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Item Impact of metabolic Acidosis on the dialysis dose: findings from a two center cross-sectional study in a low income population setting.(2021) Uduagbamen, P.K.; Ajayi, S.O.; Soyinka, F.O.; Kadiri, S.Background: Metabolic acidosis (MA) still remains a very common finding in patients with end stage kidney disease (ESRD) despite the increasing volume of research on dialysis treatment that have resulted in improved haemodialysis delivery. Its occurrence increases the risk of dialysis termination and inadequate dialysis dose that is associated with poor treatment outcome. The study endeavored to study metabolic acidosis and to determine its relationship with the dialysis dose (Kt/V). Materials and Methods: This was a two centre cross-sectional study involving 298 participants with ESKD who had 1642 sessions of maintenance haemodialysis. Serum electrolytes were analyzed by the Ion-Selective Electrode method and haematocrit was determined using a Hematocrit Centrifuge Results: Two hundred and ninety eight (192 males and 106 females) participants took part with a mean age of 51.44 + 7.31 years (males, 51.18 + 4.62 years, females, 52.14 + 2.93 years), P=0.04. The mean serum bicarbonate concentration, post dialysis (20.61 ± 6.26 mmol/L) was significantly higher than the pre dialysis, 18.41 ± 3.63 mmol/L (P<0.001) concentration. The prevalence of pre and post dialysis metabolic acidosis were 79.0% and 38.3% (P<0.001) There was a significant reduction in the mean anion gap following dialysis (P<0.001). The mean dialysis dose was significantly higher in males than females (P=0.03) and in participants with normal PSBC than participants with low PSBC (P<0.001) Risk factors for metabolic acidosis were advancing age, elevated Body Mass Index and blood pressure. Metabolic acidosis was negatively related to glomerular filtration rate and haematocrit. Aging, lesser dialysis frequency, independently predicted metabolic acidosis Conclusion: Metabolic acidosis is quite common in patients on maintenance dialysis, more common in females, advancing age and in less frequent dialysis treatment. Its occurrence increased the risk of inadequate dialysis.Item Resistivity index in the diagnosis and assessment of loss of renal function in diabetic nephropathy.(2021) Jinadu, Y.O.; Raji, Y.R.; Ajayi, S.O.; Salako, B.L.; Arije, A.; Kadiri, S.Objective: The aim of this study was to determine the haemodynamics of the intrarenal arteries from the relationship between resistivity index (RI) and kidney function, and to identify the predictors of high RI among patients with diabetic nephropathy (DN) and those with diabetes mellitus (DM) without DN. Methods: This was a cross-sectional survey of 133 participants, comprising 40 subjects with DM without DN, 53 with DM with DN and 40 healthy controls. Information obtained was demographics, lifestyle, medical and medication histories, while anthropometric and blood pressure measurements were taken. Albuminuria and estimated glomerular filtration rate were determined and RI was measured using a Doppler ultrasound scan. Results: The mean intrarenal artery RIs were higher among the patients with DM without DN (0.60 ± 0.04) and the group with DM with DN (0.61 ± 0.04) than in the controls (0.56 ± 0.04) (p = 0.02). Glycated haemoglobin (HbA1c) predicted high RI in the DM without DN group (OR 2.81; CI: 1.73–9.03) while hypertension (OR 3.60; CI: 1.06–12.22) predicted high RI in the DM with DN group. Conclusion: Elevated intrarenal artery RI was prevalent among patients with DM without DN and those with DM with DN, while elevated HbA1c level and hypertension predicted elevated RI in subjects with DM without DN and those with DM with DN.Item Impact of impaired kidney function on outcomes of Nigerians with COVID-9 infection: report of two cases from the University College Hospital, Ibadan(2021) Raji, Y.R.; Ajayi, S.O.; Abiola, B.I.; Augustine, T.; Adekanmbi, O.; Arije, A.Covid-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak. WAJM 2021; 38(3): 292–296.Item Impact of impaired kidney function on outcomes of Nigerians with COVID-9 infection: report of two cases from the University College Hospital, Ibadan(2021) Raji, Y.R.; Ajayi, S.O.; Abiola, B.I.; Augustine, T.; Adekanmbi, O.; Arije, A.Covid-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak. WAJM 2021; 38(3): 292–296.Item 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.Item 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 CKDItem 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.Item Urinary transforming growth Factor-Beta 1 (uTGF-β1) and prevalent CKD risk in HIVpositive patients in West Africa(2019) Ekrikpo, U.E.; Okuku, C.N.; Ajayi, S.O.; Ayodele, O.E.; Bello, A.K.; Wonkam, A.; Dandara, C.; Kengne, A.P.; Okpechi, I.Introduction: This study investigated the association of urinary transforming growth factor-b1 (uTGF-b1) with prevalent chronic kidney disease (CKD) in the HIV-infected population. Methods: HIV-positive patients without CKD (HIVþCKD, n ¼ 194) and 114 with CKD (HIV CKD) who did not have hypertension, diabetes mellitus, or hepatitis B or C, had their urinary protein-creatinine ratio (uPCR), serum transforming growth factor (TGF)–b1, and uTGF-b1 measured. uTGF-b1-creatinine ratios (uTGF-b1Cr) were calculated. Spearman correlation was used to determine the association between uTGF-b1Cr and various attributes, and the Cuzick trend test was used to assess the presence of a linear trend in median uTGF-b1Cr levels across the stages of CKD. Multivariable robust linear regression models were used to assess independent association with variability in uTGF-b1Cr and estimated glomerular filtration rate (eGFR) levels. Results: The age of the participants was 38.3 0.3 years with 73.4% women. The median uTGF-b1Cr was higher among HIV CKD (4.85 ng/mmol [25th–75th percentile 1.96–12.35] vs. 2.95 [1.02–5.84]; P ¼ 0.001]). There was significant correlation between uTGF-b1Cr and age (P ¼ 0.02), eGFR (P ¼ 0.001), and uPCR (P < 0.001) in the HIV CKD group. Among the HIV CKD patients, there was gradual reduction in the median level of uTGF-b1Cr with CKD severity (P ¼ 0.04). HIV CKD patients had significantly higher levels of uTGF-b1Cr after controlling for potential confounders. Using eGFR as dependent variable, proteinuria explained the changes associated with uTGF-b1Cr levels. Conclusion: HIV CKD patients express higher levels of uTGF-b1 especially in the early stages of CKD apparently related to proteinuria levels.Item Predictors and outcomes of acute kidney injury after non-cardiac paeditaric surgery.(2019) Lawal, T.A.; Raji, Y.R.; Ajayi, S.O.; Ademola, A.D.; Ademola, O.O.; Adigun, O.O.; Ogundoyin, O.O.; Olulana, D.I.; Asinobi, A.O.; Salako, B.L.Background: It is necessary to define the problem of acute kidney injury (AKI) after non-cardiac surgery in order to design interventions to prevent AKI. The study aimed to evaluate the occurrence, determinants and outcome of AKI among children undergoing general (non-cardiac) surgery. Methods: This was a prospective cohort study of patients aged ≤ 15 years who had general surgery over 18 months period at a tertiary hospital in Nigeria. AKI was evaluated at 6 and 24 h and within 7 days of surgery. Data were analysed using SPSS version 21. Results: A total of 93 patients were studied with age ranging from 3 days to 15 years (median = 4 years). AKI occurred within 24 h of surgery in 32 (34.4%) and cumulatively over 7 days in 33 (35.5%). Patients who had sepsis were nearly four times as likely as others to develop perioperative AKI (OR = 3.52, 95% CI 1.21, 10.20, p = 0.021). Crude mortality rate was 12.1% (4/33); no mortality was recorded among those without AKI, p = 0.014. Conclusion: Perioperative AKI occurred in 35.5% of children who underwent general (non-cardiac) surgery. Patients who had sepsis were four times more likely than others to develop AKI. Mortality was documented only in patients who had AKI.Item Self-reported sleep disorder and ambulatory blood pressure Phenotypes in patients with or without chronic kidney disease: findings from Ibadan CRECKID study.(2019) Ajayi, S.O.; Adeoye, A.M.; Raji, Y.R.; Tayo, B.; Salako, B.L.; Ogunniyi, A.; Ojo, A.; Cooper, R.ed the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS: Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP ≥140mmHg and/or DBP ≥90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2 Equation and CKD was defined as eGFR 60ml/min?1.73m2 Results: A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; Conclusion: This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.