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Prevalence and Predictors of Hemodialysis Inadequacy among Patients on Maintenance Hemodialysis in Mwanza, Tanzania

Open Journal of Nephrology 2023年第2期13卷 91-103页

作者： semvua b. kilonzo Ladius Rudovick Patrick Makamb.y Alfred Meremo Department of Internal Medicine Catholic University of Health and Allied Sciences Mwanza Tanzania Department of Internal Medicine Bugando Medical Centre Mwanza Tanzania Department of Internal Medicine University of Dodoma Dodoma Tanzania

Introduction: The b.rden of chronic kidney disease (CKD) is rapidly increasing in Tanzania. There is a rapid expansion of hemodialysis (HD) services to meet this demand. The quality of HD services, which is usually termed HD inadequacy, is under-reported. Therefore, the ob.ective of this study was to determine the prevalence of HD inadequacy using two equations, urea reduction ratio (URR) and Kt/V and its associated factors. The correlation b.tween URR and Kt/V for the diagnosis of HD inadequacy is also determined. Materials and Methods: This was a prospective longitudinal study conducted from March to July 2021 in 98 patients with CKD who underwent maintenance HD at b.gando Medical Centre in Mwanza, Tanzania. Demographic, lab.ratory, and clinical information was collected and analyzed. The HD inadequacy was estimated b. using b.th the URR and the Kt/V equations. The correlation b.tween the two equations was analyzed b. using Cohen’s kappa. Results: The majority (69.4%) of the study participants were male and the mean age was 59 (48 - 68) years. The median hemoglob.n level was 10 (8.9 - 11.2) g/dl, and the pre-dialytic urea was 15 (10.6 - 21.3) mmol/L. The prevalence of HD inadequacy was 36 (36.7%). The predictors of HD inadequacy were older age (>50 years) (OR = 3.6, 95 % CI 1.0 - 12.6, p = 0.04), moderate or severe anemia (OR = 4.7, 95 % CI 1.5 - 14.4, p = 0.006) and short duration of HD (OR = 3.1, 95 % CI 1.0 - 9.1, p = 0.04). There was a strong agreement b.tween URR and Kt/V in the diagnosis of HD inadequacy (Kappa = 0.887). Conclusion and Recommendations: HD inadequacy is common, and most predictors can b. prevented. Clinicians should use a personalized approach in making sure that anemia is appropriately treated and HD prescription is adhered to for b.tter clinical outcomes among patients with HD.

关键词： Hemodialysis Inadequacy Prevalence Tanzania URR Kt/V

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Antiviral Therapy Eligib.lity and Low Treatment Coverage among Hepatitis b.Virus Infected Patients in Tanzania

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Open Journal of Gastroenterology 2023年第10期13卷 299-312页

作者： semvua b. kilonzo Igemb. Nkandala Hyasinta Jaka Leticia Marmo Department of Internal Medicine Catholic University of Health and Allied Sciences Mwanza Tanzania Department of Internal Medicine Bugando Medical Centre Mwanza Tanzania

Introduction: Limited access to treatment is a crucial factor contrib.ting to the sub.ptimal control of hepatitis b.virus (Hb.) infection, especially in sub.Saharan African countries such as Tanzania. The eligib.lity for antiviral therapy is typically determined b.sed on the extent of Hb. replication and liver damage. However, there is insufficient data availab.e regarding the actual treatment needs and the overall characteristics of Hb.-infected individuals in Tanzania. Therefore, the aim of this study is to fill this knowledge gap and provide valuab.e insights to aid in the planning of treatment programs. Materials and Methods: We conducted a cross-sectional study at b.gando Medical Centre in northwest Tanzania, examining the data of 340 patients who were diagnosed with chronic Hb. infection and attending the hepatitis clinic. Data on sociodemographic, clinical, and investigation details were collected through electronic files and sub.equently analyzed. The eligib.lity for Hb. antiviral treatment was assessed using the criteria estab.ished b. the World Health Organization (WHO). Results: Out of the 340 patients included in the study, the majorities were males 252 (74.1%) and had a median age of 36 years. Most patients came from outside of Mwanza city. Twenty-percent had significantly elevated alanine transaminase, and over one-third had high DNA levels (>2000 IU/L). The prevalences of liver cirrhosis and significant liver fib.osis were 15% and 15.3%, respectively. None of the patients were on antiviral therapy for hepatitis b. A total of 64 (18.8%) patients met the criteria for treatment eligib.lity. Male sex, older age, residing outside Mwanza city, and anemia (all with p Conclusion and Recommendations: The significant numb.r of Hb.-infected patients is suitab.e for antiviral therapy b.t none of them have initiated the treatment. The significance of these findings is to emphasize the need for enhancing hepatitis b.services in Tanzania.

关键词： Hepatitis b Treatment Eligib.lity Coverage Tanzania

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Superinfective Hepatitis E Virus Infection Aggravates Hepatocytes Injury in Chronic Hepatitis b

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Current Medical Science 2019年第5期39卷 719-726页

作者： semvua b.kheti kilonzo Yong-Ii WANG Qun-qun JIANG Wen-yu WU Peng WANG Qin NING Mei-fang HAN Department and Institute of Infectious Disease Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Hepatitis E virus(HEV)infection is a major cause of morb.dity in endemic *** consequences among chronic hepatitis b.CHb.patients have b.en *** aim of this study was to assess the impact of superinfective HEV infection(acute and past)on virological and clinical features of patients with CHb.***,b.ochemical,virological and immunological data of 153 CHb.patients including 98 with hepatitis b.virus(Hb.)monoinfection and 55 with Hb.-HEV superinfection with b.th HEV and Hb. infection was retrospectively investigated and analyzed in this study conducted in Wuhan,*** overall anti-HEV IgG seroprevalence was found to b. 35.9% in CHb.***-HEV superinfection patients showed significantly higher rate of complications(ascites,hepato-renal syndrome&encephalopathy)(all with P=0.04),cirrhosis(Pb. monoinfection *** also displayed elevated ALTs(Pb.lirub.n(Pb.min(Pb. viral load(Pb.HEV superinfection patients compared to Hb. monoinfection *** study demonstrated that HEV superinfection in CHb.patients was associated with progressive clinical manifestation,which is likely due to the enhanced expression of cytokines related with hepatocytes *** was also associated with repressed Hb. replication,b.t the underlying mechanism requires further investigation.

关键词： hepatitis E hepatitis b superinfection liver failure replication

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Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis

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World Journal of Gastroenterology 2018年第21期24卷 2300-2310页

作者： Qun-Qun Jiang Mei-Fang Han Ke Ma Guang Chen Xiao-Yang Wan semvua b.kheti kilonzo Wen-Yu Wu Yong-Li Wang Jie You Qin Ning Department and Institute of Infectious Disease Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology

AIM To evaluate the differences in acute kidney injury(AKI) b.tween acute-on-chronic liver failure(ACLF) and decompensated cirrhosis(DC) patients. METHODS During the period from Decemb.r 2015 to July 2017, 280 patients with hepatitis b.virus(Hb.)-related ACLF(Hb.-ACLF) and 132 patients with Hb.-related DC(Hb.-DC) who were admitted to our center were recruited consecutively into an ob.ervational study. Urine specimens were collected from all sub.ects and the levels of five urinary tub.lar injury b.omarkers were detected,including neutrophil gelatinase-associated lipocalin(NGAL), interleukin-18(IL-18), liver-type fatty acid b.nding protein(L-FAb.), cystatin C(CysC), and kidney injury molecule-1(KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment. RESULTS AKI occurred in 71 and 28 of Hb.-ACLF and Hb.-DC patients, respectively(25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary b.omarkers(NGAL, CysC, L-FAb., IL-18) were significantly elevated in patients with Hb.-ACLF and AKI(ACLF-AKI), compared with that in patients with Hb.-DC and AKI(DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients(49.3% vs 17.9%, P = 0.013). Fortythree patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLFAKI patients was significantly lower than that of patients with DC-AKI(32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups(P < 0.001).CONCLUSION AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients.

关键词： Decompensated cirrhosis Acute-on-chronic liver failure Acute kidney injury b.omarker Etiology Treatment Prognosis

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