Bio

Prof. Joshua K. Kayima

PreviewAttachmentSize
prof._joshua_k._kayima_.pdf66.31 KB

Prof. Joshua K. Kayima

PDF Upload: 
application/pdf iconprof._kayima_jk_cv.pdf

(Last updated: November 19, 2021)

Publications

2020

Muyodi, MM, KAYIMA JK, Oyoo GO, Bhatt KM.  2020.  Prevalence of and factors associated with chronic kidney diseases is osteoarthritis patients at Kenyatta National hospital.. East African Orthopaedic Journal. 14(2):72-80. Abstract

Background: Chronic Kidney Disease (CKD) is a global health problem with an increase in prevalence especially
in Sub-Saharan Africa (SSA). It has a high morbidity and mortality. CKD and osteoarthritis (OA) are related as
they both increase with age and are associated with comorbidities e.g. hypertension, obesity etc. However,
there is limited evidence on the prevalence and associated risk factors of CKD among OA patients.
Objective: To assess the prevalence and factors associated with CKD in OA patients attending Rheumatology
and Orthopaedic clinics at Kenyatta National Hospital.
Design: A hospital-based descriptive cross-sectional study.
Methods: The study was conducted between November 2019 and January 2020 involving patients aged 18
years and above; being followed up in the rheumatology and orthopaedic clinics at Kenyatta National Hospital
with a diagnosis of knee, hip, spine and hand osteoarthritis based on the American College of Rheumatology
criteria. Chronic kidney disease was defined as an eGFR of less than or equal to 60 ml/min/1.73m2
and/or
proteinuria of 30 mg/dl detected on urinary dipstick for three months or more. Descriptive statistics were
used to describe the participants. Association between participants’ characteristics and CKD prevalence were
assessed using chi-square and factors associated with CKD among OA patients using bivariate and multivariable
logistic regressions.
Results: The overall prevalence of CKD among patients with osteoarthritis was 61.9% (56.4–66.3) as per eGFR
using Cockrauft Gault (CG). Most were in CKD stage 3 at 59.2% with 45.5% in G3a and 13.7% in G3b. One point
one percent were in stage 1, 38.3% in stage 2 and 1.4% were in CKD stage 4 and 5. Only 12.1% of the respondents
had persistent proteinuria and thus most of the patients had low and moderate risk for CKD progression at
38% and 38.2% respectively. Only 12.1% and 11.6% had high and very high risk for CKD progression. The CKD
prevalence increased with age, being highest among older adults (65+ years). The prevalence was higher
among men than women (65.9%, 95% CI: 54.7–75.5 vs. 60.2%, 95% CI: 54.4–65.7). The factors associated with
CKD in OA were old age, hypertension and poor and fair self-rated health which increased the odds of CKD
while moderate physical activity, overweight/obesity and use of more than one medication (NSAID/ACEI/ARB)
reduced the odds of CKD.
Conclusion: This study provides evidence that osteoarthritis is associated with a high prevalence of CKD.
However, most of the patients are asymptomatic and in low and moderate risk category based on Kidney
Disease Improving Global Outcomes (KDIGO) nomenclature. Osteoarthritis patients should be considered a
high-risk group for chronic kidney disease given their older age, chronic use of NSAIDs and high prevalence of
comorbidities e.g. hypertension, overweight/obesity which are known risk factors for CKD. Screening for CKD
in OA patients should therefore be done routinely as is the case in other high risk groups e.g. diabetes.
Key words: Chronic Kidney Disease (CKD), Osteoarthritis (OA), Cockrauft-Gault (CG), Estimated Glomerular
Filtration Rate (eGFR), Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Angiotensin-Converting Enzyme
Inhibitors (ACEI), Angiotensin Receptor Blockers (ARB)
Rotich, J, Nyamota W, J. K.  2020.  Nutrition knowledge and practices in management of stage 5 chronic kidney disease by adult Patients at Kenyatta National hospital, Kenya.. International Journal of Scientific and Research Publication . 10(3):613-625. Abstract

This study sought to determine nutrition knowledge and its association with practices in management of stage 5 chronic
kidney disease (CKD) among renal adult patients in Kenyatta National Hospital. A cross-sectional analytical design was used to
facilitate collection of qualitative and quantitative data and enable identification of associations between variables. Cochran formula
was used to calculate a sample of 110 respondents. A research administered questionnaire with closed ended questions was used to
collect information. Descriptive statistics such as frequency and percentage were used to describe demographic and socio-economic
characteristics of the population. Inferential statistics were done using chi square with an alpha of 0.05 to test association between
independent and dependent variables. Most participants had moderate knowledge levels whereas more than half of the participants
(66%) indicated poor nutrition management practices of their condition. There was significant association between period on dialysis
in months and practices in management of stage 5 chronic kidney disease. Knowledge on importance of diet in management of stage 5
CKD (<0.001), moderation of fluid intake (<0.001), reduction in salt/ sodium intake (<0.001), and moderation in protein intake
(<0.004) were significantly associated with nutritional management practices of stage 5 CKD. The study concluded that Knowledge
levels were low in identifying foods rich in phosphorus, calcium and fat soluble vitamins. Practice scores were also poor despite
moderate nutrition knowledge levels. Patients’ knowledge on nutrition management of their condition may be achieved through
frequent and consistent nutrition education and counseling including follow ups.
Key Terms: Knowledge, Practice, chronic kidney disease, nutrition management
J.K., K.  2020.  Non-medical effects of coronavirus (COVID-19). Journal of Kenya Association of Physicians. 3(2):S16-21.

2019

Ndinya, FO, KAYIMA JK, MCLIGEYO SO, Were AJO, magabe PC, G.O. O.  2019.  Haemodialysis vascular access function in dialysis patients at the Kenyatta National hospital.. Joint AFRAN/AFPNA Congress. , Mombasa Kenya: AFRAN/AFPNA Abstract

Background: The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise. Vascular access is the lifeline for these patients when haemodialysis (HD) is the treatment of choice. Access-related morbidity is a leading cause of hospitalization so that the function and patency of access are essential for the optimal management of patients. There is a need to recognize when a vascular access is dysfunctional because intervention must maintain function as well as preserve future vascular access sites.Methods: This was a cross-sectional study that evaluated the haemodialysis vascular access function in patients undergoing chronic haemodialysis at the Kenyatta National Hospital, Nairobi, Kenya. Peak access blood flow rates, urea reduction ratio (URR) and Kt/V were analysed in 150 patients.Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48% achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88% and for tunnelled dialysis catheters 82%. One-quarter of the patients had a URR < 65%. Higher mean blood flow rates were associated with higher URR (P = 0.004) and Kt/V (P = 0.009) values. AVF stenosis was present in 12.5% and thrombosis in 3% of patients. Aneurysms were the commonest AVF complication (47%) but were not haemodynamically significant.Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis dose. Greater blood flow rates were associated with a higher delivered dialysis dose. There is a need for routine surveillance and affordable interventional procedures to prevent loss of vascular access.
Ndinya, FO, KAYIMA JK, MCLIGEYO SO, Were AJO, magabe PC, G.O. O.  2019.  Haemodialysis vascular access function in dialysis patients at the Kenyatta National hospital.. Joint AFRAN/AFPNA Congress. , Mombasa Kenya: AFRAN/AFPNA Abstract

Background: The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise. Vascular access is the lifeline for these patients when haemodialysis (HD) is the treatment of choice. Access-related morbidity is a leading cause of hospitalization so that the function and patency of access are essential for the optimal management of patients. There is a need to recognize when a vascular access is dysfunctional because intervention must maintain function as well as preserve future vascular access sites.Methods: This was a cross-sectional study that evaluated the haemodialysis vascular access function in patients undergoing chronic haemodialysis at the Kenyatta National Hospital, Nairobi, Kenya. Peak access blood flow rates, urea reduction ratio (URR) and Kt/V were analysed in 150 patients.Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48% achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88% and for tunnelled dialysis catheters 82%. One-quarter of the patients had a URR < 65%. Higher mean blood flow rates were associated with higher URR (P = 0.004) and Kt/V (P = 0.009) values. AVF stenosis was present in 12.5% and thrombosis in 3% of patients. Aneurysms were the commonest AVF complication (47%) but were not haemodynamically significant.Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis dose. Greater blood flow rates were associated with a higher delivered dialysis dose. There is a need for routine surveillance and affordable interventional procedures to prevent loss of vascular access.
JM, K, JK K, AO W, Q Z.  2019.  Foetal outcomes in women with pregnancy related acute kidney injury in a referral facility in Kenya. . IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 18(11):52-56. Abstract

Background: Pregnancy related acute kidney injury (PRAKI) is an obstetric complication,which can occur at
any stage of pregnancy and in postpartum,often associated with significant adverse foetaloutcomes.
Objective:To determine foetal outcomes among patients with PRAKI at Kenyatta National Hospital (KNH),
Kenya.
Methods:We carried out a descriptive study on pregnant women with gestation age equal or above 28 weeks
and postpartum women within six weeks after deliverywho were admitted in labour ward or the post-natal
wards at KNH. Study commenced following approval by the KNH- University of Nairobi Ethics and Research
Committee. Data was obtained from both the patient and the medical records. Participants were followed up
until discharge orfor a maximum of two weeks. Patient management was at the discretion of attending clinician.
Results: ATotalof 66participants with a mean age of 28years and peak age between 26-30 years were enrolled
into the study out of 2068 admissions. The prevalence of PRAKI was 3.2%. Sixty (91%) participants gave birth
during the follow-up period and sixremained pregnant pastthe two weeks after enrollment. Average gestation
age at delivery was 35 weeks. Life infant were 43(71.7%) and fresh still births were 17(28.3%). Preterm births
were the majority33(55%),of whom 23were life infants and 10 were fresh still births.Comparing between
participants and women without PRAKI, the ratio of fresh still births was 1:4 while the ratio of fresh still births
among women without PRAKI was 1:23deliveries.
Conclusion:We demonstrate anaverage gestation age of 35 weeks and a six (6) fold increase in fresh still births
among women with pregnancy related acute kidney injury at KNH.
Key Words: PRAKI, KNH, Gestation age, Fresh still births, Kenya
JM, Kivai, &, JK K, AO W, Q Z.  2019.  Maternal characteristics of women with pregnancy related acute kidney injury at Kenyatta National hospital, Kenya.. IOSR Journal of Dental and Medical Sciences. 18(9):69-75. Abstract

Background: Pregnancy is a physiologic state that can becomplicated by pregnancy related acute
kidney injury (PRAKI)which may occur at any stage of pregnancy and in postpartum,in previously healthy
women.It is associated with variable obstetric outcomesoften with significant butpreventable foeto-maternal
morbidity and mortality.
Objective:To determine maternal characteristics of in-patients with PRAKI at Kenyatta National Hospital
(KNH), Nairobi, Kenya
Methods:We carried out a descriptive study on in-patient pregnant women with gestation age of 28 completed
weeks or more and postpartum women within six weeks after deliveryadmitted inlabour ward or the post-natal
wards at KNH. Study started after approval by the KNH- University of Nairobi Ethics and Research Committee.
Data was obtained from the patientthrough verbal interviews andfrom the medical records using a pretested
data capture form.The participants were followed up for a maximum of two weeks or until discharge. The
patient management wasleft at the discretion of attending clinician.
Results: We enrolled 66 (3.2%) participants out of 2068 admissions.The mean agewas 28(SD5.9)years with
peak age between 26-30 years.Forty-two were referred from other health facilities. Nineteen (27.8%) had prepregnancy medical conditions mainly cardiovascular and all participants developed obstetric complication(s).
Hypertensive disorders of pregnancy were the main associated factors. Sixty (91%) participants were delivered
within two weeks after enrollment. The average gestation age at delivery was 35 weeks.Twenty-one (35%) were
delivered through caesarian section.Live infants were 43(71.7%) and fresh still births were 17(28.3%). The
ratio of fresh still births among participantswas 1:4 while the ratio of fresh still births among women without
PRAKI was 1:23deliveries.
Conclusion and recommendations:This study demonstrated prevalence of pregnancy related acute kidney injury
was 3.2% at K.N.H. The main associated factors were hypertensive disorders of pregnancy. Participants with
PRAKI were characterized with increased premature deliveries and a six (6) fold increase in fresh still births.
There is need for screening, monitoring and close follow-up of women with hypertensive disorders in pregnancy
and related kidney complications.
Key Words: PRAKI, KNH,hypertensive disorders of pregnancy, still births,Kenya
Maina, N, KAYIMA JK, KARARI E, WERE A, Kwasa J.  2019.  Prevalence of urinary tract infections among kidney transplant recipients in Kenyatta National hospital, Kenya. Journal of Kenya Association of Physicians. 2(9):62-67.
Kivai, JM, KAYIMA JK, Were AO, Zahida Q.  2019.  Assessment of characteristics of patients with pregnancy related acute kidney injury in Kenyatta National hospital.. Abstract

Pregnancy related acute kidney injury (PRAKI) remains a grave complication of pregnancy. Studies on patient characteristics are few and demonstrate diverse patient features. Objective: To determine the demographic and clinical characteristics of patients with PRAKI at Kenyatta National Hospital (K.N.H) Methods: We carried out a descriptive study on women with gestation age equal to or above 28 weeks and on women in postpartum, within six weeks after delivery. The principal investigator or study assistant introduced study requirements to patients with diagnosis of PRAKI. After consent, clinical and demographic information was obtained from participants through verbal interviews and from medical records using a data capture form. Follow up was until discharge or maximum of two weeks which ever came first. Management of patients was at the discretion of the attending clinician. Results Out of 2068 admissions, 66 participants were enrolled into the study. The prevalence of PRAKI was 3.2%. The mean age was 28 years with peak age between 26-30 years. Forty-two (63.6%) were referred from other health facilities, of whom, 24(57.1%) were from rural areas. Nineteen (27.8%) had pre-pregnancy medical conditions, predominantly cardiovascular. All participants developed one or more obstetric complication: -preeclampsia 28(42.4%), eclampsia eight (9.1%) and hemolysis with elevated liver enzyme low platelet (HELLP) syndrome 17(25.8%). Sixty (91%) pregnancies were delivered. Average gestation age at delivery was 35 weeks, with 33(55%) preterm births, of whom, 10 (30.3%) were fresh still births. Severity of PRAKI at presentation was evenly distributed across stages 1 to 111. Forty-one (62.1%) participants improved on conservative management and 25(37.9%) worsened, of whom, 19 (76.0%) were dialyzed. No maternal mortality was reported during the study. Conclusion: We demonstrate a prevalence of PRAKI of 3.2% in K.N.H. Hypertensive disorders were the main associated factors. There was high rate of premature births and a six-fold increase in fresh still births among participants.
Kabinga, SK, KAYIMA JK, Ngigi JN, MCLIGEYO SO.  2019.  Predialysis care experience among CKD patients in Diabetes, Hypertension and Renal clinics at a teaching hospital in Kenya. Kidney International Reports. 4(DOI:10.1016/j.ekir.2019.08.011):1638–1641. Abstract

Chronic kidney disease (CKD) is a global healthproblem affecting more than 1 in every 10 of theadult population.1The leading causes of CKD are diabetesmellitus and hypertension. End-stage kidney disease(ESKD) requires kidney replacement therapy (KRT) forsustenance of bodily functions. The KRT includes kidneytransplantation and dialytic therapies. Dialytic therapiesinclude hemodialysis (HD) and peritoneal dialysis. Inrecent years, the government of Kenya has set up at leastone HD unit in each of the country’s 47 counties. Pre-dialysis care is important. Lower mortality has been re-ported in people treated with dialysis for ESKD whoreceived at least one month of predialysis care comparedwith those with shorter or no predialysis care.2Theoptimal way of managing CKD prior to KRT has been afocus of intense investigation.3Referral to a nephrologist isrecommended for people with CKD who have either anestimated glomerular filtration rate of <30 ml/min per 1.73m2, a consistent finding of significant albuminuria, or signsof progressive disease.4Patient education requires theflexibility to individualize the delivery of a standardizedCKD curriculum in partnership with a patient–healthcareteam, to fulfill the goal of informed and shared decision-making.5We studied the predialysis experience among theambulant patients on maintenance HD at Kenyatta Na-tional Hospital (KNH) in Kenya during June and July 2018(Supplementary Methods). The study was approved bythe Kenyatta National Hospital–University of NairobiEthics and Research Committee, registration number P226/04/2018
JM, K, JK K, AO W, Q Z.  2019.  Impact of pregnancy related acute kidney injury on feotal survival: a single centre experience in Kenya.. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 18(7):13-17. Abstract

Background: Pregnancy related acute kidney injury (PRAKI) is a heterogenous obstetric
complication, which can occur at any stage during pregnancy and in postpartumperiod. It often impacts
negatively on foetaloutcomes.
Objective: To determine impact of PRAKI on foetal outcomes at Kenyatta National Hospital (KNH), Nairobi.
Methods: We carried out a descriptive study on women with viable pregnancies, gestation age equal to, or
above 28 weeks and postpartum women within six weeks after delivery admitted in labour ward or the postnatal wards at KNH. The study started afterit was approved by the KNH- University of Nairobi Ethics and
Research Committee.Patient management was at the discretion of attending clinician.Data was obtained
fromthe participants and their medical records. Followupwas until dischargeor for a maximum of two weeksfor
those who remained in the wards.
Results: Total participantswere 66 out of2068 admissions. Their mean age was 28years with peak age between
26-30 years.The prevalence of PRAKI was 3.2%. Sixty (91%) participants weredelivered andsix pregnancies
were ongoing past the follow-up period.The average gestation age at birth was 35 weeks. Forty-three (71.7%)
were life infants while 17(28.3%) were fresh still births. Comparing between participant women with PRAKI
and women without PRAKI, the ratio of fresh still births among participants was 1:4 and the ratio of fresh still
births among women without PRAKI was 1 in 23deliveries.
Conclusion: Wetherefore demonstrate that pregnancy related acute kidney injury was associated with a six (6)
fold increase in fresh still births at Kenyatta National Hospital in Kenya.
Key Words: PRAKI, KNH, Preterm births,Fresh still births,Nairobi, Kenya
Kabinga, SK, KAYIMA JK, MCLIGEYO SO, Ndungu J.  2019.  Hemodialysis vascular accesses in patients on chronic hemodialysis at the Kenyatta national hospital in Kenya. Journal of Vascular Access . 20(6):697-700. Abstract

Introduction: The objective of our study was to document the level of preparedness for renal replacement therapy assessed by incident hemodialysis vascular access and the access at least 3 months after initiation of hemodialysis at Kenyatta National Hospital, Nairobi.

Methods: Between June and July 2018, we carried out a cross-sectional descriptive study on the preparedness for hemodialysis by patients who were on chronic hemodialysis in the Kenyatta National Hospital Renal Department. Sociodemographic, medical history, duration of follow-up, and state of preparedness parameters were obtained through interview and entered into the questionnaire. The data were entered in preprogrammed format in the Statistical Package for the Social Sciences (SPSS) version 20.0 for analyses.

Results: Eighty-two patients were enrolled. Males were 50% (41). The mean age was 45.39 ± 15.96 years but females were 5 years younger than their male counterparts. About 85.4% of the patients were drawn from the hypertension and diabetes clinics, and the mean, mode, and median of the duration of follow-up were 41, 0, and 0 months, respectively, in these clinics. Almost three in every four patients (74.4%) were initiated on hemodialysis as emergency (p value < 0.001). About 80% were initiated hemodialysis via acute catheters placed in the jugular and subclavian veins (p value < 0.001). At least 3 months later, 40% still had acute catheters on the same veins (p value < 0.001). Acute venous catheters in the femoral veins were in 9.2% at initiation and 6.6% of the patients at least 3 months later. Less than 2% of the patients had arteriovenous fistulae at initiation, which rose to 14.5% in 3 months. Tunneled catheters were placed in 11.8% initially and at least 3 months, were almost in 40% of the patients.

Conclusion: In conclusion, our young hemodialysis population mainly drawn from hypertension and diabetes clinic requires more input in hemodialysis vascular access planning. Focused individualized follow-up and early referrals to nephrologists are required. Uptake of arteriovenous grafts for hemodialysis might reduce the prevalence of hemodialysis catheters. As it is, this population is threatened with iterative vascular accesses complications as well as real danger of exhaustion of their vascular capital. There is real danger of increase in mortality from access complications.

Keywords: Hemodialysis; arteriovenous fistula; arteriovenous graft; end-stage renal disease; tunneled catheter; vascular access.
Ndinya, FO, KAYIMA JK, magabe PC, MCLIGEYO SO, Were AJO, G.O. O.  2019.  Haemodialysis vascular access function in dialysis patients at the Kenyatta National hospital. African Journal of Nephrology . 22(1):72-76. Abstract

Background: The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise. Vascular access is the lifeline for these patients when haemodialysis (HD) is the treatment of choice. Access-related morbidity is a leading cause of hospitalization so that the function and patency of access are essential for the optimal management of patients. There is a need to recognize when a vascular access is dysfunctional because intervention must maintain function as well as preserve future vascular access sites.Methods: This was a cross-sectional study that evaluated the haemodialysis vascular access function in patients undergoing chronic haemodialysis at the Kenyatta National Hospital, Nairobi, Kenya. Peak access blood flow rates, urea reduction ratio (URR) and Kt/V were analysed in 150 patients.Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48% achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88% and for tunnelled dialysis catheters 82%. One-quarter of the patients had a URR < 65%. Higher mean blood flow rates were associated with higher URR (P = 0.004) and Kt/V (P = 0.009) values. AVF stenosis was present in 12.5% and thrombosis in 3% of patients. Aneurysms were the commonest AVF complication (47%) but were not haemodynamically significant.Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis dose. Greater blood flow rates were associated with a higher delivered dialysis dose. There is a need for routine surveillance and affordable interventional procedures to prevent loss of vascular access.

2018

Kabinga, SK, KAYIMA JK, MCLIGEYO SO, Ndungu JN.  2018.  Preparedness for renal replacement therapy among ambulant adult patients on chronic intermittent haemodialysis in a referral hospital in Kenya: Kenyatta National hospital experience. Abstract

The prevalence of chronic kidney disease is on the rise locally and globally. The care for patients
with chronic kidney disease is multifaceted and multidisciplinary. The study aimed to explore the state of
preparedness for renal replacement therapy for patients on chronic intermittent haemodialysis at the Kenyatta
National Hospital Nairobi, Kenya. This cross-sectional descriptive study was to document the level of
preparedness for renal replacement therapy by the time the patients were initiated on haemodialysis. Despite
this contact with health provider before development of end stage kidney disease, 74.4% of the patients were
initiated on haemodialysis as emergency (p value 0.001) and 29.3% knew of dialysis as the only modality of
renal replacement therapy (p value <0.001). Acute catheters were used by about 85.30% of the patients as the
vascular access for initiation of haemodialysis with tunneled catheters use in 13.40% and arteriovenous fistulae
use in 1.2% (p value <0.001). Counseling and other supportive services such as health education and
nutritional counseling were not optimal was at least 20% of patients gave responses indicating deficiency of
information or knowledge in these domains. More than 40% of the patients had not been counseled about kidney
transplantation
Kabinga, SK, KAYIMA JK, MCLIGEYO SO, Ndungu JN.  2018.  Preparedness for renal replacement therapy among ambulant adult patients on chronic intermittent haemodialysis in a referral hospital in Kenya: Kenyatta National hospital experience. Abstract

The prevalence of chronic kidney disease is on the rise locally and globally. The care for patients
with chronic kidney disease is multifaceted and multidisciplinary. The study aimed to explore the state of
preparedness for renal replacement therapy for patients on chronic intermittent haemodialysis at the Kenyatta
National Hospital Nairobi, Kenya. This cross-sectional descriptive study was to document the level of
preparedness for renal replacement therapy by the time the patients were initiated on haemodialysis. Despite
this contact with health provider before development of end stage kidney disease, 74.4% of the patients were
initiated on haemodialysis as emergency (p value 0.001) and 29.3% knew of dialysis as the only modality of
renal replacement therapy (p value <0.001). Acute catheters were used by about 85.30% of the patients as the
vascular access for initiation of haemodialysis with tunneled catheters use in 13.40% and arteriovenous fistulae
use in 1.2% (p value <0.001). Counseling and other supportive services such as health education and
nutritional counseling were not optimal was at least 20% of patients gave responses indicating deficiency of
information or knowledge in these domains. More than 40% of the patients had not been counseled about kidney
transplantation
Essaji, LT, KAYIMA JK, JOSHI MD, Otieno CF, Amayo A, Achieng L, Gacii M.  2018.  The utility of Physiochemical and modified physiological approach in metabolic acidosis at a tertiary level hospital in Kenya. Journal of Kenya Association of Physicians . 1(1):36-40.
Taiyebali, MM, KAYIMA JK, Were AJO, Ogutu E.  2018.  PREVALENCE, SEVERITY AND OUTCOMES OF COMMUNITY ACQUIRED ACUTE KIDNEY INJURY IN MEDICAL PATIENTS AT KENYATTA NATIONAL HOSPITAL. Journal of Kenya Association of Physicians . 1(1):24-28. Abstract

Introduction
Acute kidney injury (AKI) results in a decline in the glomerular filtration rate. It has a high
prevalence both in the developed and developing countries and is frequently encountered in
hospitalized patients; it has a negative impact on mortality and morbidity.
Objectives
This study was designed to determine the prevalence of community acquired acute kidney injury
in all patients admitted to the medical wards at Kenyatta National Hospital during the study
period, to determine the severity of acute kidney injury based on the KDIGO criteria and to
elucidate the associated risk factors of acute kidney injury. The management modalities were
described as well as their outcomes at the point of discharge or after 2 weeks.
Method
A longitudinal study was carried out on acute kidney injury at Kenyatta National Hospital. All
patients over the age of 13 years admitted to the general medical wards were followed up
prospectively for 2 weeks and those diagnosed to have AKI were assessed daily for severity, risk
factors and outcome
Results
A total of 136 patients were enrolled from August 20th 2016 to November 22nd 2016. The period
prevalence was found to be 8.1% at admission. Most of the patients had stage 1 AKI (51.5%)
while the rest had stage 2 and stage 3 AKI (48.6%). Only 2 patients underwent RRT. The median
length of stay was 9 days, 11 days and 10 days in stages 1, 2 and 3 respectively. There was no
association between AKI severity and length of hospital stay. 60% had non-recovery while 21
patients (18.6%) recovered fully and the more severe the AKI, the lesser the chances of recovery
with a p value of 0.045. The in-hospital all- cause mortality during the study period was 23
patients (16.9%). The severity of AKI increased the chances of mortality with a p value of
0.012. The commonest cause of AKI was pre-renal, followed by intrinsic then obstructive.
Conclusion
AKI is common in our environment. Similar findings have been noted in developed countries.
Prevalence and mortality in patients with AKI is high. The severity of AKI was associated with
non- recovery, mortality and need of renal replacement therapy with no association in the length
of hospital stay.
A., FF, Kayima J, Otieno CF, WERE A, Ngare S.  2018.  Dysglycaemia among kidney transplant recipients at a national referral hospital in Kenya. Journal of Kenya Association of Physicians . 1(1):14-17.

2017

Kabinga, SK, Kayima J, MCLIGEYO SO, Wambugu B, NGIGI J, Chege R, Mutiso J.  2017.  Vascular thrombosis in patients on chronic maintenance haemodialysis using indwelling venous catheters: Case reports and literature review. International Journal of Sciences: Basic and Applied Research. 36(1):110-117. Abstract

Vascular access is key in patients with end stage renal disease on maintenance haemodialysis. Thrombosis is a
significant contributor of access – associated morbidity. There are several documented risk factors that
predispose to thrombosis in patients with end stage renal disease. These include: inflammation, erythropoietin
therapy, hypotension, diabetes and old age among others. Treatment of thrombosis in these patients is
challenging. We present three cases of acute vascular thrombosis attended to in the Kenyatta National Hospital,
Nairobi-Kenya, East Africa, renal department in one week and literature review.
Keywords: Vascular thrombosis; Haemodialysis catheter; endstage renal disease.
Kabinga, S, Were AJO, Kayima JK, McLigeyo SO, Mbugua P, Ngigi J, Wambugu B, Wangombe N.  2017.  Living-Related Kidney Graft Donors Sociodemographic Characteristics and Recipients Clinical Characteristics in Kenya: A Single Centre Experience Kenyatta National Hospital 2010-2015 Audit. International Journal of Sciences: Basic and Applied Research (IJSBAR). 32(2):134-142. Abstract

This article provides summary of sociodemographic and clinical characteristics of the kidney transplant donors and recipients from 2010-2015 from Kenyatta national hospital, Nairobi, Kenya, East Africa. Only living-related organ donation is practiced in Kenya. Accelerated kidney transplantation activities picked up in Kenyatta national hospital from the 2010. The duration from 2010-2015 has seen more kidney transplantations undertaken in the hospital than the ones done in the same hospital from 1984 when first transplantation was performed in Kenya to 2009. The data were extracted from manual medical records. There were about 120 kidney transplantations performed during this period but only 113 complete records were traceable. There were 113 medical records for both kidney graft donors and recipients from 2010-2015. Demographic characteristics for donors and recipients captured included age, sex, and donor-recipient relationships. The mean donor age was 32.94

2016

Kabinga, DSK, Kayima PJK, Bhatt PKM, O. DAJ, McLigeyo PSO.  2016.  Human Leucocyte Antigens (DRB1*03, DRB1*04 and DQB1*02) Associated with Type 1 Diabetes Mellitus Among 269 Kidney Graft Donors and Recipients in Kenya. International Journal of Sciences: Basic and Applied Research (IJSBAR). 30(1):57-63. Abstract

This was a descriptive study which utilized the medical records for the kidney donors and recipients who had been followed up in the kidney transplantation programme in Kenyatta National Hospital, Nairobi, Kenya. Tissue typing is rarely performed routinely among our patients partially due to cost. It is with this in mind that we engaged in extraction of more information from the tissue typing data which have been used in kidney transplantation programme in Kenyatta National Hospital, Nairobi Kenya.

S.S., S, KAYIMA JK, Oyoo GO, LULE GN.  2016.  Chronic kidney disease in rheumatoid arthritis at Kenyatta National hospital. African Journal of Rheumatology. 3(1):14-18. Abstract

Objective: To determine the prevalence of chronic kidney disease among patients with rheumatoid arthritis on follow up at the rheumatology outpatient clinic at Kenyatta National Hospital.
Design: Descriptive, cross-sectional study.
Setting: Rheumatology outpatient clinic at the Kenyatta National Hospital, a public national and referral hospital.
Subjects: Patients diagnosed to have rheumatoid arthritis who met the 2010 ACR-EULAR criteria.
Results: Out of 104 patients recruited, 93 (89.4%) were female with a female to male ratio of 8.5:1. Mean age of patients was 48.7(±15.6) years. Majority of the patients (90%) were on at least one Disease Modifying Anti-Rheumatic Drug (DMARD) with methotrexate being the commonest used. Other DMARDs were leflunomide, sulfasalazine and hydroxychloroquine. None of our patients was on a biologic agent. Use of NSAIDs and/or prednisone was very frequent (88.5%). Median duration of disease since time of diagnosis was 4 years. Majority of patients (60%) had active disease. We found the prevalence of chronic kidney disease to be 28.7% (95% CI 19.1- 37.2%) based on estimated glomerular filtration rate using the Cockroft-Gault formula. Majority (50%) of which was stage 3a disease and none with end stage renal disease. We found no patients with proteinuria using urinary dipstick.
Conclusion: Although we did not find any proteinuria in our study population, prevalence of chronic kidney disease based on estimated glomerular filtration rate was high with the majority having early stages of kidney disease. Use of urine strips alone is not an adequate screening tool.

2015

Kubo, MN, Kayima JK, Were AJ, McLigeyo SO, Ogola EN.  2015.  Factors associated with uncontrolled hypertension among renal transplant recipients attending nephrology clinics in Nairobi, Kenya. Journal of Transplantation. 746563( doi: 10.1155/2015/746563):Online. Abstract

Objective. To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting. Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5, p = 0.006), higher levels of proteinuria (p = 0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2–65.7, p < 0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1–19.0, p = 0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6–73.0, p < 0.001) were independently associated with uncontrolled hypertension. Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population.

2014

Kamau, E, Kayima J, Otieno CF.  2014.  THE DETERMINANTS OF HEALTH RELATED QUALITY OF LIFE OF PATIENTS ON MAINTENANCE HAEMODIALYSIS AT KENYATTA NATIONAL HOSPITAL, KENYA. East African Medical Journal. 91(10):368-374. Abstract

Background: Health related quality of life (HRQOL) is increasingly being recognised as a primary outcome measure in the treatment of end stage renal disease. In addition to being an important surrogate marker of quality of care in patients on maintenance haemodialysis, HRQOL measures have being shown to be robust predictors of mortality and morbidity.

Objective: To determine the health related quality of life and its determinants in patients on maintenance haemodialysis at the Kenyatta National Hospital.

Design: A cross-sectional descriptive study.

Setting: Renal unit, Kenyatta National Hospital.

Subjects: Adult patients with end stage renal disease on maintenance haemodialysis.

Results: The mean physical composite summary and mental composite summary scores were 39.09 ± 9.49 and 41.87 ± 10.56 respectively. The burden of kidney disease sub-scale, symptom and problems sub-scale and effect of kidney disease on daily life sub-scale scores were 16.15 ± 21.83, 73.46 ± 18.06 and 67.63 ± 23.45 respectively. No significant correlations were found between the health-related quality of life scores, socio-demographic and clinical factors assessed.

Conclusion: The health-related quality of life of patients on maintenance haemodialysis is reduced. The physical quality of life is more affected than the mental quality of life. No independent determinants of health-related quality of life were identified.
Ochwila, AB, KAYIMA JK, MCLIGEYO SO, Were AJO.  2014.  Renal Function of Living Kidney Donors at Kenyatta National Hospital Nairobi-Kenya. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 13(8):51-56. Abstract

Background: The outcome of live kidney donation has been of concern since the recognition of hyperfiltration
injury post live kidney donation.
Studies on the topic have arrived at different conclusions regarding kidney function following live kidney
donation; some suggest the possibility of renal progression while others report renal function similar to that of
the general population. However, there are no studies done in a homogeneously African population to compare
with.
Beginning the year 2010 at Kenyatta National Hospital, Kenya, live kidney donation happened regularly with
an average of two live related kidney donation and transplantation per month.
The purpose of this study was to assess the impact of renal donation on renal function of live kidney donors at
Kenyatta national hospital.
Objective: To determine serum creatinine levels, eGFR, prevalence of proteinuria, and hypertension among
living kidney donors at Kenyatta National Hospital.
Study design: Cross-sectional descriptive study
Methods: Using a questionnaire, a targeted history was obtained from kidney donors. A venous blood sample
was drawn for serum creatinine measurement from which an eGFR was calculated using Cockroft-Gault
equation. A sample of urine was collected from which proteinuria was determined using a standard urinary dip
stick. Furthermore, blood pressure, height and weight were measured followed by the determination of the body
mass index of the study subjects. Patient’s pre-nephrectomy records were reviewed and blood pressure, weight,
height, serum creatinine levels were recorded. Their body mass index and estimated glomerular filtration rate
pre-nephrectomy was then calculated. The prevalence of hypertension and proteinuria was expressed as
proportions. Using a paired student’s t-test, mean changes for serum creatinine, estimated glomerular filtration
rate, diastolic blood pressure and systolic blood pressure were determined. Statistical significance was pegged
at P-value of <0.05.
Results: A total of 52 subjects were enrolled in the study. The mean (± standard deviation) estimated
glomerular filtration rate post-nephrectomy was 79.96mls/min/M² (± 31.95mls/min/M²) which transformed to
85.62% of the pre-nephrectomy estimated glomerular filtration rate. The prevalence of proteinuria, and
hypertension was 21.2% and 9.6% respectively. New onset hypertension was 6%. 40% of the subjects were
either overweight or obese. There was a significant mean change for serum creatinine, estimated glomerular
filtration rate and diastolic blood pressure when pre-neprectomy and post-nephrectomy values were compared
with p values of <0.0001, 0.002 and 0.008 respectively.
Conclusion: At the mean duration of follow up of 15.9 months, the kidney donors studied regained their renal
function with a tendency towards hyperfiltration. The prevalence of proteinuria and hypertension was low. The
results of the study compared well with those obtained from other studies.

K., KJ.  2014.  Acute Renal Failure. NephroNurse Newsletter. (February):8-9.
KAYIMA, JK, JOSHI MD, Ayah R, Njau EK, Wanjiru R, Njeru EK, Mutai KK.  2014.  Prevalence of hypertension and associated cardiovascular risk factors in an urban slum in Nairobi, Kenya: A population-based survey.. BMC Public Health. 14(1177):Online. Abstract

Background: Urbanisation has been described as a key driver of the evolving non-communicable disease (NCD) epidemic. In Africa, hypertension is the commonest cardiovascular problem. We determined the prevalence and risk factor correlates of hypertension in the largest Nairobi slum. Methods: In 2010 we conducted a population-based household survey in Kibera, a large informal settlement in Nairobi City; utilising cluster sampling with probability proportional to size. Households were selected using a random walk method. The WHO instrument for stepwise surveillance (STEPS) of chronic disease risk factors was administered by trained medical assistants, who also recorded blood pressure (BP) and anthropometric measures. BP was recorded using a mercury sphygmomanometer utilising the American Heart Association guidelines. Hypertension was defined as per the 7th Report of the Joint National Committee or use of prescribed antihypertensive medication. Those with hypertension or with random capillary blood sugar (RCBS) >11.1 mmol/l had an 8 hours fasting venous blood sugar sample drawn. Age standardised prevalence was computed and multivariate analysis to assess associations. Results: We screened 2200 and enrolled 2061 adults; 50.9% were males; mean age was 33.4 years and 87% had primary level education. The age-standardised prevalence of hypertension (95% CI) was 22.8% (20.7, 24.9). 20% (53/258) were aware of their hypertensive status; 59.3% had pre-hypertension; 80% reported high levels of physical activity and 52% were classified as harmful alcohol drinkers; 10% were current smokers and 5% had diabetes. Majority of males had normal BMI and waist circumference, whereas a third of females were obese or overweight and 40% had central obesity. Older age, higher general and central obesity were independently associated with hypertension and higher SBP and DBP readings. Conclusions: Our findings of high prevalence of hypertension, in association with excess body weight in this poor urban slum community, point to the need for greater awareness and implementation of primary preventive strategies.

2013

Omonge, E, Kayima JK, Otieno FCF, Lule G, McLigeyo AA.  2013.  Metabolic factors associated with the development of lipodystrophy in patients on long-term highly active anti-retroviral therapy (HAART). Journal of AIDS and HIV Research. 5(5):142-148. Abstract

Dyslipidemia, insulin resistance and diabetes are frequent in patients on highly active anti-retroviral therapy (HAART) and especially in patients with lipodystrophy, and may lead to atherosclerosis. This study described the metabolic alterations associated with lipodystrophy in adults on chronic HAART in Kenya. The prevalence of dyslipidaemia amongst the study participants was (211) 79.6%. Elevated total cholesterol was found in 129, high low-density-lipoprotein cholesterol (LDL-C) in 107, low High-density lipoprotein cholesterol (HDL-C) in 110 and high triglycerides in 131 participants. Lipodystrophic patients were more likely to have dyslipidemia than normal lipids (55.4 versus 35.1%, p = 0.007 OR 2.2 CI 1.3 to 4.6) with 57, 45.9, 65.9 and 45.2% having elevated total cholesterol, elevated LDL-C, elevated triglycerides and low HDL-C, respectively. Hypertriglyceridemia and hypercholesterolemia were significantly associated with lipodystrophy (OR 3.8 CI 2.3 to 6.4; p = 0.000) and (OR 1.94 CI 1.2 to 3.2; p = 0.008), respectively. The odds of lipodystrophy was 2.913 times higher for patients with elevated triglycerides than for those with normal triglycerides (p < 0.001). Sixty-four (24.3%) participants had dysglycemia, with 3.5% having diabetes and 20.8% having impaired fasting glucose (IFG). Among patient with lipodystrophy, 69.8% had normal fasting glucose, 25.1% had IFG and 5.1% were diabetic. Lipodystrophic patients were not more likely to have abnormal blood sugars than normal blood sugars (p value 0.125).
J.K., K, McLigeyo AA, Lule G, Otieno CF, Omonge E.  2013.  Human immunodeficiency virus (HIV) associated lipodystrophy: The prevalence, severity and phenotypes in patients on highly active anti-retroviral therapy (HAART) in Kenya. Journal of AIDS and HIV Research. 5(4):107-113. Abstract

Highly active antiretroviral therapy (HAART) is widely accessible to human immunodeficiency virus (HIV)-infected individuals in Kenya. Their long term use is associated with chronic complications such as lipodystrophy which may lead to stigmatization, reduced self esteem and poor adherence to HAART. This cross-sectional study described the prevalence of lipodystrophy, the phenotypes and severity among adult HIV infected patients on chronic HAART at a HIV clinic in Kenya. Data were collected using an investigator administered questionnaire and anthropometric measurements done using a protocol based on the Third National Health and Nutrition Examination Survey. The prevalence of lipodystrophy was 51.3% (confidence interval (CI) 45.6 to 57.6). Lipoatrophy occurred in 44%, lipohypertrophy in 15% and mixed syndrome in 41% of patients with lipodystrophy. Facial atrophy occurred in 75.7% of patients with lipodystrophy, upper limb atrophy in 48.5%, and lower limb atrophy in 36.8%. Abdominal obesity occurred in 40.4% of patients with lipodystrophy, breast enlargement in 30.9% and dorsocervical fat accumulation in 5.1%. Most patients had severe lipoatrophy, whereas lipohypertrophy was described as mild to moderate using the HIV out-patient study (HOPS) scale. HIV associated lipodystrophy was common in HIV-infected patients on chronic HAART. The main phenotype was lipoatrophy which majority of the patients described as severe.

2012

Kamau E, Kayima J, OMMCWCP.  2012.  Health related quality of life of patients on maintenance haemodialysis at Kenyatta National Hospital. East African Medical Journal. 89(3):39-45. Abstract

Background: Health related quality of life is increasingly being recognized as a primary outcome measure in treatment of end stage renal disease. The health related quality of life of patients on maintenance haemodialysis is reduced. Several interventions directed at modifiable risk factors have been shown to improve quality of life of patients on haemodialysis.
Objective: To assess the health related quality of life of patients on maintanance haemodialysis at Kenyatta National Hospital.
Design: Cross sectional descriptive study
Setting: Kenyatta National Hospital, Renal Unit.
Subjects: The study was conducted on 96 patients with end stage renal disease on maintenance haemodialysis. Socio-Demographic and clinical factors were recorded for all patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life-36 questionnaire. Two summary scores and three sub-scale scores were calculated.
Results: The mean physical composite summary and mental composite summary scores were 39.09+/- 9.49 and 41.87+/- 10.56 respectively. The burden of kidney disease sub-scale, symptom and problems sub-scale and effect of kidney disease on daily life sub-scale score were 16.15+/- 21.83, 73.46+/-18.061 and 67.63+/-23.45 respectively.
Conclusion: Health related quality of life of patients on maintenance hemodialysis is reduced. The physical quality of life is more affected than the mental quality of life. The burden of kidney disease sub-scale is the most affected sub-scale score.

2011

Ganda, B, Oyoo GO, KAYIMA JK, Maritim M.  2011.  Peripheral arterial disease in rheumatoid arthritis patients at the Kenyatta National Hospital, Kenya. East African Medical Journal. 88(12):107-113. Abstract

Objective: To determine the magnitude of the rosclerotic arterial disease in Rheumatoid Arthritis(RA) patients at Kenyatta National Hospital.
Design: hospital based cross-sectional study.
Setting: Kenyatta National Hospital Rheumatology outpatient clinic.
Subjects: Rheumatoid Arthritis patients.
Results: We obtained ABI measurements in 90 RA patients, among them 23(25.5% 95% CI 17.2-36.1) had obstructed lower limb arteries. Among the 23, 21(91.3%) had mild PAD, two (8.7%) had moderate PAD; none had severe PAD nor incompressible vessels. The obstruction of vessels was independent of diabetes, hypertension, dyslipidemia and cigarette smoking though these factors increased the likelihood of having PAD. Risk age( ≥45 males, ≥55 females), Established RA(> 5 year duration) and severe RA were found to be significantly associated with the likelihood of having PAD. These trends remained significant after multivariable adjustment for potential confounders. twenty five (27.7%) of the study subjects exhibited symptoms of intermittent claudication, 13(52%) of them had PAD on ABI measurements, The Edinburgh claudication questionnaire was found to have 56.5% sensitivity and 82% specificity in detection
of PAD in RA patients. Conclusion: There seems to be an association between PAD in RA with chronicity and severity of the RA. This association may support the pathogenic role of accumulated systemic inflammation in atherosclerosis. Clinicians should be alert to the possibility of impared arterial function and thus subsequent cardiovascular morbidity and mortality in this group of patients.

2010

Otieno, CF, KAYIMA JK, MBUGUA PK, AMAYO AA, MCLIGEYO SO.  2010.  Prognostic factors in patients hospitalised with diabetic ketoacidosis at Kenyatta National Hospital, Nairobi. Abstract

In spite of many advances in the management of diabetes in the last 25 years, the mortality associatedwith diabetic ketoacidosis (DKA) remains high, especially in the developing countries. The mortality appears greatest in the first 24-48 hours of their treatment. Most of the previous studies on DKA focused on children and the precipitating factors thereof but not particularly on clinical predictors of outcomes. OBJECTIVE: To determine the clinico-laboratory predictors of outcomes of patients hospitalised with diabetic ketoacidosis who were undergoing treatment. DESIGN: Cross-sectional descriptive study. SETTING: The accident and emergency department and medical wards of the Kenyatta National Hospital. SUBJECTS: Fifty one patients hospitalised with diabetic ketoacidosis over a nine month period were evaluated clinically and by laboratory tests. They were managed in the standard way with insulin, intravenous fluids and appropriate supportive care. Main outcome measures: Serial assays of serum electrolytes, glucose and blood pH, HbA1c and clinical outcome of either discharge home or death. RESULTS: Of the 51 patients enrolled, 47 were included in the final analysis. Fourteen (29.8%) patients died,andthe deaths occurred within less than48 hours of hospitalisation and treatment. Of the patients who died, all (100%) had altered level of consciousness at hospitalisation, 71.4% had abnormal renal functions, 64.3% were newly diagnosed and an equal proportion of 64.3% were females. The alteration in the level of consciousness was significantly associated systolic hypotension and severe metabolic acidosis, (p < 0.001). Patients with altered level of consciousness also had poorer renal function. CONCLUSION: Apparently DKA still carries high mortality during treatment in hospital. Altered level of consciousness, which is an obvious and easily discernible clinical sign, was a major predictor of mortality in our study patients. The majority of patients with altered level of consciousness also had systolic hypotension, severe metabolic acidosis and impaired renal function. Even where and when detailed laboratory evaluation is elusive, clinical signs, especially altered level of consciousness and systolic hypotension are very important markers of severity of DKA that may be associated with unfavourable outcomes. Further studies are necessary to establish why DKA still carries high mortality in the patients who are already receiving treatment in hospitals in developing countries

2009

K., KJ, O. OP, SO. ML, O. AE, O. OE.  2009.  Nephrotoxicity of amphotericin B in the treatment of cryptococcal meningitis in acquired immunodeficiency syndrome patients.. East African Medical Journal, 86 (9): 435 . 86(9):435-441.: Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. AbstractWebsite

Objectives: To describe the incidence of renal dysfunction, hypokalaemia and hypomagnesaemia in AIDS patients with cryptococcal meningitis and on amphotericin B treatment. Secondary objective was to determine all-cause mortality in the same group.

Design: Prospective, observational study.

Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya.

Subjects: Seventy consecutive patients with AIDS and cryptococcal meningitis on amphotericin B.

Results: About 58.6% of the patients had at least 100% rise in the creatinine level. Thirty eight point six per cent of patients experienced a rise in serum creatinine of at least 50%. Ninty three per cent of the patients developed hypokalaemia and 80% had hypomagnesaemia at trough magnesium level. Only 54.3% of patients completed the intended 14-day treatment. Thirty point five per cent of patients died within the two week follow-up period.

Conclusion: The incidences of amphotericin B associated nephrotoxicity, hypokalemia and hypomagnesaemia were high in this studied population.

2008

K, DRKAYIMAJOSHUA.  2008.  Njoroge GK, Njagi EN, Orinda GO, Sekadde-Kigondu CB, Kayima JK.Environmental and occupational exposure to lead.East Afr Med J. 2008 Jun;85(6):284-91.. East Afr Med J. 2008 Jun;85(6):284-91.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
OBJECTIVE: To determine the status of environmental and occupational lead exposure in selected areas in Nairobi, Kenya. DESIGN: Cross sectional study. SETTING: Kariobangi North, Babadogo, Waithaka and Pumwani for assessment of environmental exposure to lead (Pb) and Ziwani Jua Kali works for assessment of occupational lead exposure. Olkalou in Nyandarua District was the covariate study area. SUBJECTS: Three hundred and eight children and adults participated. RESULTS: Blood lead levels (BLLs) obtained for the entire sample (n = 308) ranged from 0.4 to 65 microg/dl of blood. One hundred and sixty nine (55%) of the total sample had levels equal to or below 4.9 microg/dl, while 62 (20%) of the sample had levels ranging from 5.0 to 9.9 microg/dl. Blood lead levels above 10 microg/dl were recorded in 77 (25%) of the total sample. Within Nairobi, 32 (15.3%) of the study subjects in areas meant for assessment of environmental lead exposure had levels above the WHO/CDC action levels of 10 microg/dl of blood. The mean BLL for the occupationally exposed (Ziwani Jua kali) was 22.6 +/- 13.4 microg/dl. Among the workers, 89% had BLLs above 10 microg/dl. In general, 15% of the entire sample (for both environmental and occupational groups) in Nairobi had BLLs above 15 microg/dl. The covariate group at Olkalou had a mean BLL of 1.3 +/- 0.9 microg/dl. CONCLUSION: The prevalence of environmental lead exposure to the general public is high in Nairobi compared to Olkalou where non exposure was reported. Occupational lead exposure has been identified to be at alarming levels and urgent intervention measures are recommended.

2007

K, DRKAYIMAJOSHUA.  2007.  Maritim M. C., Joshi M. D., Kayima J. K., Amayo A. and Jowi J. O. Prevalence of Peripheral arterial disease among chronic kidney disease patients at Kenyatta National Hospital. (Abstract) Cardiovasc J. Afr (Abstract) 2007; 18 (2): 112.. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
OBJECTIVE: To determine the status of environmental and occupational lead exposure in selected areas in Nairobi, Kenya. DESIGN: Cross sectional study. SETTING: Kariobangi North, Babadogo, Waithaka and Pumwani for assessment of environmental exposure to lead (Pb) and Ziwani Jua Kali works for assessment of occupational lead exposure. Olkalou in Nyandarua District was the covariate study area. SUBJECTS: Three hundred and eight children and adults participated. RESULTS: Blood lead levels (BLLs) obtained for the entire sample (n = 308) ranged from 0.4 to 65 microg/dl of blood. One hundred and sixty nine (55%) of the total sample had levels equal to or below 4.9 microg/dl, while 62 (20%) of the sample had levels ranging from 5.0 to 9.9 microg/dl. Blood lead levels above 10 microg/dl were recorded in 77 (25%) of the total sample. Within Nairobi, 32 (15.3%) of the study subjects in areas meant for assessment of environmental lead exposure had levels above the WHO/CDC action levels of 10 microg/dl of blood. The mean BLL for the occupationally exposed (Ziwani Jua kali) was 22.6 +/- 13.4 microg/dl. Among the workers, 89% had BLLs above 10 microg/dl. In general, 15% of the entire sample (for both environmental and occupational groups) in Nairobi had BLLs above 15 microg/dl. The covariate group at Olkalou had a mean BLL of 1.3 +/- 0.9 microg/dl. CONCLUSION: The prevalence of environmental lead exposure to the general public is high in Nairobi compared to Olkalou where non exposure was reported. Occupational lead exposure has been identified to be at alarming levels and urgent intervention measures are recommended.

2005

K, DRKAYIMAJOSHUA.  2005.  Mwendwa FM, Otieno CF, Kayima JK, Amayo EO, Otieno PO.Risk factor profile and the occurrence of microvascular complications in short-term type 2 diabetes mellitus at Kenyatta National Hospital, Nairobi. East Afr Med J. 2005 Dec;82(12 Suppl):S163-72.. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
BACKGROUND: Type 2 diabetes has a long pre-clinical period before diagnosis, during which there may be development of complications, both of microvascular and macrovascular types. OBJECTIVE: To determine the risk factor profile of hyperglycaemia, hypertension and dyslipidaemia in patients with short-term (=/ < 2 years) type 2 diabetes. DESIGN: Cross-sectional descriptive study over six months. SETTING: Outpatient diabetic clinic of Kenyatta National Hospital. SUBJECTS: Ambulatory patients with type 2 diabetes. RESULTS: One hundred patients were included. The mean (SD) duration of diabetes was 10.3 (7.5) months. There were 66% of the study subjects with obesity, 50% with hypertension, 29% had ideal glucose control and less than 40% had high LDL-cholesterol. Twenty eight (28%) who had polyneuropathy had significant differences in their older age, higher total and LDL-cholesterol compared with those who did not have polyneuropathy. Twenty five (25%) of the study patients had micro-albuminuria and only 1% had macro-albuminuria. There were no significant differences in the selected characteristics between study patients with and those without albuminuria. Only 7% of the study patients had retinopathy on direct ophthalmoscopy. CONCLUSION: Microvascular complications occurred in patients with type 2 diabetes of short duration of not more than two years. The risk factors of hypertension, poor glycaemic control, dyslipidaemia and cigarette smoking were present in a fair proportion of the study patients. Patients with type 2 diabetes should be actively screened for complications and the risk factors thereof, even if the diabetes was of recent onset.
K, DRKAYIMAJOSHUA.  2005.  Otieno CF, Vaghela V, Mwendwa FW, Kayima JK, Ogola EN.Cardiovascular risk factors in patients with type 2 diabetes mellitus in Kenya: levels of control attained at the Outpatient Diabetic Clinic of Kenyatta National Hospital, Nairobi. East Afr Med J. 2005. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
OBJECTIVES: To determine the proportion of specific cardiovascular risk factors in ambulatory patients with type 2 diabetes and the levels of control achieved in them. DESIGN: Prospective, cross-sectional study over a six month period. SETTING: Out-patient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Two hundred and eleven patients with type 2 diabetes. MAIN OUTCOME MEASURES: Sociodemographic attributes, duration of diabetes, levels of glycaemia, body weight, blood pressure, fasting lipids and modes of treatment. RESULTS: A total of 211 patients were enrolled, 57.3% were females. The mean (SD) age for women was 54.45 (9.44) and that of men was 55.8 (9.02) years. About 77% of the study population were on oral glucose-lowering agents with or without insulin but less than 30% achieved HbA1c < 7%; 15% were active cigarette smokers; about 50% were hypertensive with female predominance but 65% of them did not achieve desired blood pressure level inspite of treatment. Just over 50% had raised LDL-cholesterol and over 75% had raised total cholesterol but only three men were on statins without achieving desired targets. Body mass index above 30 kg/m2 as a measure obesity was found in 32% of females and 16% males. Most of the study patients admitted use of Aspirin at certain times in the course of their diabetes. CONCLUSION: The study showed that specific cardiovascular risk factors of hyperglycaemia, dyslipidaemia, hypertension and obesity were prevalent although not adequately controlled to targets. Statin use was extremely low in people who already needed them. Regular Aspirin use was infrequent because many patients did not quite understand its role in their diabetes treatment. It is recommended that a more pro-active approach in multifactorial address of cardiovascular risk factors be used in high-risk patients with type 2 diabetes to forestall future cardiovascular events.
K, DRKAYIMAJOSHUA.  2005.  Mbugua PK, Otieno CF, Kayima JK, Amayo AA, McLigeyo SO.Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi. East Afr Med J. 2005 Dec;82(12 Suppl):S191-6.. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
OBJECTIVE: To determine the clinico-laboratory features and precipitating factors of diabetic ketoacidosis (DKA) at Kenyatta National Hospital (KNH). DESIGN: Prospective cross-sectional study. SETTING: Inpatient medical and surgical wards of KNH. SUBJECTS: Adult patients aged 12 years and above with known or previously unknown diabetes hospitalised with a diagnosis of diabetic ketoacidosis. RESULTS: Over a nine month period, 48 patients had DKA out of 648 diabetic patients hospitalised within the period, one died before full evaluation. Mean (SD) age was 37 (18.12) years for males, 29.9 (14.3) for females, range of 12 to 77 years. Half of the patients were newly diagnosed. More than 90% had HbA1c > 8%, only three patients had HbA1c of 7-8.0%. More than 90% had altered level of consciousness, with almost quarter in coma, 36% had systolic hypotension, almost 75% had moderate to severe dehydration. Blunted level of consciousness was significantly associated with severe dehydration and metabolic acidosis. Over 65% patients had leucocytosis but most (55%) of them did not have overt infection. Amongst the precipitating factors, 34% had missed insulin, 23.4% had overt infection and only 6.4% had both infection and missed insulin injections. Infection sites included respiratory, genito-urinary and septicaemia. Almost thirty (29.8%) percent of the study subjects died within 48 hours of hospitalisation. CONCLUSION: Diabetic ketoacidosis occurred in about 8% of the hospitalised diabetic patients. It was a major cause of morbidity and mortality. The main precipitant factors of DKA were infections and missed insulin injections. These factors are preventable in order to improve outcomes in the diabetic patients who complicate to DKA.
K, DRKAYIMAJOSHUA.  2005.  Otieno CF, Kayima JK, Omonge EO, Oyoo GO.Diabetic ketoacidosis: risk factors, mechanisms and management strategies in sub-Saharan Africa: a review. East Afr Med J. 2005 Dec;82(12 Suppl):S197-203. Review. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract

BACKGROUND: Diabetic ketoacidosis is the most common hyperglycaemic emergency in patients with diabetes mellitus, especially type 1 diabetes. It carries very high mortality in sub-Saharan Africa, both in the treated patients and those who are presenting to hospital with diabetes for the first time. OBJECTIVE: To review the risk factors, mechanisms and management approaches in diabetes ketoacidosis in published literature and to discuss them in the context of why a significant proportion of patients who develop diabetic ketoacidosis in sub-Saharan Africa still have high mortality. DATA SOURCE: Literature review of relevant published literature from both Africa and the rest of the world. DATA SYNTHESIS: The main causes or precipitants of DKA in patients in SSA are newly diagnosed diabetes, missed insulin doses and infections. The major underlying mechanism is insulin deficiency. Treated patients miss insulin doses for various reasons, for example, inaccessibility occasioned by; unavailability and unaffordability of insulin, missed clinics, perceived ill-health and alternative therapies like herbs, prayers and rituals. Infections also occur quite often, but are not overt, like urinary tract, tuberculosis and pneumonia. Due to widespread poverty of individuals and nations alike, the healthcare systems are scarce and the few available centres are unable to adequately maintain a reliable system of insulin supply and exhaustively investigate their hospitalised patients. Consequently, there is little guarantee of successful outcomes. Poor people may also have sub-optimal nutrition, caused or worsened by diabetes, more so, at first presentation to hospital. Intensive insulin therapy in such individuals mimics 're-feeding syndrome', an acute anabolic state whose outcome may be unfavourable during the period of treatment of diabetic ketoacidosis. CONCLUSIONS: Although mortality and morbidity from diabetic ketoacidosis remains high in sub-Saharan Africa, improved healthcare systems and reliable insulin supply can reverse the trend, at least, to a large extent. Individuals and populations need empowerment through education, nutrition and poverty eradication to improve self-care in health and living with diabetes.

2003

O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  2003.  Otedo A. E. O., McLigeyo S.O., Okoth F.A. and Kayima J. K. Seroprevalence of hepatitis B and C in maintenance dialysis in a public hospital in a developing country South African Medical Journal, 93 (3): 380-384; 2003. South African Medical Journal, 93 (3): 380-384; 2003. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract

BACKGROUND: Patients with end-stage renal disease (ESRD) on maintenance dialysis are predisposed to hepatitis B virus (HBV) infection for a number of reasons. In a similar way, the prevalence of anti-hepatitis C virus (HCV) antibodies among patients on chronic haemodialysis and peritoneal dialysis is consistently higher than in healthy populations. There are few published data on these diseases in patients undergoing maintenance dialysis in sub-Saharan Africa. OBJECTIVE: To determine the seroprevalence of HBV and HCV in patients on maintenance dialysis. SETTING: Renal Unit, Kenyatta National Hospital, the largest public referral and teaching hospital in Kenya. DESIGN: Cross-sectional descriptive study. STUDY POPULATION: All 100 patients on maintenance dialysis during the 9-month study period were evaluated. METHOD: The following information was obtained from all the patients: socio-demographic data, date of diagnosis of ESRD and commencement of dialysis, and number of blood transfusions. Additionally, a history suggestive of hepatitis in spouses was looked for and physical examination for tattoos and other scars was carried out. Laboratory investigations included urea, electrolytes and serum creatinine, liver enzymes, hepatitis B surface antigen (HBsAg), immunoglobulin M anti-hepatitis B core antibody (IgM anti-HBc), hepatitis B e antigen (HBeAg) and anti-HCV antibodies. Student's t-test was used to assess the significance of the data collected. RESULTS: The results were expressed as mean (+/- SD). Fifty-seven males and 43 females were studied. Mean age was 44.3 +/- 14.6 years. Ten patients (10%) had elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (> 40 U/l for both). HBsAg was found in 8 patients (8%), IgM anti-HBc in 2%, and HBeAg in none. Anti-HCV antibody was found in 5%. Six of the HBsAg-positive patients were on haemodialysis, the other 2 on continuous ambulatory peritoneal dialysis (CAPD). There was no coexistence of HBV and HCV markers. Longer duration of dialysis and the number of blood transfusions were associated with an increased seroprevalence of HBV and HCV. CONCLUSION: There is a low seroprevalence of HBV and HCV in our dialysis population. This should not lead to complaisance in screening for these potentially lethal complications.

UoN Websites Search