The Role of Dietary Fiber and Gut Microbiome Modulation in Progression of Chronic Kidney Disease

Nutrition is one of the fundamental approaches to promoting and preventing all kinds of diseases, especially kidney diseases. Dietary fiber forms a significant aspect of renal nutrition in treating chronic kidney disease (CKD). Dietary fiber intake influences the composition and metabolism of the gut microbiome with proven roles in reducing uremic toxin production, preserving kidney function, and retarding the progression of CKD through mechanisms of regulating metabolic, immunological, and inflammatory processes. Understanding dietary fiber’s pathogenesis and mechanistic action in modulating host and microbiome interactions provides a potential adjunct therapeutic target for preventing, controlling, and treating CKD patients. In this regard, a recommendation of adequate and appropriate dietary fiber intake to restore beneficial gut microbiota composition would reduce the risks and complications associated with CKD. This mini review summarizes current evidence of the role of dietary fiber intake in modulating the gut microbiome to improve kidney health.

Public private partnership in in-service training of physicians: the millennium development goal 6-partnership for African clinical training (M-PACT) approach

Introduction

in-service training of healthcare workers is essential for improving healthcare services and outcome.

Methods

The Millennium Development Goal (MDG) 6 Partnership for African Clinical Training (M-PACT) program was an innovative in-service training approach designed and implemented by the Royal College of Physicians (RCP) and West African College of Physicians (WACP) with funding from Eco Bank Foundation. The goal was to develop sustainable capacity to tackle MDG 6 targets in West Africa through better postgraduate medical education. Five training centres were establised: Nigeria (Abuja, Ibadan), Ghana (Accra), Senegal (Dakar) and Sierra Leone (Freetown) for training 681 physicians from across West Africa. A curriculum jointly designed by the RCP-WACP team was used to deliver biannual 5-day training courses over a 3-year period.

Results

Of 602 trained in clinical medicine, 358 (59.5%) were males and 535 (88.9%) were from hosting countries. 472 (78.4%) of participants received travel bursaries to participate, while 318 (52.8%) were residents in Internal Medicine in the respective institutions. Accra had the highest number of participants (29.7%) followed by Ibadan, (28.7%), Dakar, (24.9%), Abuja, (11.0%) and Freetown, (5.6%). Pre-course clinical knowledge scores ranged from 35.1% in the Freetown Course to 63.8% in Accra Course 1; whereas post-course scores ranged from 50.5% in the Freetown course to 73.8% in Accra course 1.

Conclusion

M-PACT made a positive impact to quality and outcome of healthcare services in the region and is a model for continued improvement for healthcare outcomes, e.g malaria, HIV and TB incidence and mortality in West Africa.

Pilot study of probiotic dietary supplementation for promoting healthy kidney function in patients with chronic kidney disease

INTRODUCTION

Uremic syndrome consists of nitrogenous waste retention, deficiency in kidney-derived hormones, and reduced acid excretion, and, if untreated, may progress to coma and eventual death. Previous experience suggests that oral administration of a probiotic formulation of selected microbial strains may extend renoprotection via intraintestinal extraction of toxic waste solutes in patients with chronic kidney disease (CKD)stages 3 and 4. This report presents preliminary data from a pilot study.

METHODS

This was a 6-month prospective, randomized, double-blind, placebo-controlled crossover trial of a probiotic bacterial formulation conducted in four countries, at five institutions, on 46 outpatients with CKD stages 3 an nd 4: USA (n=10), Canada (n=113), Nigeria (n=115), and Argentina (n=8). Outcomes were compared using biochemical parameters:blood urea nitrogen (BUN), serum creatinine, and uric acid. General well-being was assessed as a secondary parameter by a quality of life (QQOL) questionnaire on a subjective scale of 1-10.

RESULTS

Oral ingestion of probiotics (90 billion colony forming units [CFUs]/day) was well tolerated and safe during the entire trial period at all sites. BUN levels decreased in 29 patients (63%, P<0.05), creatinine levels decreased in 20 patients (43%, no statistical significance), and uric acid levels decreased in 15 patients (33%, no statistical significance). Almost all subjects expressed a perceived substantial overall improvement in QOL (86%, P<0.05).

CONCLUSION

The main outcomes of this preliminary trial include a significant reduction of BUN, enhanced well-being, and absence of serious adverse effects, thus supporting the use of the chosen probiotic formulation for bowel-based toxic solute extraction. QOL and BUN levels showed statistically significant differences in outcome (P<0.05) between placebo and probiotic treatment periods at all four sites (46 patients). A major limitation of this trial is the small sample size nd elated inconsistencies.

Lipid profile in HIV/AIDS patients in Nigeria

INTRODUCTION

Alterations of serum lipid profiles have been reported widely among Human Immuno deficiency Virus (HIV) positive patients on Highly Active Anti Retroviral Therapy (HAART). However, there are few data on serum lipid profile among treatment naïve HIV positive patients in our environment.

OBJECTIVES

To describe the pattern of lipid profile among treatment naïve HIV positive patients and changes following HAART initiation.

METHODS

One hundred and thirty HIV positive patients seen in HIV center in an urban area in Nigeria and 44 matched individuals were recruited. Data were collected on socio demographic characters, baseline lipid profiles and CD4 count. Values of lipid parameters were retrieved after 12 months on HAART.

RESULTS

The mean Low density lipoprotein(LDL) was 2.26+ 0.9 mmol/l among the test group compared with 0.96+0.39 mmol/L among the control, p value=0.000. The mean High density lipoprotein (HDL) was also significantly lower, 0.8+0.6 mmol/L reaching a dyslipidemic level, in the HIV positive group than the control, p value = 0.00. Tuberculosis/HIV co infected patients had a significantly elevated mean LDL, p=0.002.

CONCLUSION

Abnormality of serum lipid is common among treatment naïve HIV patients seen in Nigeria. The NNRTI regimen is associated with elevation of HDL and some stabilization of TC and TG.

Obstructive sleep apnea among adults in Nigeria

INTRODUCTION

Obstructive sleep apnea syndrome (OSAS) is a common medical condition with significant adverse medical and public health consequences, but OSAS remains undiagnosed in many individuals. The Berlin questionnaire is a validated instrument that is used to identify individuals who are at risk for OSAS.

OBJECTIVES

To determine the prevalence of high risk of OSAS in an adult population in Nigeria.

DESIGN

A cross-sectional survey was done of 370 young adults and adults living in Abuja, Nigeria, using the Berlin questionnaire. This instrument includes questions about snoring; witnessed apneas, self-reported hypertension, and daytime sleepiness. Data were collected on sociodemographic characteristics. Excessive daytime sleepiness was determined using Epworth Sleepiness scale. Body mass index (BMI) and blood pressure were calculated and measured, respectively.

RESULTS

Of the 370 respondents, 218 (59%) were females. The overall prevalence of snoring was 31%. Overall, 19% of participants (22% of men and 16% of women) met the Berlin questionnaire criteria indicating a high risk of OSAS. The highest prevalence of risk of OSAS occurred in ages 50 to 59 years for male. Respondents with a high risk for OSAS were more likely to be obese (BMI >30 kg/m2), have a higher mean ESS score, and a chronic medical condition than those who were at lower risk.

CONCLUSIONS

OSAS may be more common a medical problem than ever imagined among Nigerians.

Hepatitis B and C virus co-infection in Nigerian patients with HIV infection

INTRODUCTION

We set out to determine the seroprevalence of hepatitis B and hepatitis C viruses among human immunodeficiency virus infected individuals and its impact on pattern of presentation.

METHODOLOGY

A serological study for hepatitis B and hepatitis C viruses was performed on 260 HIV-positive individuals. These patients were tested for the presence of hepatitis B surface antigen and anti-hepatitis C virus (HCV) antibody.

RESULTS

Thirty (11.5%) patients tested positive for hepatitis B surface antigen, six (2.3%) tested positive for anti-hepatitis C virus antibody, four (1.5%) were positive for both hepatitis B surface antigen and anti-hepatitis C virus and the overall prevalence was 15.4% . Individuals younger than 40 years of age were more affected, and the odds ratio of a female being co-infected was 1.2, 25% versus 75% p value = 0.03. The prevalence of HIV and hepatitis co-infection rises with age except for hepatitis C. There was no significant difference in the mean levels of liver enzymes (AST, ALT) among the various groups. The groups differ significantly in their mean CD4 count: it was lowest for those co-infected with hepatitis B and hepatitis C; 106 cells/mm(3), 171 cells/mm(3) for those with HIV alone; and the highest value of 260 cells/mm(3) was obtained in those who tested positive for anti-HCV. Scarification marks and multiple blood transfusions were more common among those infected. There was no case of intravenous drug abuse identified.

CONCLUSION

This low frequency of HIV/HCV co-infection is probably due to the uncommon intravenous drug abuse in this population. Co-infection with hepatitis B virus is common among our HIV-infected patients and should be a major consideration in the initiation and choice of therapy.