-sectional survey of the Australian public, the participants’ mean (SD) age was 47.6 (±16.6) years and 51.2% were female. The mean (SD) knowledge score was 10.3 (± 5.0). The multivariate analysis showed that participants with a higher level of education; with a family history of kidney failure; with a personal history of diabetes; and currently or previously living in a relationship had significantly higher knowledge scores. Conclusion The Australian public knowledge of CKD was relatively poor. Improving public knowledge may assist in increasing early detection and subsequent management of CKD in Australia. Electronic supplementary material The online version of this article (10.1186/s12889-018-5301-4) contains supplementary material, which is available to authorized users.
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Wanitsriphinyo S, Tangkiatkumjai M. Herbal and dietary supplements related to diarrhea and acute kidney injury: a case report. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2017; 14:/j/jcim.2017.14.issue-1/jcim-2016-0061/jcim-2016-0061.xml. [PMID: 28282296 DOI: 10.1515/jcim-2016-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/18/2016] [Indexed: 11/15/2022]
Abstract
Background There is very little evidence relating to the association of herbal medicine with diarrhea and the development of acute kidney injury (AKI). This study reports a case of diarrhea-induced AKI, possibly related to an individual ingesting copious amounts of homemade mixed fruit and herb puree. Case presentation A 45-year-old Thai man with diabetes had diarrhea for 2 days, as a result of taking high amounts of a puree made up of eight mixed fruits and herbs over a 3-day period. He developed dehydration and stage 2 AKI, with a doubling of his serum creatinine. He had been receiving enalapril, as a prescribed medication, over one year. After he stopped taking both the puree and enalapril, and received fluid replacement therapy, within a week his serum creatinine had gradually decreased. The combination of puree, enalapril and AKI may also have induced hyperkalemia in this patient. Furthermore, the patient developed hyperphosphatemia due to his worsening kidney function, exacerbated by regularly taking some dietary supplements containing high levels of phosphate. His serum levels of potassium and phosphate returned to normal within a week, once the patient stopped both the puree and all dietary supplements, and had begun receiving treatment for hyperkalemia. Results The mixed fruit and herb puree taken by this man may have led to his diarrhea due to its effect; particularly if the patient was taking a high concentration of such a drink. Both the puree and enalapril are likely to attenuate the progression of kidney function. The causal relationship between the puree and AKI was probable (5 scores) assessed by the modified Naranjo algorithm. This is the first case report, as far as the authors are aware, relating the drinking of a mixed fruit and herbal puree to diarrhea and AKI in a patient with diabetes. Conclusions This case can alert health care providers to the possibility that herbal medicine could induce diarrhea and develop acute kidney injury.
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