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A case report on Lassa fever and hearing loss: a rare occurrence and review of the literature.
(2017) Daniel, A.; |Raji, Y.R.; |Ijitola, J.O.; Bello, T.O.; Jinadu, O.Y.; Ajayi, S.O.; Olaleye, O.D.; Salako, B.L; Lasisi, O.A.
Lassa fever is highly endemic in Nigeria and other West African countries, it is a disease associated with high case fatality and chronic sequelae in those that survived. Lack of effective vaccine has made the disease difficult to control and it prevention depends on eradications of the multmammate rats and universal precautions by all when a case is identified. We report a case of a 51 years old health worker who had a severe form of Lassa fever complicated by sensorineural deafness at the University College Hospital, Ibadan, South West Nigeria.
A predominance of hypertensive heart failure in the Abuja heart study cohort of urban Nigerians: a prospective clinical registry of 1515 de novo cases.
(2012) Ojji D.; Stewart, S.; Ajayi, S.; Manmak, M.; Sliwa K.
Aims: Even though cardiovascular disease is gradually becoming the major cause of morbidity and mortality in sub-Saharan Africa, there are very few data on the pattern of heart disease in this part of the world. We therefore decided to determine the pattern of heart disease in Abuja, which is one of the fastest growing and most westernized cities in Nigeria, and compare our findings with those of the Heart of Soweto Study in South Africa. Methods and results: Detailed clinical data were consecutively captured from 1515 subjects of African descent, residing in Abuja, and equivalent Soweto data from 4626 subjects were available for comparison. In Abuja, male subjects were on average, 2 years older than female subjects. Hypertension was the primary diagnosis in 45.8% of the cohort, comprising more women than men [odds ratio (OR) 1.96, 95% confidence interval (CI) 1.26– 2.65], and hypertensive heart failure (HF) was the most common form of HF in 61% of cases. On an age- and sex-adjusted basis, compared with the Soweto cohort, the Abuja cohort were more likely to present with a primary diagnosis of hypertension (adjusted OR 2.10, 95% CI 1.85– 2.42) or hypertensive heart disease/failure (OR 2.48, 95% CI 2.18–2.83); P , 0.001 for both. They were, however, far less likely to present with CAD (OR 0.04, 95% CI 0.02 –0.11) and right heart failure (2.5% vs. 27%). Conclusion: As in Soweto, but more so, hypertension is the most common cause of de novo HF presentations in Abuja, Nigeria.
Acute kidney injury among patients undergoing major surgery in a tertiary hospital in Nigeria .
(2018) Raji, Y.R.; Ajayi, S.O.; Ademola, A.F.; Lawal, T.A.; Ayandipo, O.O.; Adigun, T.A.
Background. Acute kidney injury (AKI) is an underreported but major cause of morbidity and mortality among patients undergoing major surgical interventions in sub-Saharan Africa (SSA). Whereas AKI is often seen following major cardiac surgery in high-income countries, a similar spectrum of surgical diseases and interventions is not seen in developing countries. The impacts on surgical outcomes have also not been well characterized in SSA. This study aimed at identifying risk factors, incidence and determinants and short-term outcomes of AKI among patients undergoing major surgery. Methods. This was a cohort study of adult patients undergoing major surgery at the University College Hospital, Ibadan, Nigeria. Data obtained were sociodemographic details, risk factors for AKI, details of surgery, anaesthesia and intraoperative events and short-term outcomes. Blood samples were obtained for pre-operative (pre-op) full blood count, serum electrolytes, blood urea and creatinine (SCr). Post-operatively (Post-op) SCr was determined at 24 h, Day 7 post-op and weekly until each patient was discharged. Results. A total of 219 subjects who had major surgery (86.3% elective) were enrolled. The median age of the patients was 46 (range 18–73) years and 72.6% were females. The surgeries performed were mostly simple mastectomies (37.4%), exploratory laparotomies (22.8%) and total thyroidectomies (16.4%). The incidences of AKI were 18.7% at 24 h and 17.4% at Day 7 post-op, while cumulative AKI incidence was 22.5% at 1-week post-op. Pre-op elevated SCr [odds ratio (OR) 3.86], sepsis (OR 2.69), anaemia (OR 2.91) and duration of surgery >120 min (OR 1.75) were independently associated with AKI. In patient mortality was 20.4% in individuals with AKI and 5.3% in those without AKI (P < 0.01) Conclusion. Peri-operative risk factors for AKI are common among patients undergoing major surgery in SSA hospitals. The cumulative incidence of AKI was high and independently associated with pre-op sepsis, anaemia, pre-existing kidney dysfunction and duration of surgery >120 min
Assessment of iron deficiency anaemia and its risk factors among adults with chronic kidney disease in a tertiary hospital in Nigeria
(2021) Raji, Y.R.; Ajayi, S.O.; Gbadegesin, B.A.; Bello, T.O.; Salako, B.L.
A substantial proportion of patients with chronic kidney disease (CKD) develop iron deficiency anaemia (IDA). Despite the association of IDA with adverse cardiovascular outcomes, it remains underdiagnosed and poorly managed. Up to 70% of patients with CKD are anaemic at the time of initiating dialysis, while the predictors of IDA in these patients in our setting are unknown. This study aimed to determine the prevalence and risk factors for IDA in patients with CKD. Materials and Methods: This is a case–control study of 157 patients with CKD and 157 age and gender matched subjects without CKD. Information obtained from the participants were socio demographic details, aetiology of CKD, medication history and features of IDA. All participants had serum ferritin, total iron binding capacity (TIBC), transferrin saturation (TSAT), highly sensitive C reactive protein, serum creatinine and complete blood count determined. Results: The median estimated glomerular rate (22.7 [3.4–59.5] vs. 110.2 [60.3–152.8] ml/min/1.73 m2 , P < 0.01), the mean haemoglobin concentration (9.3 ± 2.6 vs. 11.4 ± 1.7 g/dl, P < 0.01), and TSAT (27.9% ± 6.4% vs. 34.8% ± 8.1%, P < 0.04) were significantly lower in patients with CKD. The mean age, serum ferritin and TIBC were similar in both groups. The prevalence of absolute (24.8% vs. 13.4%, P < 0.01) and relative (17.8% vs. 7.6%, P < 0.01) iron deficiencies were higher among individuals with CKD compared to the controls. Female gender (odd ratio [OR]:1.50, 95% confidence interval [CI]:1.0267–4.1163, P < 0.04) and severity of CKD (OR: 3.43, 95% CI: 1.5568–7.8324, P < 0.02) were independently associated with IDA. Conclusion: IDA is common among individuals with CKD while female gender and severity of CKD were factors that independently predicted IDA
Assessment of risk factors for kidney disease in an unselected population of nigerians: a report of the routine screening conducted during the national kidney disease awareness and sensitizing programme.
(2006) Ulasi I.; Arogundade, F.A.; Aderibigbe, A.; Oviasu, E.; Akinsola, A.; Arije, A.; Ijoma, C.K.; Anteyi, E.A.; Ajayi, S.O.; Mamven, M.; Adeniyi A.B.; Mbah I.; Salako B.L.; Sanusi A.A.; Angbarzo I.; Kwaifa A.
To be able to define some risk factors for renal disease in an unselected population of Nigerians the Nigerian Association of Nephrology conducted a screening exercise during the National Kidney Disease Awareness and Sensitization Programme whose theme was “Renal Disease in Nigeria: Taming the Lion” which was held at the capital city of Abuja on the 9th of February 2006. A total of unselected 129 respondents who consented were screened. One hundred and nine (56 male and 72 female respondents) were analyzed and the others [2] could not be analyzed because of incomplete data. The mean age of respondents was 27.03 (±10.75) years and majority (89.1 %), were in age group 15 to 44 years with no sex preference. Most of the respondents had normal BMI, the mean being 23.32 (±4.52)mg/m2. More females than males were found to be obese (16% versus 4%), the difference was not statistically significant (p=0.76). A relatively high percentage of respondents gave positive family history of hypertension (40%) as against 25% for diabetes mellitus. Only 5% of respondents gave positive history of renal disease. Use of nephrotoxic agents - medicated soap, native medication and herbal supplements/tea was found in 40%, 30% and 19% respectively. More than half of the studied population did not have routine medical check and about a third engaged in self medication. The prevalence of hypertension and proteinuria were 13.6% and 19% respectively. It is concluded from this study that the risk factors for development of chronic kidney disease (CKD) is high in the studied population and the level of awareness regarding need for routine medical check and appropriate attitude to health low. There is crying need for more intensive, aggressive and comprehensive education aimed at increasing the health seeking attitude of our population as well as establishment of preventive programmes against CKD in the country.
Association between depression and hypertension in the Ibadan Study of Ageing. African
(2020) Ajayi, S.O.; Oladeji, B.; Abiona, T.; Gureje, O.
Introduction: The elderly population is growing all over the world with attendant increase in occurrence of comorbid conditions. Using data from a longitudinal study of community-dwelling elderly persons in Nigeria, we explored the prevalence and corelates of hypertension and depression as well as the factors associated with the comorbidity of these two conditions. Methods: The Ibadan Study of Ageing, a longitudinal community-based cohort study conducted between 2003 and 2009 on the profile and determinants of successful ageing. A multistage cluster random sampling was used to select a cohort of elderly participants from across eight contiguous Yoruba speaking states in Nigeria- Ekiti, Kogi, Kwara, Lagos, Ogun, Ondo, Osun, and Oyo. Participants (non-institutionalized elderly, aged 65 years or over) were assessed at 4 time points: baseline(2003/2004) and annually from 2007 (wave 1), 2008 (wave 2 and 2009 (wave 3). Data was collected in face-to-face interviews; depression was assessed using the World Mental Health initiative version of the Composite International Diagnostic Interview (CIDI), social engagement was assessed using an adapted World Health Organization Disability Assessment Schedule WHODAS) and functional disability using activities of daily living (ADL) and instrumental activities of daily living (IADL). Hypertension was defined according to the Joint National Committee-7(JNC7) recommendations as systolic blood pressure of 140 mmHg and above, diastolic blood pressure of 90mmHg. This current study is based on cross-sectional data from the wave 1(2007) assessment. Results: Of the 1597 participants, 58% were females and 42% were 70 years and older. The mean age was 74.2 years (SD ±7.8). Nine hundred and ninety-eight (62.5%) participants had hypertension while 177 (10.6%) met the criteria for major depression while comorbid depression and hypertension was present in 122 (7.1%). The comorbidity of hypertension and depression was significantly associated with gender (higher in women) (p=0.001), insomnia (p=0.001), lack of family participation (p=0.001), lack of community participation (p=0.002), and experiencing a negative life event in the past year (p=0.003). In a multivariate analysis, lack of participation in family activities was associated with an increased risk of co-morbidity between hypertension and depression (OR 4.51, p=0.000, CI 2.14-9.50). Conclusions: These findings suggest that the comorbidity of depression and hypertension could potentially be minimized by modifying social risk factors such as keeping the elderly involved in family and community life participation by promoting their involvement in recreational and volunteer activities as well as social gatherings.
Association between Perfluoroalkyl substance exposure and renal function in children with CKD enrolled in H3Africa kidney disease research network.
(2019) Sood, S.; Ojo, A.O.; Adu, D.; Kannan, K.; Ghassabian, A.; Koshy, T.; Vento, S.M.; Pehrson, L.J.; Gilbert, J.F.; Arogundade, F.A.; Ademola, A.D.; Salako, B.O.; Raji, Y.; Osafo, C.; Antwi, S.; Trachtman, H.; Trasande, L.
Association of Genetic Polymorphisms of TGF-β1, HMOX1, and APOL1 with CKD in Nigerian patients with and without HIV.
(2020) Ekrikpo, U.E.; Mnika, K.; Effa, E.E.; Ajayi, S.O.; Okwuonu, C.; Waziri, B.; Bello, A.; Dandara, C.; Kengne, A.P.; Wonkam, A.; Okpechi, I.
Rationale & Objective: Recent studies in the human immunodeficiency virus (HIV)-infected population have suggested that there are genetic predispositions to the development of chronic kidney disease (CKD) in this context. We investigated the association of genetic polymorphisms of the genes encoding apolipoprotein L1 (APOL1), transforming growth factor β1 (TGFβ1; a profibrotic cytokine), and heme oxygenase 1 (HMOX1) with prevalent CKD among adults with and without HIV infection. Study Design: Case-control study. Setting & Participants: West African adults including 217 HIV-infected patients with CKD (HIV+ /CKD+ group), 595 HIV-infected patients without CKD (HIV+ /CKD− group), 269 with CKD and no HIV infection (HIV− /CKD+ group), and 114 with neither CKD nor HIV (HIV− /CKD− group). Exposure: The genetic polymorphisms with reference single-nucleotide polymorphism (rs) identification numbers rs1800469 (TGF-β1), rs1800470 (TGF-β1), rs121918282 (TGF-β1); rs60910145 (APOL1 G1 risk allele), rs73885319 (APOL1 G1 risk allele), rs71785313 (APOL1 G2 risk allele), and rs743811 (HMOX1); HIV. Outcome: CKD. Analytical Approach: Single-nucleotide poly morphism (SNP) genotyping of rs1800469 (TGF-β1), rs1800470 (TGF-β1), rs121918282 (TGF-β1); rs60910145 (APOL1), rs73885319 (APOL1), rs71785313 (APOL1), and rs743811 (HMOX1) was performed. Hardy-Weinberg equilibrium was evaluated for all SNPs, and minor allele frequencies were reported. A case control analysis was performed, and multivariable logistic regression was used to control for potential confounders. Results: Minor allele frequencies for TGF-β1 (rs1800469, rs1800470, and rs1800471), APOL1 (rs60910145, rs73885319, and rs71785313), and HMOX1 (rs743811) were 0.25, 0.46, 0.46, 0.44, 0.45, 0.17, and 0.14, respectively. Among HIV-positive individuals, only TGF-β1 rs1800470 (GG vs AA), APOL1 (in the recessive model), and hypertension were associated with prevalent CKD (adjusted ORs of 0.44 [95% CI, 0.20-0.97], 2.54 [95% CI, 1.44-4.51], and 2.17 [95% CI, 1.35-3.48], respectively). No SNP polymorphisms were associated with prevalent CKD among HIV negative individuals. Limitations: The lack of histopathology data for proper categorization of the type of HIV-related nephropathy. Conclusions: APOL1 polymorphisms were highly prevalent in this population and among adult patients infected with HIV and were associated with increased CKD risk. The TGF-β1 (rs1800470) polymorphism was associated with reduced risk, and HMOX1 polymorphisms were unassociated with CKD
Blood pressure changes in haemodialysis: the nigerian experience
(1998) Salako, B.L.; Ajayi, S.O.; Kadiri, S.; Arije, A.; Osoba, O.A.
The blood pressure changes in haemodialysis were assessed during 59 sessions in 21 patients. Blood pressure was measured with I he corresponding pulse before and subsequently hourly during dialysis, and the patients weights were measured before and after dialysis. The mean systolic blood pressure before dialysis was 170,22 + 29.64mmHg. This showed a statistically sig nificant decrease at l hour. being 167^31.79mmHg (P < 0.002 at 2 hours, being 164.83 + 40.26mmHgwith (P < 0.001). at 3 hours, being 166.84+ 36.94mm Hg (P< 0.001) intradialysis, and immediately after 4 hours of dialysis 166.28 ±35.70mmHg t P < 001). The mean diastolic blood pressure before dialysis of 109.90 + 20.SOmmHg also showed a significant decrease at 1 hour 106.07 + 22.84mmHg (P< 001) 2 hours 105.98+ 22.10mmHg (P < 0.001) and 3 hours intradialysis 107.81 + 25.39mmHg (P< 0.001). These findings suggest that blood pressure changes in haemodialysis are affected by drop in weight that invariably occurs in haemodialysis due to the accompanying process of ultrafiltration
Bronchial asthma: a risk factor for hypertension?
(2000) Salako, B.L.; Ajayi, S.O.
Several attempts have been made to improve primary prevention of essential hypertension and many of these have been directed at avoiding the well known risk factors. Both asthma and hypertension are spastic disorders of smooth muscle, also asthmatics and hypertensives have been found to be salt sensitive. There is a suspicion that the similarities between these two diseases may predispose the individuals with one disease to the other, as pulmonary hypertension has been described during exercise- induced bronchoconstriction. We therefore, studied the blood pressure pattern during and after acute severe asthma (ASA) along with the frequency of hypertension in stable asthmatic patients. Two groups of patients were studied. Group 1 consisted of 12 patients with ASA (2 males, 10 females) with a mean age of 30 ± 9,9.years. The mean blood pressure during attack of ASA (147±16.9/ 100±8.2 mmHg) was higher than the mean BP (132±8.3/82±7 mmHg) 2 weeks after discharge from hospital without treatment in all patients (P < 0.05). Group 2 included 134 asthmatic subjects in stable state (54 males, 80 females) with a mean age of 45 ± 15 years and a range of 15-90 years. The overall frequency of hypertension was 37% with a proportion of 39% in males and 35% in females. Hypertension was defined as systolic blood pressure of £ 140mmHg and or diastolic blood pressure of £ 90mmHg. There was no difference between the frequency of attack of ASA in hypertensives (5.7 ±5.6 per year) and nonhypertensives (5.5 ± 3.8 per year), P < 0.05. We concluded that transient elevation of blood pressure may occur during ASA. The frequency of hypertension among asthmatics is quite high and concurrent family history of hypertension and frequency of attack of ASA did not seem to determine the status of blood pressure. Patients with asthma should have regular blood pressure check during follow-up visits.
Cardiac baroreceptor sensitivity: a prognostic marker in predialysis chronic kidney disease patients?
(2005) Bavanandan S.; Ajayi, S.O.; Fentum B.; Paul S.K.; Carr S. J.; Robinson T.G.
Background. Small, uncontrolled studies of dialysis dependent chronic kidney disease (CKD) patients have demonstrated abnormalities of cardiovascular autonomic control and vascular compliance, which may contribute to adverse cardiovascular morbidity in this population. However, there is little information utilizing newer, noninvasive techniques in predialysis patients with increasing degrees of uremia. Methods. One hundred and five nondialysis CKD patients with a median GFR of 23 mL/min/1.73m2 (range: 6 to 102) at baseline were studied. Cardiac baroreceptor sensitivity (BRS) was recorded by time- and frequency-domain techniques, and its relationship with increasing degrees of uremia studied. During a mean follow-up period of 42 months (range: 3 to 70), primary (death, dialysis, transplantation) and secondary (fatal and nonfatal cardiovascular events) outcome measures were recorded. The importance of cardiac BRS in comparison to other important renal and cardiovascular prognostic variables in predicting outcome was assessed. Results. Median cardiac BRS by time domain analysis at baseline was 8.85 msec/mm Hg (interquartile range: 6.85), and impaired cardiac BRS was related to reduced GFR, increasing age, and hypertension on quantile regression analysis. ‘Impaired’ cardiac BRS was associated with a trend toward increased likelihood of both primary and secondary outcomes, and may act as a surrogate measure of other cardiovascular risk factors, including age, hyperlipidemia, hypertension, previous cardiovascular disease, and doubling of creatinine. Conclusion. Nondialysis-dependent CKD patients have impaired cardiac BRS, and this was related to decreasing GFR. There was a trend toward poorer prognosis in patients with impaired cardiac BRS that requires further study. Cardiac BRS may provide a simple, bedside, noninvasive assessment of overall cardiovascular risk in this population.
Challenges and possible solutions to peritoneal dialysis use in Nigeria.
(2020) Ajayi, S.; Raji, Y.; Bello, T.; Arije, A.
Introduction: peritoneal dialysis is a form of renal replacement therapy that is both effective and relatively affordable. Peritoneal dialysis (PD) was first used in Nigeria as a treatment option for renal failure. Its use was first reported in Nigeria in 1969 and became more widespread in the 80s and 90s. Haemodialysis, which is capital intensive to set up and requires infrastructures and facilities such as electricity, intense water consumption and buildings, seems to have upstaged peritoneal dialysis both in demand and supply. Methods: this cross-sectional study is a convenient survey of nephrologists, renal technicians and nurses in Nigeria. We used a structured, self-administered questionnaire on a cross-section of members and associate members attending a national nephrology association meeting. Results: there were 68(54.4%) doctors, 43(27.2%) nurses, and 14(11.2%) renal technicians, all from medical institutions with renal treatment programs who participated in the study. The most common problems encountered with PD use are financial constraints (51.7%), inadequate fluid supply (50%), frequent line blockage (22.4%) and frequent infections (17.2%). Reasons attributed to the stoppage of PD in the centres included lack of PD fluids (50.8%), unavailability of PD catheters (22.8%), lack of expert personnel to train (15.8%). Conclusion: main challenges to peritoneal dialysis use in Nigeria include limited experience and training and availability and cost of consumables. Effort to overcome the factors militating against its use should be positively pursued so that peritoneal dialysis will be reintegrated into the mainstream of renal replacement therapy once more
Challenges facing the growth of kidney transplantation in nigeria: perceptions and knowledge of the nephrologists and other health-care providers
(2021) Raji, Y.R.; Ajayi, S.O.; Gbadegesin, B.A.; Bello, T.O.; Salako, B.L.
Objective: The objective of this study was to determine the perception and knowledge of health-care providers to the challenges of sustaining the growth of kidney transplantation programs in Nigeria. Materials and Methods: We conducted a survey of 166 health-care providers. A pretested questionnaire was administered on all participants. Information obtained were demographics, characteristics of end-stage renal disease (ESRD) patients, and prospective kidney donors encountered and perception of the barriers to the growth of kidney transplantation program. Results: The respondents returned 134 questionnaires out of 166 (response rate: 80.7%) and only 121 with complete responses were included in the analysis. The mean age was 42.5 ± 0.8 years and 47.9% were females. A quarter of the health-care providers encountered ESRD patients who were more likely to refuse kidney transplantation and 34.1% reported that most of the prospective kidney donors were unwilling to donate. Most of the health care professionals (71.1%) preferred centers outside Nigeria for their patient’s kidney transplantation, while three leading barriers to the growth of kidney transplantation program reported were lack of patients’ trust (58.8%), failure of inter-program collaborations (55.0%), and absent of governmental supports (48.1%). Conclusions: The health-care professionals reported that more than a third of ESRD patients were not likely to accept kidney transplantation and an equal proportion of prospective donors will not agree to kidney donation. Majority of the health care professionals preferred centers outside Nigeria for patients’ kidney transplantation.
Confusion and delirium in acute falciparum malaria infection
(1996) Salako, B.L.; Ajayi, S.O.
Crossed fused renal ectopia presenting as recurrent lower abdominal pain and urinary tract infection
(2013) Ajayi S.O.; Mamven M.H.; Tabari, A.; Ojji D.B.; Ibrahim A.
Background: Crossed fused renal ectopia is a relatively rare condition which may remain undiagnosed for a long time. Renal function is usually preserved. It usually involves the left kidney. It is usually associated with mal-rotation, and may be a cause of urinary tract infection, hydronephrosis and renal calculi. Material and method: We report a case of a 15- year old boy who was referred to our clinic with complaints of abdominal pain, and an ultrasound report of “absent right kidney”. Results: Urine examination indicated a partially treated infection, but the tests of kidney functions were normal. Intravenous urography confirmed crossed fused renal ectopia, and a flush aortogram showed two anomalous right renal arteries arising from the left side of aorta. Conclusion: An “absent” kidney in its normal location should prompt further investigations. Recurrent chronic lower abdominal pain and urinary tract infection in a young person may be due to congenital renal abnormality. Evaluation of persistent urinary abnormalities in a child should include screening for congenital abnormalities.
Data resource profile: Cardiovascular H3Africa Innovation Resource (CHAIR)
(Oxford University Press, 2018-12) Owolabi, M. O.; Onoja, M. A.; Made, F.; Adebamowo, S. N.; Ojo, A.; Dwomoa, A.; Motala, A. A.; Bongani, M.M.; Ovbiagele, B.; Adebamowo, C.; Bamidele, T.; Rotimi, C.; Akinyemi, R.; Gebregziabher, M.; Sarfo, F.; Wahab, K. W.; Parekh, R. S.; Engel, M. E.; Chisala, C.; Peprah, E.; Mensah, G.; Wiley, K.; Troyer, J.; Miche` le, R.
Low- and middle-income countries (LMIC) constitute the majority of the world’s population and bear more than 80% of the global burden of cardiovascular disease (CVD).1,2 The recent increases in CVD globally are also reflected in LMIC, where the prevalence of overall deaths from CVD was 28% in 20013 and premature CVD mortality was 37% in 2015.4 The paucity of data regarding the drivers of the CVD epidemic and contextualized solutions is, in part, because less than 10% of the global research resources and facilities for implementation are found in LMIC.5,6 Therefore LMIC are particularly disadvantaged in dealing with the CVD burden with...
Decreased dose requirement of antihypertensive agents with age.
(2001) SalakoB.L.; Ajayi, S.O.; Kadiri, S.; Arije, A.
Hypertension is very prevalent in the elderly and treatment has been shown to be beneficial. However, inappropriate doses of drugs may impair the quality of life in this group of patients. In an attempt to assess the role of advancing age on therapy and doses of antihypertensives, the authors studied the antihypertensive dose/response pattern as hypertensive subjects on regular treatment move from the young to the elderly age group. Forty-nine hypertensives who were still being followed up at the medical outpatient clinic. University College Hospital, Ibadan were recruited into the study. The patients were extensively inter viewed and information relating to age, sex, year, age of diagnosis, as well as blood pressure at diagnosis, 6 months and 5 years of therapy were noted. There were HI males and 39 females with mean ages of 66.5 ± 6.6 and 64.5 ± 4.5 years respectively. The mean ages at diagnosis for both male and female groups were 52 ± 9.3 and 50 ± 7.5 years respectively. At diagnosis, 22 (44.8%) patients were started on single (antihypertensive) drug therapy, 23 (46.9%) on two drags while 4 (8.3%) were on 3 drugs. By 5 years of fairly consistent therapy, there were 33 (67.3%) patients on single drug and 16 (32.7%) patients on 2 drugs. No patient was on 3 drugs regimen. The mean blood pressure at diagnosis of 174 ± 24/105 ± 9 mmHg dropped significantly and was maintained at 6 months of therapy at (139 ± 20 / 87 ± 13 mmHg) p < 0.001. After 5 years of therapy the mean was (139 ±24/81 ±8 mmHg) inspite of dose reduction in these patients (p < 0.001). The authors concluded that, in a hypertensive patient who is un regular treatment, consistent and gradual reduction of antihypertensive doses may be carried out with blood pressure remaining within acceptable limits as the patient grows old.
eGFR and chronic kidney disease stages among newly diagnosed asymptomatic hypertensives and diabetics seen in a tertiary health centre in Nigeria.
(2014) Ajayi S.O.; Mamven M.H.; Ojji. D.
Objectives: Moderate to severe CKD, may be symptomless and therefore may be undetected if effort is not made to assess kidney function. The aim of this study was to determine the eGFR of asymptomatic newly diagnosed hypertensives and diabetics with a view to creating awareness for early screening, evalu ation and intervention especially in resource poor settings where kidney replacement therapy is prohibitive. Design, Setting, Participants: This is a retrospective study. Records of all hypertensive and diabetic patients referred to the medical clinic were included in the study for analysis. They were considered newly diagnosed if they were just being referred and were not on antihypertensive therapy or had been on therapy only in the last one month. The diagnosis of diabetes mellitus was made according to the guideline of the American Diabetes Association. We included in the analysis patients who had anthropometric measurements and serum creatinine from which we calculated the eGFR. Main Outcome Measures: Use of eGFR and CKD stage in asymptomatic newly diagnosed hypertensives and diabetics. Results: Six hundred and twenty-eight patients were included in the study. The mean age (SD) for men and women were 50.19 (12.41) and 48.63 (14.43) respectively. A total of 242 (38.5%) had stage CKD stages 3a, 3b and 4 with a predominance of females: 184 (29.6%) vs 58 (9.2%). There was an association between CKD stage, sex (x25135.56, P,.001) and age (x2530.83, P5.01). Conclusion: A substantial number of asymptomatic patients with hypertension and diabetes have CKD stages 3 and 4, associated with age and sex, but not with the BP stage. Without a proper evaluation, which includes determination of GFR, significant deterioration of kidney function may be missed and an appropriate intervention may not be instituted
Ethical and legal issues in renal transplantation in developing countries.
(2016) Ajayi, S.O.; Raji, Y.; Salako, B.L.
With the increasing number of patients being offered kidney transplantation by many centers in the developing world, it is not unexpected that there would be attendant ethical and legal issues even when the selection process for transplantation seems medically justified. Because of the inadequate infrastructure for hemodialysis and peritoneal dialysis, coupled with the challenges of logistics for maintenance dialysis, transplantation would seem to be the best option for patients with end-stage renal failure, even in developed economies where these can easily be tackled. The main issues here revolve around incentives for donors, organ trade and trafficking and the economics of eliminating the waiting list and the criminal activities of organ trans-plantation. In the developing world, with the current level of corruption and poverty, there is a need to redouble efforts to monitor transplant activities. Professional bodies should take the lead in this regard. Furthermore, there is a need for governments to engage in public consultation and community awareness concerning organ donation in living and deceased persons.
Exposure to agrochemicals and markers of kidney damage among farmers in rural communities in Southwestern Nigeria
(2021) Ajayi, S.O.; Raji, Y.R.; Michael, O.S.; Adewole, D.; Akande, T.; Abiola, B.; Aminu, S.; Olugbenga-Bello, A.; Arije, A.
Background: Chronic kidney disease of unknown origin (CKDu) is assuming an epidemic proportion, especially in farming communities worldwide. We explored the relationship between CKD markers and agrochemical exposure among rural farmers in South Western Nigeria. Methods: We studied selected farming communities in Southwestern Nigeria where the use of agrochemicals was widespread. A pre-tested questionnaire was administered to participants. Anthropometric data, information on use of agrochemicals; urine and blood samples were obtained. Informed consent was obtained from participants. The study was approved by the Institutional Ethics committee and complied with 1975 Helsinki declaration, as revised in 2000. Results: A total of 438 farmers made up of 202 males (46.1%) and 236 females (53.9%) were studied. The mean microalbuminuria was 30.2 ±11.7 mg/dl. Majority of the farmers had CKD stage 2 (42.0%) and CKD stage 3 (37.7%). The type of farming engaged in had a positive, but not significant, correlation with eGFR (r=0.012, p=0.832). There was positive correlation between type of farming and GFR category (r=0.24, p=0.000). Frequency of use of hexachlorocyclohexane had a positive and significant correlation with eGFR (r=0.111, p=0.045). Annual crop farming had a correlation with UACR (r=0.149, p=0.024). Conclusion: Annual crop farming had a positive correlation with UACR, eGFR and GFR category. The prolonged use of agrochemicals on an annual basis can cause kidney damage.