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    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.
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    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.
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    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.
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    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.
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    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.
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    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
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    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.
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    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
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    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.