Haematological Indices and Iron Status in Pre-Dialysis Chronic Kidney Disease Patients

BACKGROUND

Chronic kidney disease (CKD) is associated with haematological changes, the commonest being anaemia. The number and function of white blood cells (WBC) and platelets are equally affected. Iron deficiency is a common cause of anaemia in the CKD population and anaemia has been associated with reduced cardiac function, increased rates of hospitalization, morbidity and mortality. This study aimed to determine the haematological indices and iron status among pre-dialysis CKD patients.

METHOD

A hospital-based cross-sectional study involving 95 predialysis CKD patients and 95 age- and sex-matched apparently healthy controls. Full blood count, peripheral blood film, serum ferritin, transferrin saturation, C-reactive protein (CRP), electrolytes, urea and creatinine, serum folate and vitamin B12 were done in all study participants. Comparisons were made between results obtained from participants in both groups.

RESULT

The mean ages were 58.1 ± 14.9 years and 58.3 ± 15.0 years in the CKD group and controls, respectively. The male:female ratio was 1:0.9 in both groups. The prevalence of anaemia was 51.6% and 3% in patients with CKD and controls, respectively. There was no significant difference in the total WBC count, neutrophil and lymphocyte differentials, platelet count, serum vitamin B12 and folate in patients with CKD and controls. The prevalence of iron deficiency among patients with CKD was 32.6%, of which 62.5% were absolutely iron-deficient while 37.5% were functionally iron-deficient. The median ferritin and CRP were also higher in CKD. (p =0.001).

CONCLUSION

Anaemia and iron deficiency are common in predialysis CKD patients. Early diagnosis and treatment are important to avoid the problems associated with them.

MOTS-CLÉS

Maladie rénale chronique, Anémie, Carence en fer, Pré-dialyse.

Determinants of Interest in Nephrology Career Choice among Internal Medicine Junior Residents in Nigeria

INTRODUCTION

There has been decreased interest in postgraduate nephrology training over the years. This trend could worsen the shortage of nephrologists and inability to meet the health needs of patients with kidney diseases if not urgently addressed.

AIM

To determine interest in and determinants of nephrology career choice among junior internal medicine residents in Nigeria.

METHODOLOGY

This was a cross-sectional study that enrolled 273 junior residents in internal medicine across Nigeria. A self-administered questionnaire that was adapted from two previous studies was used for data collection.

RESULTS

The mean age of the respondents was 33.6±4.4 years with a male: female ratio of 1.8:1. This study showed that 16.8% and 21.6% of junior residents in internal medicine considered nephrology as their first and second choice area to specialize, respectively. Factors that ranked high as determinants of a decision to do nephrology were personal interest (94.3%), opportunities to perform renal procedures (93.3%), and exposure to nephrology training (85.7%). Factors that discouraged a choice of nephrology according to respondents were high mortality of renal patients (67.3%), poor outcomes of renal patients (70.2%), in ability to fund treatment by renal patients (66.1%), unsatisfactory life-work balance among nephrologists (60.7%), and late presentation of renal patients (59.0%). Others were high workload compared to available doctors (59.0%) and poor job satisfaction (55.4%). Factors that could stimulate more interest in nephrology according to respondents included creation of better working environment with adequate equipment for training (96.3%), provision of health insurance with adequate coverage for renal patients (97.4%), and increased government support for renal care services (99.3%).

CONCLUSION

There is a need to promote and sustain interest of residents in nephrology by ensuring improved survival of patients through better access to renal care, ensuring an adequate and well motivated work force, provision of adequate facilities and health insurance services.

Self-perceived Burden on Caregivers, Anxiety and Depression among Chronic Kidney Disease Patients in Southern Nigeria

INTRODUCTION

Psychosocial problems are common in chronic kidney disease (CKD) patients and are associated with poor overall outcomes; however, their evaluation has not received the deserved attention. This study assessed self-perceived burden on caregivers, psychosocial wellbeing, anxiety and depression among CKD patients, and the impact on their quality of life (QoL) in two hospitals in Nigeria.

METHODS

This was a cross-sectional study. Self-perceived burden on caregivers, QoL, anxiety, and depression of the patients, were assessed using the Cousineau questionnaire, modified SF-12 questionnaire, Hospital Anxiety and Depression Scale, respectively.

RESULTS

There were 141 participants in the study comprising 50 haemodialysis (HD) patients, 41 pre-dialysis CKD patients and 50 controls. The male: female ratio for CKD patients and controls were 1.1 and 1.4 respectively. Prevalence of depressive and anxiety symptoms in the CKD patients were 46.2% and 33.0% respectively. The QoL score was significantly higher in the control group compared to the CKD patients (p= <0.001) and significantly lower in the HD patients compared to the pre-dialysis CKD patients (p= <0.001). Self-perceived burden score was significantly higher in the HD group compared to the pre-dialysis CKD group (p = < 0.001) There was a negative correlation between QoL score and self-perceived burden, hospital anxiety score and hospital depression score (p =<0.001).

CONCLUSION

Psychological disorders and self-perceived burdens are highly prevalent among CKD patients. They have negative impact on their QoL, hence regular evaluation and management of these disorders should be incorporated into the care of CKD patients.