Three hundred patients with chronic kidney disease and 80 patients with acute kidney injury were managed at our unit over 5 years. One hundred and eighty (60%) out of the 300 patients had chronic kidney failure necessitating HD while 45 (56.2%) out of the 80 patients with AKI seen required HD. Seven hundred and eighty-one dialysis sessions were offered to the 225 patients with both CKF and AKI during this period ().
Comparing a 5 year pattern of HD in Osogbo with two other centres located in south western Nigeria
There were 155 (68.9%) males and 70 (31.1%) females with a male preponderance in the ratio of 2.2:1. There were more males affected in both the AKI/CKD groups. Also for AKI, the highest number of people were those in the 50–60year age group as opposed to 31–40, 41–50 up to 70 years.
The number of haemodialysis sessions ranged from 1 to 10 for the AKI cases and 1 to 27 for the CKF cases, with an average of 3 sessions/patients. Vascular access was mainly by femoral or internal jugular cannulation. Only 15 of the 180 CKF patients presented de-novo with Arterio-venous fistulas and all were referral cases from other centres.
Out of the 180 CKF patients, 2 received 3 sessions of HD/week, 2 had 2 sessions/week, 40 patients had 1 session /week, while 136 patients had inconsistent pattern varying from every 10 days to as high as once in 21 days. Also with regards to the CKF patients, 114 patients (63.3%) had less than 5 sessions of haemodialysis; 54(30%) had between 5 and 10 sessions and the remainder between 11 and 20 sessions of dialysis spanning 3 years with substantial financial support from non-governmental institutions and corporate organizations.
For the 45 AKI patients, 17 had 1 HD session ( 10 died after the first session, while 7 recovered renal function), 15 patients had thrice weekly 4–5hours sessions of intermittent HD) , 5 patients had twice weekly HD while 8 patients had infrequent IHD sessions over 3 weeks.
Long standing hypertension was seen in 70 (38.8%) and this accounted for majority of the patients with CKF followed by chronic glomerulonephritis 52 (28.8%) and diabetic nephropathy 40(22.2%) (). However, in the last 2 years, there has been an upsurge in the cases of nephropathy with at least 2 new cases of diabetes mellitus presenting commonly in CKD stages 4 and 5 at our unit (personal observation).
Showing the pattern of distribution of the Aetiologies in CKF and AKF
Sepsis syndrome accounted for 16 (35.5%) of the 45 patients with acute kidney injury while pregnancy/postpartum related cases (i.e. pre-eclampsia, septic abortions, post-partum haemorrhage) accounted for 10 (22.2%) of the cases. Others included toxins, 6(13.3%), hypervolemia from diarrhoeal illnesses; 4(8.8%), acute glomerulonephritis 3(35.5%), snakebites 1(2.2%) and rhabdomyolysis from major burns (1) (2.2%).
The average presenting serum haematological/biochemical parameters for both AKI and CKD () shows haematocrit of 28%, serum urea of 14.3mmol/l, serum potassium of 5.5mmol/l, serum bicarbonate of 22mmol/l and serum creatinine of 300µmol/lit for the former (AKI) and haematocrit of 18%, serum urea of 30mmol/l, serum potassium of 6.5mmol/l, serum bicarbonate of 18mmol/l and serum creatinine of 925µmol/l for the latter (CKD).
showing the presenting haematological and biochemical parameters.
The mortality by cause of AKI showed that muscle cramps were seen in 21 patients (2.68%), sudden death in 5 patients, while majority, 566 (72.47%) had no complications.
Out of the 180 patients with chronic kidney failure, 4 were transplanted, 41 patients were lost to follow up, 131 patients did not survive, and no patient was converted to peritoneal dialysis while 3 patients are presently on maintenance haemodialysis.