Browsing by Author "Davids, M. Razeen"
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- ItemGitelman syndrome in a South African family presenting with hypokalaemia and unusual food cravings(BioMed Central, 2017-01-26) Van der Merwe, Pieter Du Toit; Rensburg, Megan A.; Haylett, William L.; Bardien, Soraya; Davids, M. RazeenBackground Gitelman syndrome (GS) is an autosomal recessive renal tubular disorder characterised by renal salt wasting with hypokalaemia, metabolic alkalosis, hypomagnesaemia and hypocalciuria. It is caused by mutations in SLC12A3 encoding the sodium-chloride cotransporter on the apical membrane of the distal convoluted tubule. We report a South African family with five affected individuals presenting with hypokalaemia and unusual food cravings. Methods The affected individuals and two unaffected first degree relatives were enrolled into the study. Phenotypes were evaluated through history, physical examination and biochemical analysis of blood and urine. Mutation screening was performed by sequencing of SLC12A3, and determining the allele frequencies of the sequence variants found in this family in 117 ethnically matched controls. Results The index patient, her sister, father and two aunts had a history of severe salt cravings, fatigue and tetanic episodes, leading to consumption of large quantities of salt and vinegar. All affected individuals demonstrated hypokalaemia with renal potassium wasting. Genetic analysis revealed that the pseudo-dominant pattern of inheritance was due to compound heterozygosity with two novel mutations: a S546G substitution in exon 13, and insertion of AGCCCC at c.1930 in exon 16. These variants were present in the five affected individuals, but only one variant each in the unaffected family members. Neither variant was found in any of the controls. Conclusions The diagnosis of GS was established in five members of a South African family through clinical assessment, biochemical analysis and mutation screening of the SLC12A3 gene, which identified two novel putative pathogenic mutations.
- ItemHypernatraemia in South African hospitalized patients(African Association of Nephrology, 2019) Abohajir, Ali; Rensburg, Megan A.; Davids, M. RazeenBackground: Hypernatraemia is a common electrolyte problem in hospitalized patients and is associated with a high mortality rate. We determined the incidence, causes, management, and outcomes of hypernatraemia in adult hospitalized patients at a large South African tertiary hospital. Methods: A retrospective study was conducted at Tygerberg Hospital in Cape Town, South Africa. Adult patients with hypernatraemia (at least one serum sodium concentration ≥150 mmol/L) during a 3-month period in 2014 were identified from our laboratory database for inclusion. Results: There were 204 patients with hypernatraemia, a prevalence of 1.5%. Of these patients, 101 (49.5%) were male, and the mean age was 53 years. There were 66 patients (32.4%) who had hypernatraemia on admission, and 138 who developed it during the course of their stay in hospital. The overall in-hospital mortality was 38.7%, with higher rates for older patients and those with more severe degrees of hypernatraemia. Contributory causes which were most commonly present included dehydration/hypovolaemia (45%), followed by sepsis (39%). Net sodium gain, rather than water deficit, was identified as the main mechanism in most of the patients who developed hypernatraemia in the intensive care units. We found little evidence of any diagnostic work-up and also found that the details of fluid therapy and intake–output charting were poorly documented. Conclusions: There is a very high mortality rate in our hospitalized patients with hypernatraemia. The diagnostic work-up and therapy were often inadequate or poorly documented. The management of this important condition needs to be improved with the aid of standardized protocols.
- ItemPeritoneal dialysis technique survival at Tygerberg Hospital in Cape Town, South Africa(African Association of Nephrology, 2017) Kapembwa, Kenneth C.; Bapoo, Nabeel A; Tannor, Elliot K.; Davids, M. RazeenBackground: The use of peritoneal dialysis (PD) as a treatment modality for patients with end-stage renal disease (ESRD) has been declining in many countries over the past few years. One of the reasons is technique failure, which occurs more frequently than is the case with chronic haemodialysis. Identifying and addressing the causes of technique failure is important in order to maintain more patients on PD, especially in settings where there are limited resources for chronic haemodialysis and a “PD first” approach is followed. Methods: In this retrospective study at Tygerberg Hospital in Cape Town, South Africa, we investigated 170 patients who were started on chronic ambulatory PD between January 2008 and July 2014, and determined rates of technique and patient survival. Demographic, clinical and laboratory data were assessed to identify risk factors for these outcomes. Results: The median age of the patients was 36 years and the most common cause of ESRD was glomerulonephritis. Only one patient had diabetes mellitus. Technique survival at 1, 3 and 5 years was 80%, 54% and 39%, respectively, while patient survival was 90%, 82% and 63%. Patients started on PD during the second half of the study period had improved rates of technique survival. Peritonitis was the most common cause of technique failure. Increasing age and Black ethnicity were associated with increased likelihood of technique failure. Other clinical and social factors were not significantly associated with the occurrence of technique failure. Conclusions: In our patients on PD, peritonitis, increased age and Black ethnicity were important factors associated with the development of technique failure. Concerted efforts are required to reduce peritonitis rates at our centre as this is the leading cause of technique failure.
- ItemPrevalence of chronic kidney disease and association with cardiovascular risk factors among teachers in Cape Town, South Africa(Oxford University Press, 2017) Adeniyi, Aderemi B.; Laurence, Carien E.; Volmink, Jimmy A.; Davids, M. RazeenBackground: There is a need to determine the feasibility of conducting studies of chronic diseases among large cohorts of African patients. One aim of the South African feasibility study was to determine the prevalence of chronic kidney disease (CKD) and its association with cardiovascular disease (CVD) risk factors among school teachers. Methods: In a cross-sectional survey of 489 teachers we captured data on demographics, CVD risk factors, anthropometry and blood pressure. Serum glucose, creatinine, cholesterol and urine protein/creatinine ratio was measured. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease study equations. Results: The mean (± standard deviation) age of the participants was 46.3±8.5 years, with 70.3% being female and 74.6% of mixed ethnicity. The crude prevalence of CKD using the CKD-EPI equation was 6.1% while the age-adjusted prevalence was 6.4% (95% confidence interval 3.2–9.7%). CKD was associated with the presence of diabetes and higher diastolic blood pressures. Conclusions: In our study population of relatively young, working individuals CKD was common, clinically silent and associated with cardiovascular risk factors. The long-term complications of CKD are serious and expensive to manage and this, therefore, constitutes an important public health problemfor South Africa.
- ItemQuality of life in patients on chronic dialysis in South Africa : a comparative mixed methods study(BioMed Central, 2017-01-05) Tannor, Elliot K.; Archer, Elize; Kapembwa, Kenneth; Van Schalkwyk, Susan C.; Davids, M. RazeenBackground: The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis. Dialysis should not only be aimed at prolonging lives but also improve quality of life (QOL). Using mixed methods, we investigated the QOL of patients on chronic haemodialysis (HD) and peritoneal dialysis (PD). Methods: We conducted a cross-sectional study at Tygerberg Hospital in Cape Town, South Africa. All the PD patients were being treated with continuous ambulatory peritoneal dialysis. The KDQOL-SF 1.3 questionnaire was used for the quantitative phase of the study. Thereafter, focus-group interviews were conducted by an experienced facilitator in groups of HD and PD patients. Electronic recordings were transcribed verbatim and analysed manually to identify emerging themes. Results: A total of 106 patients completed questionnaires and 36 of them participated in the focus group interviews. There was no difference between PD and HD patients in the overall KDQOL-SF scores. PD patients scored lower with regard to symptoms (P = 0.005), energy/fatigue (P = 0.025) and sleep (P = 0.023) but scored higher for work status (P = 0.005) and dialysis staff encouragement (P = 0.019) than those on HD. Symptoms and complications were verbalised more in the PD patients, with fear of peritonitis keeping some housebound. PD patients were more limited by their treatment modality which impacted on body image, sexual function and social interaction but there were less dietary and occupational limitations. Patients on each modality acknowledged the support received from family and dialysis staff but highlighted the lack of support from government. PD patients had little opportunity for interaction with one another and therefore enjoyed less support from fellow patients. Conclusions: PD patients experienced a heavier symptom burden and greater limitations related to their dialysis modality, especially with regards to social functioning. The mixed-methods approach helped to identify several issues affecting quality of life which are amenable to intervention.
- ItemA renal registry for Africa : first steps(Oxford University Press European Renal Association, 2016) Davids, M. Razeen; Eastwood, John B.; Selwood, Neville H.; Arogundade, Fatiu A.; Ashuntantang, Gloria; Gharbi, Mohammed Benghanem; Jarraya, Faical; MacPhee, Iain A. M.; McCulloch, Mignon; Plange-Rhule, Jacob; Swanepoel, Charles R.; Adu, DwomoaENGLISH ABSTRACT: There is a dearth of data on end-stage renal disease (ESRD) in Africa. Several national renal registries have been established but have not been sustainable because of resource limitations. The African Association of Nephrology (AFRAN) and the African Paediatric Nephrology Association (AFPNA) recognize the importance of good registry data and plan to establish an African Renal Registry. This article reviews the elements needed for a successful renal registry and gives an overview of renal registries in developed and developing countries, with the emphasis on Africa. It then discusses the proposed African Renal Registry and the fi rst steps towards its implementation. A registry requires a clear purpose, and agreement on inclusion and exclusion criteria, the dataset and the data dictionary. Ethical issues, data ownership and access, the dissemination of fi ndings and funding must all be considered. Well-documented processes should guide data collection and ensure data quality. The ERA- EDTA Registry is the world ’ s oldest renal registry. In Africa, registry data have been published mainly by North African countries, starting with Egypt and Tunisia in 1975. However, in recent years no African country has regularly reported national registry data. A shared renal registry would provide participating countries with a reliable technology platform and a common data dictionary to facilitate joint analyses and comparisons. In March 2015, AFRAN organized a registry workshop for African nephrologists and then took the decision to establish, for the fi rst time, an African Renal Registry. In conclusion, African nephrologists have decided to establish a continental renal registry. This initiative could make a substantial impact on the practice of nephrology and the provision of services for adults and children with ESRD in many African countries
- ItemStrengthening renal registries and ESRD research in Africa(Elsevier, 2017) Davids, M. Razeen; Caskey, Fergus J.; Young, Taryn; Balbir Singh, Gillian K.ENGLISH ABSTRACT: In Africa the combination of non-communicable diseases, infectious diseases, exposure to environmental toxins and acute kidney injury related to trauma and childbirth are driving an epidemic of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Good registry data can inform the planning of renal services and can be used to argue for better resource allocation, audit the delivery and quality of care, and monitor the impact of interventions. Few African countries have established renal registries and most have failed due to resource constraints. In this paper we briefly review the burden of CKD and ESRD in Africa then consider the research questions which could be addressed by renal registries. We describe examples of the impact of registry data and summarise the sparse primary literature on country-wide renal replacement therapy (RRT) in African countries over the past 20 years. Finally, we highlight some initiatives and opportunities for strengthening research on ESRD and RRT in Africa. These include the establishment of the African Renal Registry and the availability of new areas for research. We also discuss capacity-building, collaboration, open access publication and the strengthening of local journals, all measures which may improve the quantity, visibility and impact of African research outputs.