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Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

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Open Journal of Nephrology 2024年第1期14卷 86-103页

作者： Denis Georges Teuwafeu Fombo Enjeh Jabbossung Maimouna Mahamat Eric aristide nono Tomta Mbapah Leslie Tasha Francois Kaze Folefack Gloria Ashuntantang Faculty of Health Sciences University of Buea Buea Cameroon Triad Research Fundation Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Department of nephrology Yaounde General Hospital Yaounde Cameroon Departement of Nephrology Yauonde Teaching Hospital Yaounde Cameroon

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

关键词： Predictors Fatal Outcome Acute Kidney Injury Tertiary Hospital

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Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

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Open Journal of Nephrology（肾脏病） 2024年第1期 86页

作者： Denis Georges Teuwafeu Fombo Enjeh Jabbossung Maimouna Mahamat Eric aristide nono Tomta Mbapah Leslie Tasha Francois Kaze Folefack Gloria Ashuntantang

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Epidemiological and Clinical Profiles of Chronic Kidney Disease Patients Presenting for Emergency Hemodialysis: A Five-Year Retrospective Study in Two Dialysis Centres in Cameroon

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Open Journal of Nephrology 2022年第1期12卷 75-86页

作者： Denis Georges Teuwafeu Nlend Bah Joseph Maimouna Mahamat nono aristide Kaze Folefack Francois Ashuntantang Gloria Faculty of Health Sciences University of Buea Buea Cameroon General Hospital Yaoundé Yaoundé Cameroon Yaoundé University Teaching Hospital Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Faculty of Health Sciences University of Bamenda Bamenda Cameroon

Background: Late referral of Chronic Kidney Disease (CKD) patients requiring emergency hemodialysis (HD) for survival poses a serious threat to global health particularly in sub-Saharan Africa (SSA). Objective: Describe the epidemiological and clinical profiles of CKD patients starting HD in emergency. Methodology: This was a retrospective cross-sectional study. Files of patient files of CKD patients who underwent dialysis from January 1st, 2016 to December 31st, 2020 were reviewed at the HD centres of the two main hospitals of the Cameroon city capital, Yaoundé. We included all emergency HD for End Stage Renal Disease (ESRD). Socio-demographic and clinical data including past medical history, signs and symptoms at presentation and indications for emergency HD were recorded. Emergency HD was defined as a dialysis session performed in ESRD with a temporary vascular access. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 26 for Windows. Results: Out of 700 recorded CKD patients who started HD, 570 underwent an emergency HD, thus a prevalence of 81.43%. We included 311 patients, 63.7% were males. The mean age was 47.05 ± 15.60 years ranging from 8 to 83 years with a modal age group of 40 - 59 years. The most prevalent co morbidities were hypertension (66.2%), diabetes mellitus (28.6%) and HIV infection (10%). The commonest presenting symptoms were asthenia (68.2%), lower limbs swelling (52.1%) and anorexia (41.8%) and the main clinical signs were high blood pressure (74.92%), and pallor (60.5%) and altered general state (55%). The indications for emergency HD were dominated by uremic encephalopathy (33.4%) and pulmonary oedema (25.7%). Conclusion: More than eight out of ten CKD patients start emergency HD. Patients are mostly middle-aged adults with a male predominance. Hypertension and diabetes mellitus remain the most common co morbidities and uremic encephalopathy is by far the first indication for emerg

关键词： Epidemiology Clinical Profile Chronic Kidney Disease Emergency Hemodialysis Cameroon

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Burden of COVID-19 in a Hemodialysis Center in Sub-Saharan Africa

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Open Journal of Nephrology 2022年第3期12卷 293-302页

作者： Mahamat Maimouna Hermine Fouda Menye Victorine Nzana Grace Nkoro aristide nono Karla Acha Mukwelle François Jerôme Kaze Folefack Gloria Ashuntantang Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Yaoundé General Hospital Yaoundé Cameroon

Background: The current COVID-19 pandemic remains a great challenge to healthcare workers, especially caregivers of patients with chronic diseases. Despite the advances in knowledge on COVID-19, data on COVID-19 in haemodialysis (HD) remains rare in Africa. Methods: We conducted a review of records from 2020 May 13th to 2021 June 24th in the HD center of Yaoundé General Hospital. All staff and patients in the HD unit were included. Sociodemographic, clinical, laboratory, and radiological data and patient outcome data were collected. All statistical analyses were performed with SPSS 21.0 software (Chicago, IL). Results: In all 30 HD patients and 3 staff members were positive for COVID-19 during the period. The median age of the infected population was 56 years (37.25 - 62). The median dialysis vintage was 42 months (24 - 96). Hypertension (73.3%) and diabetes (36.6%) were frequent comorbidities. About 10% (n = 3) were asymptomatic whereas those who were symptomatic had a mean duration of symptoms of 7 ± 5.6 days. Fatigue (23/30), fever (21/30), cough (14/30) and diarrhoea (11/30) were the main symptoms. Oxygen saturation was low in 36.6% (n = 11) ranging from 82% - 89%. About 50% were admitted in hospital for social isolation;there was no admission in intensive care unit. Three patients (10%) died: 2 for respiratory distress and 1 for severe anaemia. Laboratory test was done in 60% (n = 18) of case and revealed in 72.2% (n = 13) patients low lymphocytes count (median 896/mm3 [800 - 1513]) and anaemia in 77.7% (median 8.5 g/dl [7.5 - 9.8]). Conclusions: HD patients are highly susceptible and HD centres are high risk areas during the outbreak of COVID-19 pandemic.

关键词： COVID-19 Hemodialysis Sub-Saharan Africa

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Burden of COVID-19 in a Hemodialysis Center in Sub-Saharan Africa

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Open Journal of Nephrology（肾脏病） 2022年第3期

作者： mahamat maimouna hermine fouda menye victorine nzana grace nkoro aristide nono karla acha mukwelle françois jerôme kaze folefack gloria ashuntantang

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