Introduction: Despite the rising prevalence of chronic kidney disease (CKD), access to adequate renal care is still not available to a very large part of the populace, essentially due to inadequate funds and this has further heightened the burden of the disease on patients and the general society. Measures are therefore needed to highlight this health challenge and proffer solutions. Methods: A comparative study in which consented 354 consented participants with CKD stage 3-5 gave history, were examined and had blood taken for serum biochemistry and hematocrit to access kidney function. Results: Two hundred and thirty six males and 118 females participated. The mean age of the participants was 52.11 ± 6.04 yrs. A greater percentage (44.6%) of participants had hypertension as cause of CKD and earned a monthly income less than the national minimum wage (47.7%). A greater proportion of participants had tertiary education (51.4%), were married (64.1%) and travelled less than 50 kilometers (67.5%) to access renal care. The health insured were more likely to be males (P=0.002), aged (P<0.001) have higher hematocrit (P=0.002), albumin (P=0.06), bicarbonate (P=0.04) and GFR (P=0.01).. The health insured had more frequent dialysis (P<0.001) and erythropoietin use (P<0.001. Forty percent of the health insured had renal transplant compared to 1.6% of the uninsured, P<0.001. The insured were more associated with IDHT as the uninsured were more associated with IDH. The health insured had a mean dialysis dose (Kt/V 1.34 ± 0.9) compared to 1.13 ± 0.5 for the uninsured, P<0.001. The dialysis dose was positively correlated with frequency of dialysis (P<0.001), and erythropoietin (P<0.001) but was negatively correlated with age (P=0.01) and serum creatinine (P=0.004). Predictors of dialysis dose were insurance status, frequency of dialysis, and erythropoietin, hematocrit, serum albumin and bicarbonate. Conclusion: Only 11.9% of the CKD cohorts had health insurance coverage and they were more likely to be males, aged, highly educated, with higher hematocrit, and albumin. The health insured had a mean dialysis dose of Kt/V 1.34±0.9 as against 1.13±0.5 for the uninsured. The uninsured had more metabolic acidosis, were younger and being the most active working population, their affectation only further worsens the burden associated with CKD. Key words: health insured, intradialysis hypotension, intradialysis hypertension, dialysis dose.
Introduction: Anemia is a modifiable and very common complication of chronic kidney disease that could be difficult to manage, more so in low income settings due to late recognition, and cost of undergoing required investigations and treatment. Methods: A cross sectional study in which participants with chronic kidney disease and with glomerular filtration rate (GFR) <60ml/min had urine, blood and radiological investigations to determine albuminuria, GFR with electrolytes concentrations kidney length respectively. Results: One hundred and forty four (82 females and 62 females) cohorts participated. The mean age of all participants was 48.76 ± 15.87 years. Only cohorts in stage 5 CKD were receiving ESAs, and of the 22, 19 (86.3%) had anemia. The 45-59 years group had the highest blood pressure. A greater proportion of the participants had hypertension as the cause of CKD. The prevalence of anemia was 39.58%, 37.80% in males and 41.93% in females. The mean hemoglobin concentration for cohorts was 10.96 ± 1.85 g/dL, and was higher in males, P=0.06, and was least with chronic interstitial nephritis. Metabolic acidosis was commoner in females, P=0.04. Calcium x Posphate product was elevated in 10.5% of the participants. The mean serum creatinine was higher in males than females, P=0.001. The mean eGFR and urine ACR were higher in males, P=0.02, P=1.1. The severity of anemia was positively related to stage of CKD, P<0.001. Conclusion: Anemia complicating CKD is common, with a prevalence of 39.58% in our study. It was commoner in females, aged and elevated urine ACR and was negatively correlated with serum albumin. Determinants of renal anemia were age, and kidney function while predictors were increasing age, stage 5 CKD and urine ACR. Improvement in kidney function, frequent reviews of red cell indices and medications are needed to minimize complications of renal anemia. Key words: anemia, chronic kidney disease, erythropoiesis stimulating agents, hemoglobin concentration,
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