Journal of Kenya Assocation of Physicians

The Evolving Nature of Evidence-Based Medicine: The Past Present and Future

J.A. Aluoch — Mon, 15 Apr 2024 00:00:00 +0000

No Abstract

Aetiology and Management Practices of Pleural Effusions among Hospitalized Adult Patients at a Referral Facility in Kenya: A 5-Year Retrospective Study

P.M. Borome , A. Owuor , J.W. Kagima , J. Mecha , E.O. Amayo — Mon, 15 Apr 2024 00:00:00 +0000

Background: Pleural Effusion (PE) is a condition associated with significant mortality and morbidity, with varying aetiologies influenced by geography, patient age, and time trends. The variations in aetiologies of PE according to time necessitate the need to investigate the current trends of causation, and management of pleural effusion in Kenya.

Objective: This study described the common practices of care of patients presenting with PE at Kenyatta National Hospital in Kenya.

Methodology: We utilized a retrospective crosssectional design, involving 1234 patients admitted with PE at Kenyatta National Hospital (KNH) between January 2018 and December 2022. The data collected included information on aetiology, presentation, management practices, length of stay, and mortality associated with PE. SPSS version 25 was used for data analysis. Continuous data was described using means and standard deviation. Proportions were utilized in describing the categorical variables. Logistic regression model was applied on significant variables to assess for independent risk factors for mortality due to pleural effusion and results to be reported in odds ratios and the associated 95% confidence interval.

Results: The predominant presenting symptoms was dyspnea (80.1%). Exudative effusions were the most common (65.8%), with tuberculosis being the primary cause of infectious effusions. Among transudative effusions, heart failure (53.0%) was the most common cause. Intercostal chest drainage, with large bore tubes, was a common therapeutic intervention. The average length of hospital stay was 18.57 days, and the mortality rate was 12.4%.

Conclusion: Pleural effusions remain to be the most common with infectious aetiology as the predominant cause. There still remains a huge gap in unreported data and adoption of electronic data entry may be a solution to this challenge.

Determinants of Functional Status in End Stage Kidney Disease Patients on Maintenance Haemodialysis at Kenyatta National Hospital, Nairobi, Kenya

A.A. Suleh , J.K. Kayima , J.K. Kwasa — Mon, 15 Apr 2024 00:00:00 +0000

Background: Functional status refers to an individual’s ability to conduct activities of daily living and includes functions such as feeding oneself, maintaining personal hygiene and transferring. Maintenance haemodialysis in End Stage Kidney Disease (ESKD) patients is linked to a significant decline in functional status and this decline is an important prognostic factor affecting the outcomes of this group of patients.

Objectives: The primary objective was to establish the functional status of ESKD patients on maintenance haemodialysis at the Kenyatta National Hospital (KNH) Renal Unit and grade it using the Karnofsky Performance Status scale. The secondary objective was to determine the selected factors associated with better physical function among ESKD patients on maintenance haemodialysis.

Methods: This was a cross-sectional descriptive tudy in which 82 patients with ESKD undergoing maintenance haemodialysis (>3 months) at the KNH Renal Unit were recruited. Relevant sociodemographic and clinical data was collected, and the Karnofsky Performance Status (KPS) scale was used to assess the functional status of the participants. The SPSS version 25 software was used for data entry and to perform the analyses. The participants’ sociodemographic and clinical characteristics were summarized into percentages, means, standard deviations and median. Functional status was assessed using the KPS scale and categorized into either functionally dependent or independent and summarized as a percentage. A chisquare test of association and logistic regression was used to evaluate the relationship between functional status and the selected variables.

Results: The participants enrolled in the study were 82 with the median age being 46 years (inter-quartile range 34-58 years). Functional status was assessed with 44 (53.7%) participants being categorized as independent (KPS score 80-100%) and 38 (46.3%) being functionally dependent (KPS score <80%). In the univariable logistic regression model, age, dialysis vintage and fluid overload were significant predictors of functional status. The multivariable model demonstrated that dialysis vintage was a significant predictor at a 5% significance level.

Conclusion: Patients with ESKD undergoing haemodialysis at the KNH Renal Unit have a high prevalence of functional status impairment at 46.3%. Younger age, longer dialysis vintage and normal fluid status were the significant predictors of better physical function.

Prevalence of Hyperuricemia in Adult Renal Transplant Patients at The Kenyatta National Hospital, Nairobi, Kenya

I. Kapule , J. Kayima, S.O. Mcligeyo , E.O. Amayo , G.O. Oyoo — Mon, 15 Apr 2024 00:00:00 +0000

Background: Hyperuricemia is prevalent in renal transplant recipients and has been shown to be a cause of adverse graft outcome through its direct effects on the kidney and indirectly through its cardiovascular effects that can result in impaired graft function. Hyperuricemia is modifiable in renal transplant recipients.

Objective: To determine the burden of hyperuricemia and clinical features associated with it among patients attending the renal transplant clinic at a tertiary hospital in Nairobi, Kenya.

Design: Cross sectional study.

Setting: Renal transplant clinic at the Kenyatta National hospital

Methods: A total of 96 patients were included in the study. Clinical characteristics, blood uric acid and creatinine levels for the purpose of estimating the glomerular filtration rate were determined from renal transplant recipients greater than 6 months posttransplant. Hyperuricemia was defined as serum uric acid of greater than 360 umol/l in females and greater 420 umol/l in males

Results: The mean age of the patients was 46.4 (SD 14.3) years, mean post-transplant time was 5.9 (SD 5.3) years, mean creatinine was 135.5 (SD 117.6) umol/l. The prevalence of hyperuricemia was 40.6% (n=96). The patients were predominantly male at 65.6%. The most common cause of End Stage Renal Disease (ESRD) was hypertension at 32%. Hyperuricemic patients had worse graft function (mean eGFR 59.4 vs. 74.5 mL/min/1.73 m2 ; p=0.005), higher creatinine levels (116.0 vs. 98.0 umol/l; p=0.014), less likely to be diabetic patients (12.8% vs. 33.3%, p=0.023), or be on insulin (7.7% vs. 29.8%; p=0.009).

Conclusion: Prevalence of post-transplant hyperuricemia is high, particularly in those with higher creatinine and estimated Glomerular Filtration Rate (eGFR) and lower in diabetics and those who use insulin.

Recommendation: Screening for hyperuricemia should be done regularly for renal transplant recipients at the Kenyatta National Hospital transplant clinic due to its high prevalence.

A Runners Nightmare: Rhabdomyolysis strikes, Kidneys suffer: A Case Report

M. Iqbal , G. Moturi , O. Akunga — Mon, 15 Apr 2024 00:00:00 +0000

Exercise Induced Rhabdomyolysis (EIR) refers to breakdown of striated myocytes and release of their contents into circulation after prolonged intense physical activity. The presentation is variable from asymptomatic to symptoms like intense muscle pain, weakness and dark tea-coloured urine. Potential complications like volume depletion, metabolic and electrolyte abnormalities, acute kidney injury (AKI), multi organ failure and death can occur if early diagnosis and treatment is missed. A high index of suspicion is important to avoid this. We report a case of EIR causing AKI in a 44-year-old male who presented with lower limb muscle pain for 5 days after running 70 km marathon followed by symptoms of fluid overload requiring haemodialysis.

Social Health Insurance Fund vs The Social Determinants of Health: Putting the Cart before the Horse?

J.A. Aluoch — Mon, 15 Apr 2024 00:00:00 +0000

No Abstract