Browsing by Author "Davidson, Bianca"

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    A comparison of clinical, biochemical, and histological characteristics as well as evaluation of outcomes of patient with mesangiovapillary glomerulonephritis (MCGN) in HIV positive and negative patients at a tertiary hospital in Cape Town, South Africa
    (2023) Sorathia, Shaheed Salim Gulamali; Wearne, Nicola; Jones Erika; Davidson, Bianca
    Background & Aim Mesangiocapillary glomerulonephritis (MCGN) is a common histological pattern of glomerular injury in developing countries. South Africa has the highest proportion of people living with HIV (PWH) and the co-existence of MCGN and HIV may affect kidney prognosis. The aim of this study was to compare the clinical and biochemical features between PWH and HIV-negative individuals with a diagnosis of MCGN and to review kidney function and survival. Materials and Methods A retrospective study was conducted in patients with a biopsy diagnosis of MCGN between January 2010 and December 2017. The following data were collected: age, sex, use of illicit drugs, date of initiation of antiretroviral therapy (ART), blood pressure, presence of oedema, need for kidney replacement therapy, HIV status, CD4 and viral load. Secondary causes were excluded. Kidney outcomes [(serum creatinine, estimated glomerular filtration rate (eGFR), urine protein creatinine ratio (uPCR)] were assessed at 6, 12 and 24 months post biopsy. The composite outcome was defined as a 40% decline in eGFR, progression to end stage kidney disease or death. Results: The study included 116 participants: 27 (23%) were PWH, 89 (77%) were HIV-negative. The median age was 33 years. There were more males in the HIV-negative group [63/89 (71%)]. Oedema was more common in HIV-negative patients [66/86 (77%), p=0.011]. Haemoglobin and albumin were lower in PWH [9.1g/dL vs 11.2 g/dL (p=0.053) and 20 g/L vs 27 g/L, (p=0.053), respectively]. Baseline creatinine, eGFR and uPCR were not different between the groups. However, at 6 and 12 months the creatinine was higher in PWH: 137 μmol/L compared to 97 μmol/L (p=0.028) and 125 μmol/L compared to 87 μmol/L(p=0.023), respectively. uPCR was higher in PWH at 6 and 12 months: 0.63 g/mmol vs 0.075 g/mmol, (p=0.002) and 0.28 g/mmol vs 0.028 g/mmol, (p=0.022), respectively. The composite endpoint was not different between the two groups in the first three years of follow-up.
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    Acute kidney injury in tenofovir exposed patients in HIV infected individuals admitted at Groote Schuur hospital, Cape Town and Livingstone hospital, Gqeberha, South Africa
    (2021) Mazondwa, Simthandile Fiona; Dave, Nicola; Davidson, Bianca
    Introduction: Tenofovir disoproxil fumarate (TDF) is vastly used in South Africa (SA) as a first line agent for the treatment of human immunodeficiency virus (HIV). TDF is known to be associated with nephrotoxicity with identified risk factors. This study aimed to describe the demographics, clinico-biochemical features, kidney function and mortality outcomes in TDF exposed patients with acute kidney injury (AKI) in two tertiary centres in SA. Method: This observational cohort study reviewed all HIV infected in-patients presenting with AKI referred to the nephrology units at both Groote Schuur Hospital, Cape Town and Livingstone hospital, Gqeberha. Baseline characteristics, contributory factors to the AKI, associated clinical and biochemical features were recorded. Where a kidney biopsy was indicated, histological features were documented. Kidney and mortality outcomes of the enrolled patients were assessed over a 1-year period. Results: There were 213 patients enrolled from 1 August 2013 to 30 September 2016, 114/213 (51.8%) of the patients were TDF-exposed and 99/213 (45%) were TDF-unexposed. The median age was 37 years (IQR: 31 - 45yrs). The TDF-exposed were significantly older, 40 years versus 34 years (p<0.01) The TDF-unexposed group had a higher prevalence of hypertension: 21/99 (21.2%) versus 11/114 (9.7%), (p=0.02). The median creatinine at referral was 642 µmol/L (IQR: 340 - 1116 µmol/L) and 96/210 (45.7%) required dialysis. HIV/tuberculosis (TB) coinfection was common, 119/199 (59.8%). There was significant exposure to nephrotoxic drugs and drugs associated with idiosyncratic drug reactions in both groups, with anti-tuberculous treatment being the most common. Rifampicin was used by 51/212 (24.1%) [TDF-exposed 31/114 (27.2%) and TDF-unexposed 20/98 (20.4%), p=0.25]. There were no differences in serum and urinary biochemical features between the TDFexposed and unexposed groups. Of the enrolled patients, 57/213 (26.8%) underwent a kidney biopsy. On histology, the incidence of acute tubular necrosis (ATN) was higher in TDFexposed individuals (TDF-exposed: 47% versus TDF-unexposed: 22% p=0.05) whilst in TDF-unexposed, HIV associated nephropathy was most common. In the total cohort, chronic kidney disease (CKD) developed in 22/212 (10.4%) and the mortality was 62/213 (29.1%). There were no significant differences between the TDF-exposed and non-exposed cohorts in terms of CKD or mortality. Conclusion: This study demonstrated that hospitalized people living with HIV in SA have a high rate of tuberculosis co-infection and significant drug exposures. The clinical characteristics, severity of AKI and outcomes were similar in TDF-exposed and -unexposed. TDF exposure was associated with a greater degree of ATN on kidney biopsy. AKI in this HIV infected cohort carried a high mortality, regardless of the aetiology.medicib
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    Clinico-pathological characteristics and outcomes of nephrology adolescents and young adults in Cape Town: a single centre study
    (2022) Barday, Zibya; Davidson, Bianca; Wearne, Nicola; Jones, Erika; McCulloch, Mignon
    Background Adolescents and young adults [AYA] are important users of the nephrology health care services. Worldwide, there is a paucity of data on AYA kidney disease and outcomes. This study evaluates kidney outcomes, survival and challenges faced by AYA in a South African setting. Methods This 5-year retrospective study included AYA [aged 10-24] with chronic kidney disease, at a tertiary nephrology service in South Africa. Descriptive analysis characterised the aetiology of kidney disease. A comparative analysis of baseline characteristics, outcomes and social challenges were performed between patients attending a dedicated AYA clinic and those attending the standard adult clinics [non-AYA clinics]. Primary composite outcome assessed included doubling of creatinine, reduction of eGFR >40%, end-stage kidney disease and death. Logistic regression evaluated associations between relevant variables, death and lost to follow up [LTFU]. Results The total AYA cohort consisted of 292 patients, 111 (38.0%) attended the AYA clinic and 181 (62.0%) the non-AYA clinics. The main aetiologies of disease were glomerular 212 (72.6%), congenital anomalies of the urinary tract 31 (10.6%), and hereditary conditions 24 (8.2%). There was a significantly lower mortality (p=0.007) and reduction in LTFU (p=0.012) in the cohort attending the AYA clinic. A statistically significant composite outcome (p=0.018), with improved kidney survival was found in the AYA clinic group. High proportions of nonadherence (33.9%) and substance use (25.0%) was demonstrated in both cohorts. Conclusion This study adds to the dearth of literature on AYA kidney disease. A dedicated nephrology AYA clinic is shown to have lower mortality, less LTFU and improved kidney outcomes, which is essential in a resource-limited setting where access to kidney replacement therapy is restricted.
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    Impact of socio-economic factors and Health Related Quality of Life on patients on renal dialysis in Cape Town
    (2020) Welgemoed, Waldo; Wearne, Nicola; Davidson, Bianca
    Background: South Africa [SA] has a growing burden of chronic kidney disease [CKD], with limited health resources. Cape Town offers a PD-First policy due to both limitations on haemodialysis slots and cost saving measures. This study aimed to compare health related quality of life [HRQOL] between haemodialysis [HD] and peritoneal dialysis [PD], given the lack of autonomy in modality choice and socioeconomic challenges our patients face. Methods: This cross-sectional study was performed at Groote Schuur Hospital between July 2015 and December 2016. Demographic, socio-economic variables and perception of safety were collected. HRQOL was assessed using the Kidney Disease Quality of Life-Short Form [KDQOL-SFTM] version 1.3. All data was compared between the two dialysis modalities. Results: 77 HD patients and 33 PD patients were included in the study (Total n=110). There were no significant differences in demographics. The median age was 42.5 years [IQR: 32.4-48.6] and 57.3% were female. HD patients had less pain [p=0.036], better emotional well-being [p=0.020] and better energy/fatigue score [p=0.015]. Both cohorts experienced impairment in physical health, with PD having significant limitation [p=0.05]. The only significant symptoms in the renal domain was that PD experienced more shortness of breath [p=0.0001]. Overall, patients in both groups had very poor socio-economic circumstances. Safety was a major concern with the majority reporting feeling unsafe in their homes. Conclusions: The patients in our dialysis service have very challenging social circumstances with high rates of poverty and profound safety concerns. Patients on PD scored worse in 4 HRQOL domains, possibly due to a lack of autonomy in dialysis modality choice and less frequent contact with dialysis staff to provide encouragement and support. Additional psychological and social support needs to be instituted to help improve our patient's wellbeing on PD.
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    Outcomes of patients with hypertensive heart disease and heart failure with reduced ejection fraction (HFrEF) at a tertiary centre in South Africa
    (2022) Boakye, Darlene; Kraus, Sarah; Ntusi, Ntobeko; Davidson, Bianca
    Introduction. Hypertension is endemic in Sub-Saharan Africa and has been shown to be the leading cause of heart failure (HF) on the continent. Clinical observation suggests that hypertensive heart disease (HHD) is potentially reversible with medical therapy and that baseline characteristics and outcomes differ from other causes of HF. Method. This was a single centre, retrospective hospital-based observational study of patients diagnosed with HF with reduced and mid-range ejection fraction (HFrEF and HFmrEF) secondary to HHD, seen at the Cardiomyopathy Clinic at Groote Schuur Hospital over a threeyear period. Ethics approval was obtained (HREC REF 677/2018). Results. A total of 59 patients were included, with an equal representation of both genders [female 49.2%]. The majority of patients were of mixed race [57.6%] and black African [39%] ethnicity. The mean age at presentation was 44 ±12.0 years. At baseline, 71.7% of patients had effort intolerance [NYHA Class II, 36.2%; Class III, 32.8%; Class IV, 1.7%] and the most common symptoms were dyspnoea [65.5%], pedal oedema [34.5%] and orthopnoea [29.3%]. A pre-existing diagnosis of hypertension was present in 66.8%, 30,5% had other comorbidities (HIV, 5 [8.5%]; diabetes mellitus, 5 [8.5%]; chronic kidney disease, 5 [8.5%]) and 62% of women presented in the peripartum period. At baseline, the mean systolic and diastolic blood pressures were 130±20.1 and 81±12.8mmHg, respectively. Congestive HF was observed in 40.7% of cases despite being on medical therapy (loop diuretics [88.5%]; ACE-I [88.5%]; beta blocker [84.6%]; MRA [51.9%]). Atrial fibrillation [3.5%] and LBBB [10.5%] were infrequent. Left ventricular hypertrophy (LVH) was noted in 54.4% on ECG, and the mean QTc was prolonged [466±35ms]. On echocardiogram, mean wall thickness was normal [IVSd 1.0 [0.9-1.2]; LVPWd 1.1 [0.8-1.3], however, left atrial [4.4±0.9cm] and LV end-diastolic dimensions [LVEDD 6.4±0.8cm] were increased. LV ejection fraction (EF) was markedly impaired [29.9±10.4%]. At follow up, there was a significant (p< 0.001). Recovery of LVEF was observed in 86.5% patients where repeat imaging was done [LVEF ≥ 50% in 45.9%; LVEF improved ≥10% in 40.5%]. 1- and 3-year transplant-free survival was 98.3% and 90.5%, respectively. Conclusion. Most patients with HHD and impaired LVEF have a pre-existing history of hypertension and present with effort intolerance, congestion and mildly elevated or ‘pseudonormal' blood pressures. Concentric LVH was not a prominent feature on echocardiogram and AF was infrequent. Despite severely impaired LVEF at baseline, mortality was lower than expected for HF patients and improvement in LVEF on therapy was observed in the majority of patients.
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    Patient outcomes in a PD First Program in Cape Town, South Africa
    (2017) Davidson, Bianca; Wearne, Nicola
    Background: South Africa [SA] currently performs the most peritoneal dialysis [PD] in Africa. Yet, outcome data is limited. With the collision of epidemics of communicable and non-communicable diseases in Africa the need for chronic dialysis is escalating. PD remains a life-saving modality especially as haemodialysis is limited in the state sector. Methods: We retrospectively analysed all patients undergoing PD at Groote Schuur Hospital from January 2008 until June 2014 and thereafter prospectively until June 2015. Variables included demographics, adequacy, modality, fluid, cardiovascular risk and diabetes. The influences of these variables on peritonitis rate, technique and patient survival were assessed. Results: 230 patients were initiated on PD, 31 were excluded as they were on PD for < 90 days. The mean age was 39.7 +/- 10.4 years [SD], 49.8% were male and 63.8% were mixed ancestry. 9.8 % were diabetic at dialysis initiation. The average length of time on PD was 17 months (IQR 8 - 32). The peritonitis rate was 0.87 events per patient years. One, 2 and 5 year patient and technique survival was 94.4%, 84.3% and 60.2% and 82.5%, 69.0% and 37.4% respectively. Fluid overload (p=0.019) and low haemoglobin (p=0.001) were independent risk factors for poor survival. African race (HR 1.97, 95% CI (1.16 - 3.37) and fluid overload (p= 0.002) were both predictors of technique failure. Conclusions: In our PD-First programme the results are encouraging, despite lack of home visits due to safety, resource limitations and a high disease burden. Technique failure in African race needs further evaluation. Peritoneal dialysis remains a viable, life-saving alternative in an African setting.