Increase in serum creatinine in a patient on continuous peritoneal dialysis: potential mechanisms and management.

A large elevation in serum creatinine (S(Cr)) on an unchanged peritoneal dialysis (PD) schedule is usually caused by a decrease in total creatinine clearance (C(Cr)), but may also reflect an increase in creatinine (Cr) production. A meticulously compliant 43-year-old man with lupus nephritis on automated nocturnal PD plus an additional daytime exchange developed a rise in S(Cr) to 16.73 mg/dL from 8.

Comparison of the fatty acid composition of the serum phospholipids of controls, prediabetics and adults with type 2 diabetes.

Objective: Although abnormalities in the fatty acid composition of serum and red cell membrane phospholipids of patients with type 2 diabetes are well-documented, lacking are studies of this issue in prediabetic individuals.

Materials/methods: For this cross-sectional study, we recruited 180 subjects (30-80 years), 56 of whom were normal with regard to glucose control (HbA1c, <5.7%), 61 who had prediabetes (HbA1c, 5.

Comparison of diets of urban American Indian and non-Hispanic whites: populations with a disparity for biliary tract cancer rates.

Aim: The incidnece of biliary tract cancer (BTC) is many-fold higher for American Indians (AI) relative to non-Hispanic whites (NHW). Neither gallstones nor genetics can account for this difference. There is speculation that certain fatty acids in bile may play a role in preventing BTC.

Low fatty acid concentrations in neonatal cord serum correlate with maternal serum.

Objective: Lactating women in New Mexico have low levels of important fatty acids relative to reported international data. The objective was to correlate the proportions of long-chain polyunsaturated fatty acids (LCPUFA) in the serum phospholipids in mothers and newborns within the same population.

Methods: The serum phospholipids of 52 maternal:neonatal pairs were analyzed.

Assessment of the vitamin B12 status of pregnant women in Nigeria using plasma holotranscobalamin.

Maternal vitamin B12 deficiency during pregnancy is an independent risk factor for neural tube defects and other neurological problems in infants. We determined the vitamin B12 status of 143 pregnant women in Nigeria representing all trimesters who presented to an antenatal clinic in Jos, Nigeria, using holotranscobalamin II levels (holoTCII), which is a measure of the vitamin B12 that is available for uptake into tissues. The holoTCII concentration ranged from 13 to 128 pmol/L.

Low docosahexaenoic acid in the diet and milk of American Indian women in New Mexico.

A recent finding of low levels of docosahexaenoic acid (DHA) in the milk of lactating Hispanic and non-Hispanic white women in New Mexico prompted a study of the DHA content of the breast milk and diets of American Indian women in the state. Nineteen urban American Indian women (18 to 40 years) who had been lactating for 1 to 6 months and who were attending clinics at the University of New Mexico Hospital were enrolled in a cross-sectional study that was conducted between June 2005 and February 2009. Descriptive statistics and correlations were performed.

Vitamin D status of seminomadic Fulani men and women.

The purpose of this study was to assess the vitamin D status of Fulani men and women in northern Nigeria. The Fulani are seminomadic pastoralists whose culture, economy, and diet are centered on cattle. Most of the foods consumed by the Fulani are not good sources of vitamin D.

Lipid profiles and trans fatty acids in serum phospholipids of semi-nomadic Fulani in northern Nigeria.

The Fulani are semi-nomadic pastoralists of West Africa whose diet, culture, and economy are centred on cattle. Previous studies have shown that the Fulani of northern Nigeria derive 50% of their total calories from fat and 30% of their calories from milk, cheese, yogurt, and butter oil that contain significant amounts of trans fatty acids (TFAs), primarily vaccenic acid, which raise total serum cholesterol and low-density lipoproteincholesterol (LDL-C), and lower high-density lipoprotein-cholesterol (HDL-C). The study was conducted to know how the consumption of relatively large amounts of dairy products by adult Fulani affected the TFA content of their serum phospholipids.

Sources of variation in estimates of lean body mass by creatinine kinetics and by methods based on body water or body mass index in patients on continuous peritoneal dialysis.

Objective: We identified factors that account for differences between lean body mass computed from creatinine kinetics (LBM(cr)) and from either body water (LBM(V)) or body mass index (LBM(BMI)) in patients on continuous peritoneal dialysis (CPD).

Design: We compared the LBM(cr) and LBM(V) or LBM(BMI) in hypothetical subjects and actual CPD patients.

Patients: We studied 439 CPD patients in Albuquerque, Pittsburgh, and Toronto, with 925 clearance studies.

Low docosahexaenoic acid in the diet and milk of women in New Mexico.

Because docosahexaenoic acid (DHA) is critical for the development of the nervous system, especially during the first year of life, the content of DHA in human milk is important for the well-being of exclusively breastfed infants. The aim of this study was to determine the fatty acid composition, including DHA, of the breast milk fat and serum phospholipids of women in New Mexico, and to correlate these data with dietary fatty acid content. Samples of blood and breast milk, 3-day diet records, and information on dietary supplement use were obtained from 29 women.

Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study.

Background: Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI) with activity level, since energy expenditure correlates with length of training and by extension, magnitude of skeletal loading.

Methods: We recruited 102 male athletes: these included football (n = 68), running (n = 15), handball (n = 7), taekwando (n = 6), cycling (n = 2), judo (1), badminton (1) and high jump (1).

The prescription of peritoneal dialysis.

In addition to the maintenance of normal extracellular electrolyte composition, the prescription of continuous peritoneal dialysis (CPD) should address four other specific issues: (i) prevention of uremia by achievement of adequate clearance of azotemic substances, (ii) prevention of progressive expansion of the extracellular volume by adequate peritoneal ultrafiltration, (iii) prevention of loss of residual renal function, and (iv) prevention of deterioration of the peritoneal membrane structure and function. Urea clearance, in the form of Kt/V(Urea), is the index of removal of azotemic substances proposed by current guidelines. The target total (renal plus peritoneal) Kt/V(Urea) is >or=1.

Hydration abnormalities in Nigerian patients on chronic hemodialysis.

The state of hydration affects the outcomes of chronic dialysis. Bioelectrical impedance analysis (BIA) provides estimates of body water (V), extracellular volume (ECFV), and fat-free mass (FFM) that allow characterization of hydration. We compared single-frequency BIA measurements before and after 14 hemodialysis sessions in 10 Nigerian patients (6 men, 4 women; 44+/-7 years old) with clinical evaluation (weight removed during dialysis, presence of edema) and with estimates of body water obtained by the Watson, Chertow, and Chumlea anthropometric formulas.

Use of calcaneal ultrasound and biochemical markers to assess the density and metabolic state of the bones of adults with hepatic cirrhosis.

Bone loss has been shown to be associated with chronic liver disease (CLD) caused by ethanol consumption or viral infection, and trabecular bone is affected more than cortical bone. We therefore used calcaneal ultrasound to compare the bone status of 54 males and 20 females with CLD in northern Nigeria with 88 age- and gender-matched healthy controls. Serum levels of bone-specific alkaline phosphatase (BSAP) and the N-terminal telopeptide of type-1 collagen (NTx) were also measured to estimate relative rates of bone synthesis and turnover, respectively.

Pulmonary function correlates with body composition in Nigerian children and young adults with sickle cell disease.

Sickle cell disease (SCD) is associated with impaired growth and skeletal maturation. Decreased fat-free mass (FFM) and body fat (BF) have been reported in Nigerian children with SCD relative to healthy age- and gender-matched controls. Pulmonary abnormalities, including reduced forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)) and total lung capacity (TLC), have also been described in children with SCD.

Computation of the dose of continuous peritoneal dialysis required for adequate peritoneal urea clearance without taking into account peritoneal transport indices.

To test the feasibility of calculating, in the absence of peritoneal transport studies, the dose (daily drain volume) of continuous peritoneal dialysis (CPD) that will produce a high probability of adequate fractional peritoneal urea clearance (Kpt/Vurea), we randomly separated 619 clearance studies in patients on continuous ambulatory peritoneal dialysis (CAPD) with 4 daily exchanges into a derivation (n = 322) and a validation (n = 297) group. In the derivation group, the dialysate-to-plasma urea concentration ratio (D/Purea) was < or = 0.799 within the lowest 5% of the studies.

Nutritional factors associated with anaemia in pregnant women in northern Nigeria.

This study was conducted to assess the relative contribution of iron, folate, and B 12 deficiency to anaemia in pregnant women in sub-Saharan Africa. In total, 146 pregnant women, who attended two antenatal clinics in Gombe, Nigeria, were recruited into the study. The majority (54%) of the women were in the third trimester.

Management of extreme azotemia from urinary tract obstruction without dialysis. Clinical correlates and kinetic modeling of the recovery of renal function.

The recovery of renal function following release of urinary tract obstruction with advanced azotemia determines both the need for emergency dialysis in the early post-obstructive period and the long-term planning for chronic kidney disease management. A man with prostatic cancer who presented with 16 days of anuria and a serum creatinine (Scr) of 42.7 mg/dl but had evidence suggesting residual renal function was managed conservatively and reached a steady-state Scr of 1.

Lack of precision of indirect estimates of body water affects urea kinetic analysis in chronic peritoneal dialysis.

To test the precision of estimates of body water and urea clearance in peritoneal dialysis (PD), we compared, in 925 PD patients who underwent formal urea kinetics studies, estimates of V and Kt/V urea obtained by the use of the Watson, Hume, and Sahlgrenska anthropometric formulas and two novel formulas, one (Vcreat) computed using fat-free mass (FFM) estimated from creatinine kinetics as 0.73 x FFMcreat, and the other (VBMI) calculated as 0.73 x FFM(BMI) where FFM(BMI) was obtained by the Gallagher formula, which estimates body composition as a function of body mass index (BMI).

Trans fatty acids and conjugated linoleic acids in the milk of urban women and nomadic Fulani of northern Nigeria.

Background: Trans fatty acids (TFAs) and conjugated linoleic acids (CLAs) are present in dairy products and human milk and can have detrimental and beneficial effects in humans. The content of TFAs and CLAs in milk is determined largely by the diet of the mother.

Methods: We compared the proportions of TFAs and CLAs in the milk of rural Fulani in northern Nigeria who consume dairy products to that of women living in an urban center who consume little in the way of dairy products.

Nutrient content of four edible wild plants from west Africa.

Non-cereal plant foods in the Western Sahel of Africa contribute significantly to the diets of local residents, especially during periods of grain shortages. In this paper, we analyze four such plant foods including diyan kwakwa (nut of coconut palm, Cocos nucifera L.), muricin giginya (young shoot of Borassus aethiopum), tsamiya biri (fruit of the tree, Tamarindus indica), and yari (a mixture of lichens, mainly Rimelia reticulate) that grows on ebony trees (Diospyros mespiliformis).

Effect of Norplant contraceptive on the bones of Nigerian women as assessed by quantitative ultrasound and serum markers of bone turnover.

Levonorgestrel is a commonly used progestin-only contraceptive that is available as subdermal (Norplant) and intrauterine implants. Other progestin-only contraceptives such as injectable medroxyprogeterone acetate have been shown to decrease bone mineral density in long-term users. We used calcaneal ultrasound to compare the bone quality of Nigerian women between 25 and 50 years of age who had Norplant implants for 1-4 years to that of women who were not using any form of hormonal contraceptive.

Characteristics of end stage renal disease diabetic patients in two countries with different socioeconomic conditions.

Purpose: To identify differences that may affect morbidity and mortality of type 2 diabetic patients reaching ESRD between countries with different socioeconomic conditions.

Methods: Comparison of clinical and laboratory features between 21 Nigerian (N) and 57 American patients (A) reaching ESRD over a 30 month period.

Results: Differences were noted in age at ESRD (N, 55.