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Outcomes of Hemodialysis Patients in Public Centres in Abidjan from September 2018 to October 2021: Data from the Renal Registry of Cote d’Ivoire

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Open Journal of Nephrology 2024年第3期14卷 413-426页

作者： Sery Patrick Diopoh Arthur Kanganga Serge Didier Konan Kolo Claude Ouattara Marie-Dominique Kouadio Mohamed Alex Moudachirou Kouamé hubert yao Department of Medicine and Medical Specialties University Flix Houphout-Boigny Abidjan Cote dIvoire National Centre for Prevention and Treatment of Renal Failure Abidjan Cte dIvoire

Background: Hemodialysis is the most widely used renal replacement therapy in developing countries such as Cote d’Ivoire. Objective: To study the outcome of chronic hemodialysis patients in public centres in Abidjan using data from the Renal Registry of Cote d’Ivoire (2RCI). Method: This was a prospective analytical cohort study of End Stage Kidney Disease (ESKD) patients undergoing iterative hemodialysis in the network of public hemodialysis centres in Abidjan and who had been registered in the 2RCI register by September 2018. Results: Our study involved 363 cases out of 379 patients registered in the 2RCI registry database in 2018. The mean age of the patients was 47.3 ± 12.1 years, with a male predominance (sex ratio 1.97). In 70.24% of cases, they had no health insurance. The average duration of dialysis for our patients was 6.94 ± 4.1 years, with extremes of 2 and 28 years. This duration was less than 5 years in 44.3% of cases, between 6 and 10 years in 42.9% and more than 10 years in 12.6% of cases. The comorbidities found were hypertension in 95.6% of cases, diabetes in 7.8% and HIV in 4.6%. Anemia was found in 68% of cases and stroke in 8.6%. During the study period, 161 deaths were observed, representing a mortality rate of 44.35%. Acute lung oedema (29.8%), stroke (6.8%) and other cardiovascular diseases (19.3%) were the main causes of death. In multivariate analysis, factors such as age ≥ 65 years (HR = 3.66;CI 95% = 1.55 - 8.67;p = 0.003), “married/coupled” status (HR = 2.02;CI 95% = 1.24 - 3.31;p = 0.005) and normal weight at the start of dialysis (OR = 9.59, CI95% = 4.19 - 21.95;p = 0.001) were associated with the risk of death. Conclusion: Hemodialysis is performed in Abidjan on young patients. The mortality rate after three years of dialysis is very high. Hence the need to pursue the policy of decentralizing public centres and optimizing access to dialysis in terms of quality and quantity in order to improve patient survival.

关键词： Chronic Hemodialysis Death Renal Registry Cote d’Ivoire

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Chronic Kidney Disease (CKD) in Patients Living with HIV under Antiretroviral Treatment: Prevalence and Risk Factors

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Open Journal of Nephrology 2019年第4期9卷 87-96页

作者： Yawovi Mawufemo Tsevi Abdou Razak Moukaila Lidaw Déassoua Bawe hubert yao Nephrology and Hemodialysis Department Sylvanus Olympio Hospital of Lomé University of Lome-Togo Lomé Togo Internal Medicine Department Sylvanus Olympio Hospital of Lome University of Lome-Togo Lome Togo Infectious and Tropical Diseases Department Sylvanus Olympio Hospital of Lome University of Lome-Togo Lome Togo Internal Medicine Department Treichville University Hospital Université of Cocody (Ivory Coast) Abidjan Ivory Coast

CKD is one of the major complications when infected by HIV. The surveillance of CKD indicators and control of its determinants in the HIV-infected population in our African communities is essential. This was a descriptive and analytical cross-sectional study of people living with HIV received at the Ambulatory Treatment Center (ATC) at Infectious Diseases department of Sylvanus Olympio University Hospital (CHU-SO). The study period was 6 months—from January 1, 2018 to June 30, 2018—CKD was defined by a clearance below 60 ml/min/1.73 m2 for at least 3 months. A total of 117 patients were enrolled during the study period. The average age of patients for trial treatment was between 9.49 and 42.0 7 years. The duration of follow-up for antiretroviral treatment was ±3.22 to ±5.64 years. The female gender was predominant (70.09%) with a sex ratio (M/F) of 0.43. Most of people living with HIV were mostly classified at clinical stage 2 (31.03%) and 3 (31.90%) of WHO at initiation of HAART. The main CD4 rate was 223.30 ± 143.764 at initiation of HAART and 462.58 ± 202.723 at the time of the study. The majority of patients were placed in a fixed combination of Tenofovir/Lamivudine/Efavirenz in a proportion of 81.20% cases. CKD was found in 13 patients—that is 11.11% of patients. Univariate analysis shows that age greater than 45 years plus (p = 0.017) and pathological proteinuria (p = 0.021) were associated with CKD. In multivariate analysis, only ages (p = 0.045) and pathological proteinuria (p = 0.035) were significantly associated with CKD. The prevalence of CKD in HIV-infected patients is significant in Togo. The occurrence of proteinuria is linked to the delay in taking antiretroviral therapy.

关键词： CKD HIV HAART Togo

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Cardio-Renal Syndrome: Frequency and Associated Factors in the Abidjan Heart Institute’s Medical Department

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Open Journal of Nephrology 2023年第3期13卷 292-305页

作者： Diane Meto Arnaud Ekou Serge D. Konan Rodrigue Hazoume Kolo Claude Ouattara Roland Nguetta hubert yao Nephrology Department of the Teaching Hospital of Treichville Abidjan Ivory Coast Heart Institute of Abidjan Abidjan Ivory Coast

Introduction: Cardio-renal syndrome (CRS) is a pathophysiological disorder of the heart and kidneys in which acute or chronic dysfunction of one organ can lead to acute or chronic dysfunction of the other. In Africa, particularly in C?te d’Ivoire, the incidence of cardio-renal syndrome is not precisely known. The aim of this study was to assess the frequency of CRS and to contribute to a better understanding of the condition in the medical department of the Abidjan Heart Institute. Materials and Methods: We conducted a prospective analytical study including all patients with heart failure hospitalised in the medicine department of the Abidjan Heart Institute from March to October 2020. Data were analysed using SPSS software version 22. Results: We included 111 patients in the study. The incidence of CRS was 64%, with a predominance of males (sex ratio 1.8). The mean age was 53 ± 15 years. Patients’ medical history was dominated by hypertension (56.8%), diabetes (15%), dyslipidaemia (18%), obesity (17.1%) and smoking (14.4%). The main causes of heart failure were dilated cardiomyopathy (22.8%) and ischaemic heart disease (21.4%). Symptomatology was mainly congestive heart failure (42.8%). Mean evaluated clearance (MDRD) was 39.9 ± 17.1 ml/min/m2. Doppler echocardiography showed a decrease in left ventricular ejection fraction in 74.3% of patients. Factors statistically associated with the occurrence of cardio-renal syndrome were: age > 60 years (p = 0.04), diabetes (p = 0.03), arterial hypertension (p = 0.001) and Hb Conclusion: The cardio-renal syndrome is a reality and marks an important point in the evolution of cardiac and renal diseases. It is highly frequent in the medical department of the Abidjan Heart Institute, as well as a high rate of CKD.

关键词： Cardio-Renal Syndrome Heart Failure Renal Failure

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COVID-19 Infection and Acute Kidney Injury: About 43 Cases Report Collected at the Nephrology Department of the Farah Polyclinic in Abidjan

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Open Journal of Nephrology 2022年第4期12卷 410-425页

作者： Badomta Dolaama Serge Didier Konan Sery Patrick Diopoh Mohamed Alex Moudachirou Komlan Georges Tona Eyram Yoan Makafui Amekoudi Mawufemo Claude Tsevi Kouamé hubert yao Farah Polyclinic Abidjan Cote d’Ivoire Nephrology and Hemodialysis Department Teaching Hospital of Sylvanus Olympio Lome Togo Nephrology Department Teaching Hospital of Treichville Treichville Cote d’Ivoire Nephrology Department Teaching Hospital of Kara Lome Togo

Background: Acute kidney injury (AKI) is one of the increasingly described complications of coronavirus infection. Objectives: To identify factors associated with death in patients with acute kidney injury (AKI) during Coronavirus disease (COVID-19) in Abidjan, C?te d’Ivoire. Material and Method: This was a monocentric retrospective analytical study of all patients over 18 years of age with AKI during COVID-19 at the Farah Polyclinic in Abidjan, C?te d’Ivoire. AKI was defined and ranked according to Kidney Disease Improving Global Outcomes (KDIGO) 2012. The data were collected from the medical record and processed using RStudio. Results: Forty-three cases were collected. The average age was 58.5 12 years. The sex ratio (M/F) was 4.4. The main comorbidities were high blood pressure (60.4%) and diabetes (37.2%). AKI was at KDIGO stage 3 in 58%, KDIGO 2 in 21% and KDIGO 1 in 21%. The diagnosis of acute tubular necrosis was retained in 44.2% of patients followed by acute functional kidney injury in 32.6%. Hemodialysis was initiated in 48.8% of cases. The main indication of dialysis was anuria (46.6%). In total, 55.8% of patients died. Factors associated with death were KDIGO stage (p = 0.049), and invasive ventilation (p Conclusion: Mortality is high in patients with AKI during COVID-19 infection.

关键词： Coronavirus Acute Kidney Injury Abidjan 2020

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Epidemiological and Clinical Characteristics of Renal Diseases Diagnosed by Biopsies in Ivory Coast

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Open Journal of Pathology 2022年第3期12卷 100-113页

作者： Kouame Justin N’Dah Weu Melanie Tia Alain Didier Abouna Ibrahiman Toure Amelie Delphine Lagou Monley Cyr Guei Ibrahim Cherif Moussa Traore Eyram Amekoudi Attaah Ange Rebecca Kobenan Sery Patrick Olivier Diopo Kouame hubert yao N’Guessan Clement Ackoundou Koffi Laurence Adonis Dazé Apolinaire Gnionsahié Mohenou Isidore Jean Marie Diomande Department of Anatomic Pathology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Nephrology University Teaching Hospital of Bouake Bouake Ivory Coast Department of Anatomic Pathology University Teaching Hospital of Cocody Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Yopougon Abidjan Ivory Coast Department of Nephrology University Teaching Hospital of Donka Conakry Guinea Department of Nephrology Sylvanus Olympio University Teaching Hospital Lomé Togo Department of Nephrology University Teaching Hospital of Treichville Abidjan Ivory Coast Department of Pediatric Nephrology University Teaching Hospital of Yopougon Abidjan Ivory Coast

Renal biopsy is an invasive procedure used to evaluate the activity and the therapeutic management of kidney disease and kidney transplantation. Objective: The aim of this study was to describe the epidemiological, clinical, and pathological features of kidney disease diagnosed by biopsy in the Ivory Coast. Materials and Methods: This was a descriptive and prospective study conducted between January 2015 and December 2018 in the Department of Anatomy and Cytology of the Pathology of Cocody (Abidjan) and Bouake. Specimens were obtained from the nephrology department of Ivory Coast and from teaching hospitals in Togo, Guinea, Burkina Faso, and Mali. Samples were analyzed according to standard renal biopsy procedures. One kidney fragment was fixed in acetic acid formalin (AAF) for optical microscopy examination. The other fragment, soaked in physiological water, was immediately sent for immunofluorescence examination. All renal pathologies were included in this study. The study parameters were frequency, age, sex, origin, occupation, clinical and biological signs, and pathological aspects with optical microscopy, and immunofluorescence. Results: 153 cases (2.23%) of kidney biopsies were examined on a total of 10,573 specimens. Ivory Coast specimens accounted for 91.5% of cases (n = 140). Nephrotic syndrome (49%) was the most common clinical sign and indication for renal biopsy, followed by acute renal failure (16.3%), chronic renal failure (19.6%), and a combination of chronic renal failure with hypertension (11.18%) and glomerulonephritis (4%). Mean proteinuria was 3.03 g/24h (range, 0.14 to 11.5 g/24h). Histologically, 90.8% (n = 139) were glomerular nephropathies, including 26.6% HIV-associated nephropathy, 17.3% focal segmental glomerulosclerosis, 13.6% nephroangiosclerosis, 11.5% post-infectious glomerulonephritis, 9.3% membranous glomerulonephritis, and 21.6% miscellaneous glomerular nephropathies (n = 30). The incidence of various tubulo-interstitial lesions was

关键词： Kidney Biopsy Disease Pathology Ivory Coast

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Multiple Antihypertensive Therapy in Nephrology Practice

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Open Journal of Nephrology 2017年第3期7卷 80-93页

作者： yao Kouame hubert Doro Arouna Guehi Monlet Cyr Konan Serge Didier Gnionsahe Daze Appolinaire Department of Nephrology Treichville Teaching HospitalAbidjanCote d'Ivoire

Introduction: Hypertension (HT) can be the cause or consequence of chronic kidney disease. Its management often requires a multiple therapy due to its severity. Objective: To describe the profile of patients receiving a multiple anti-hypertensive therapy in nephrology practice. Materials and Methods: This was a prospective, descriptive study conducted in the department of Nephrology, Yopougon Teaching Hospital, from January 1 to October 31, 2016. We included all patients admitted to this department who had received at least three anti-hypertensive drugs. Results: Out of a total of 625 hypertensive patients admitted over the study period, we included 120 patients on multiple therapy, i.e. a 19% prevalence. HT was essential in 60% of cases, secondary to chronic glomerulonephritis (CGN) in 25%, to diabetes in 13.3% and to polycystic kidney disease (PKD) in 1.7%. The therapy consisted of the combination of 3 antihy-pertensive drugs in 36.7% of cases, 4 drugs in 49.2% and 5 drugs in 4.2%. The antihypertensive classes used were Calcium channel blockers (CCB) in 99.2% of cases, Diuretics (D) in 87.5%, Angiotensin Converting Enzyme Inhibitors (ACEI) in 70%, Centrally acting medication (C) in 66.7%, Angiotensin Receptor Blockers (ARB) in 25.8% and Beta-blockers (β-) in 6.7%. The main combinations were CCB + D + ACEI + C in 34.2% of cases, CCB + D + ACEI in 23.3%, and CCB + D + ARB + C in 12.5%. The combinations of antihypertensive drugs varied according to the cause of HT with a non-significant difference. Patient outcome was characterized by normal blood pressure in 64.2% of cases and normal renal function in 13.3%. The mortality rate was 17.5%. In multivariate analysis, stage 5 renal disease (p = 0.001), hypertensive retinopathy (p = 0.04) and hemoglobin level < 8 g/dl (p = 0.039) were associated with mortality. Conclusion: Multiple antihypertensive therapy, which is common in nephrology, is related to the severity of HT and not to its cause. We still use centrally acting

关键词： Hypertension Multiple Therapy Nephrology

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Sexual Dimorphism,Female Reproductive Characteristics and Embryonic Thermosensitivity in the Tonkin Forest Skink(Sphenomorphus tonkinensis)from Hainan,South China

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Asian Herpetological Research 2023年第4期14卷 271-279页

作者： Yu DU Chixian LIN Xiaming ZHU Yuntao yao Xiang JI Hainan Key Laboratory for Herpetological Research College of Fisheries and Life SciencesHainan Tropical Ocean UniversitySanya 572022HainanChina Zhejiang Provincial Key Laboratory for Water Environment and Marine Biological Resources Protection College of Life and Environmental SciencesWenzhou UniversityWenzhou 325035ZhejiangChina

We collected 75 adult Tonkin forest skinks(Sphenomorphus tonkinensis) from Hainan, South China and incubated eggs at four constant temperatures ranging from 22 ℃ to 28 ℃ to study sexual dimorphism, female reproductive characteristics and embryonic thermosensitivity. The largest male was 53.4 mm snout-vent length(SVL), and the largest female was 54.3 mm SVL. The mean SVL was slightly greater in adult females(49.9 mm) than in adult males(48.8 mm), but the difference was not *** length, head width, fore-limb length and hindlimb length were longer in adult males and abdomen length was longer in adult females after accounting for SVL. Accordingly, we conclude that S. tonkinensis is basically a sexually size-monomorphic species with sexual dimorphism in head size, abdomen(trunk)length and limb size. Females laid up to two clutches of 1–4 eggs each per egg-laying season from February to May. Egg mass, clutch size and clutch mass were independent of female SVL. Embryonic stages at laying varied from Dufaure and hubert’s stage 30 to 31. With female SVL held constant, the negative correlation between egg mass and clutch size was not significant, suggesting that the offspring(egg) sizenumber trade-off between is not evident or eggs are well optimized for size in S. tonkinensis. None of the eggs at 28 ℃ hatched;hatching success was lower at 22 ℃ than at 24 ℃ or 26 ℃. The mean incubation length was 52.9 d at 22 ℃, 40.4 d at 24 ℃ and 33.6 d at 26 ℃. Hatchlings from eggs incubated at 22 ℃,24 ℃ and 26 ℃ did not differ morphologically at hatching, suggesting that temperatures within this range do not differentially affect hatchling morphology in S. tonkinensis.

关键词： egg hatching success hatchling morphology incubation length reproduction Scincidae sexual dimorphism

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Renal Risk among Diabetic Patients in Togo

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Open Journal of Nephrology 2022年第3期12卷 249-261页

作者： Kodjo Kossi Tsevi Yawovi Mawufemo Dolaama Badomta Tona Komlan Georges Balaka Abago yao K. hubert Gnionsahe Daze Apollinaire Centre Hospitalier Universitaire Sylvanus Olympio Lome Togo Centre Hospitalier Universitaire de Treichville Abidjan Cote d’Ivoire Centre Nationale de Prévention et de Traitement de l’Insuffisance Renal Abidjan Cote d’Ivoire

Background: Diabetic patients have risk of kidney disease. The aim of this study was to assess the level of renal risk in our study population and to identify the associated predictive factors. Methods: It was a descriptive and analytical cross-sectional study carried out over 5 years (January 1, 2016 to December 31, 2020). All patients were included regardless of the duration of diabetes and having achieved at least one serum creatinine and at least two (2) proteinuria in the 24 hours over a period of at least three months. The level of renal risk was assessed using the KDIGO 2012 classification. Results: A total of 320 patient medical files were retained. The sex ratio M/F was 1.2. The average age was 57.2 ± 11.8 years. Hypertension was the most common comorbidity (84.4%). Diabetic nephropathy was found in 177 patients, a frequency of 42.8%. The very significant renal risk was found in 174 patients (54.4%). In multivariate logistic regression, the risk factors significantly associated with renal risk were: Male sex (OR = 2.50;95% CI = 1.29 - 4.84, p-value = 0.006);microangiopathy (OR = 5.54;95% CI = 1.82 - 16.85 p = 0.002) and beta-blockers (OR = 5.64;95% CI = 1.04 - 30.53 p = 0.004). The Oral Antidiabetes (OR = 0.23;95% CI = 0.10 - 0.55, p = 0.001), the blockers of Renin-Angiotensin system (OR = 0.58;95% CI = 0.41 - 0.90, p = 0.040) and the average socioeconomic level (OR = 0.50;95% CI = 0.25 - 0.98, p = 0.044) were rather the protective factors.

关键词： Diabetic Kidney Disease Kidney Risk Togo

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First Emergency Hemodialysis Session at the Nephrology Department of the Teaching Hospital of Yopougon: About 146 Cases

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Open Journal of Nephrology 2020年第4期10卷 338-347页

作者： Konan Serge Didier Kissou Pegdebamba François Guei Monlet Cyr Diopoh Sery Patrick Aka Jean Astrid yao Kouamé hubert Nephrology-Internal Medicine Department D CHU Treichville Abidjan Ivory Coast Department of Nephrology CHU Yopougon Abidjan Ivory Coast

Context: Due to the late referral of the pads to the nephrologist and the lack of medical follow-up, many patients are admitted with complications from kidney disease requiring the urgent start of hemodialysis sessions. Purpose: Study the profile of emergency hemodialysis patients in order to ease their management. Methods: This was a retrospective, descriptive and analytical study carried out at the Nephrology Department of the Teaching Hospital of Yopougon from January 1st to December 31st, 2016. This study included all patients who had received a first session of hemodialysis in an emergency context. Results: We collected 146 patients with an average age of 39.80 ± 14.55 years and a sex ratio of 0.6 for men. Before admission, patients were known as hypertensives (63.9%), followed by CKD (23.9%) and HIV-infected (8.2%). The main clinical signs were hypertension (64.3%), edema (44.5%) and coma (30.1%). Anemia was observed in 97.2% of cases and it was less than 8 g/dl in 57.5%. Kidney failure was chronic in 75.3% and acute in 24.6%. Chronic nephropathies were glomerular (54.1%), vascular (20.5%). The main indications for hemodialysis were encephalopathy (33.5%), severe uremia (28%), acute pulmonary edema (19.8%), persistent anuria (11.6%) and hyperkalemia (5.4%). The vascular approach was a catheter in 97.2% (femoral site in 53.4% and jugular in 43.8% and arteriovenous fistula in 2.7%). Death was observed in 17.8%. In univariate analysis, age > 65 years (p = 0.04), coma (p = 0.004) and acute kidney failure (p = 0.02) were associated with the risk of death, and in multivariate analysis, only coma (p = 0.024, OR = 5.88) seemed to be associated with mortality risk for our patients. Conclusion: Hemodialysis in an emergency situation is a common practice in the Teaching Hospital of Yopougon and mainly concerns patients with CKD.

关键词： Kidney Failure Hemodialysis Emergency

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Evolution of Proteinuria and Renal Function in Women with Pre-Eclampsia at the Gynecology Department of the Teaching Hospital of Cocody

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Open Journal of Nephrology 2023年第4期13卷 405-419页

作者： Ouattara Kolo Claude Meudje Youmbi Chimène Diopoh Sery Patrick Konan Serge Didier Kouadio Marie Dominique Gnamon Ophélia Aka Marie Josiane yao Kouamé hubert Nephrology-Internal Medicine Department D CHU Treichville Université Felix Houphouet Boigny Abidjan C&ocircte d’Ivoire

Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.

关键词： Proteinuria Pre-Eclampsia Renal Function

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