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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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Factors Associated with Renal Impairment in Patients on Tenofovir for Chronic Hepatitis B in Yaoundé (Cameroon)

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Open Journal of Gastroenterology 2024年第1期14卷 18-30页

作者： Antonin Wilson Ndjitoyap Ndam Sonia Charlsia Ewuo Shu Mahamat Maimouna Winnie Bekolo Nga Isabelle Dang Babagna Paul Talla Mathurin Kowo Firmin Ankouane Andoulo gloria Enow ashuntantang Hepato Gastroenterologist Service Yaoundé General Hospital Yaoundé Cameroon Internal Medicine Department Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Department of Clinical Sciences Faculty of Health Sciences University of Bamenda Bamenda Cameroon Nephrologist Service Yaoundé General Hospital Yaoundé Cameroon Department of Clinical Sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Hepato Gastroenterologist Service Centre Medical la Cathedrale Yaoundé Cameroon

Background: Tenofovir (TFV) is widely used to treat patients with hepatitis B virus (HBV) infection. But kidney abnormalities are the main concern using this drug. Few studies have described the renal impairment due to the TFV in chronic hepatitis B (CHB) in Sub-Saharan Africa. The objective was to evaluate factors associated with renal impairment observed in patients on TFV for CHB. Method: It was a hospital based cross sectional prospective study carried out from June 2023 to July 2023 in Yaoundé (Cameroon) and included any patient treated with TFV for CHB during at least a period of 6 months. For each participant, we collected in the medical report socio-demographic data, clinical data, baseline creatinine, treatment information (type of TFV which was Disoproxil Fumarate (TDF) or Alafenamide (TAF), duration). Then, we collected blood samples to measure serum creatinine and phosphate levels and urine dipstick analysis. Factors associated with renal impairment were assessed with the Odds Ratio. A p value of Results: A total of 60 participants were included. The median age was 44 years [36-55] and median duration of TFV therapy was 17.5 months [11.7-25.7]. The prevalence of reduced eGFR (Conclusion: Kidney function was impaired in some patients receiving TFV for CHB. It should be monitored, particularly after 36 months and for those receiving TDF prodrug.

关键词： Chronic Hepatitis B Tenofovir Factors Associated Renal Impairment Cameroon

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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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Factors Associated with Renal Impairment in Patients on Tenofovir for Chronic Hepatitis B in Yaoundé (Cameroon)

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Open Journal of Gastroenterology（肠胃病学期刊） 2024年第1期

作者： Antonin Wilson Ndjitoyap Ndam Sonia Charlsia Ewuo Shu Mahamat Maimouna Winnie Bekolo Nga Isabelle Dang Babagna Paul Talla Mathurin Kowo Firmin Ankouane Andoulo gloria Enow 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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Sleep Quality on Maintenance Hemodialysis Patients in Douala General Hospital in Cameroon

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Open Journal of Nephrology 2017年第3期7卷 61-68页

作者： Fouda Menye Ebana Hermine Danielle Maimouna Mahamat Kaze Folefack Francois Halle Marie-Patrice ashuntantang gloria Department of Internal Medicine Faculty of Medicine and Biomedical Sciences of Yaoundé Yaoundé Cameroon Department of Internal Medicine Faculty of Medicine and Pharmaceutic Sciences of Douala Douala Cameroon

Background: Poor sleep quality is reported to be common in hemodialysis patients. However, limited data are available about its prevalence in sub-Saha-ran region. The aim of this study was to assessed sleep quality and its predictors among hemodialysis patients. Methods: We conducted a cross sectional study of 2 weeks in the Douala General Hospital hemodialysis center of Cameroon involving 46 chronic hemodialyzed patients for at least six months with arteriovenous fistula. Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and laboratory data were collected in patients’’ fields. Result: Thirty-five (76.1%) subjects reported poor sleep quality. The most frequent abnormal sleep components were subjective sleep quality, sleep disturbances and sleep latency (87%, 85% and 76% respectively). In univariate linear regression, hemoglobin level, sleep quality, sleep latency, sleep duration, habitual sleep efficiency and sleep disturbance were associated with poor sleep quality. In multivariate linear regression only hemoglobin level (p = 0.004) and sleep latency (p = 0.002) were associated with poor sleep quality. Conclusion: Poor sleep quality is frequent in our hemodialysis patients and hemoglobin seems to be a good predictor of sleep quality in these patients.

关键词： Sleep Quality Hemodialysis Cameroon Anemia

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Clinical Profile and Outcome of Pediatric Acute Kidney Injury in Cameroon: Comparison between an Urban and a Semi-Urban Health Facility

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Open Journal of Nephrology 2018年第2期8卷 56-64页

作者： Fouda Menye Ebana Hermine Danielle Teuwafeu Denis George Halle Marie-Patrice Kaze Folefack Francois ashuntantang gloria Faculty of Medicine and Biomedical Sciences of Yaoundé University of Yaoundé I Yaoundé I Cameroon General Hospital of Douala Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Regional Hospital of Buea Buea Cameroon Faculty of Medicine and Pharmaceutic Sciences University of Douala Douala Cameroon Teaching Hospital of Yaoundé Yaoundé Cameroon General Hospital of Yaoundé Yaoundé Cameroon

Introduction: Pediatric Acute Kidney Injury (AKI) seems to be a major cause of morbidity and mortality in Subsahara Africa. However, data on its epidemiology are scare and mainly originate from tertiary and urban health facilities such as large university Teaching hospitals with a nephrology service. Objective: The aim of this study was to compare the epidemiology of pediatric AKI in urban and semi-urban health facility. Patients and method: We conducted a retrospective study of 16 months in a tertiary urban hospital (General Hospital of Douala) and a secondary semi-urban health facility (Region hospital of Buea). Diagnostic of AKI was done using usual criteria. Age, sex distribution, etiologies of AKI, access to dialysis, renal recovery at hospital discharge, at 1 and 3 months and patient survival at hospital discharge was compared. Results: A total of 31 patients were included (GD 17 and RHB 14). Boys were more prevalent in the semi-urban setting (86% Vs 47% p = 0.029). Median age was comparable in the both group although most semi-rural patient were older (6.5 Vs 10 years p = 0.093). Hospital acquired AKI was only found in urban setting and account for 40% of pediatric urban AKI. Malaria related AKI (mainly black water fever) and sepsis were the main etiologies of AKI in urban and semi-urban milieu. Dialysis access was the same but 30% of children could not access to it in urban setting compare to none in semi-urban area. Reasons of non-access to dialysis were lack of pediatric material and financial constraints. In Hospital mortality was the same but was more severe amount patient who could not receive dialysis. Among the survivor, CKD was only found in urban setting. Conclusion: Although mainly due to malaria, pediatric AKI differs from urban tertiary and semi-urban secondary health facility in Cameroon. Hospital acquired AKI is only found in urban setting where children are younger and less boys. AKI in urban setting seems to be more severe with less access to

关键词： Pediatric AKI Urban Tertiary Health Facility Semi-Urban Secondary Health Facility Malaria Black Water Fever Boys Hospital Acquired AKI CKD

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Cardiovascular Disease Burden in Patients with Non-Dialysis Dependent Chronic Kidney Disease in Cameroon: Case of the Douala General Hospital

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Open Journal of Nephrology 2020年第3期10卷 171-186页

作者： Marie Patrice Halle Mogo Franklin Kom Felicite Kamdem Sidick Mouliom Hermine Fouda Anasthase Dzudie Folefack Francois Kaze Enow gloria ashuntantang Department of Clinical Sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Internal Medicine Douala General Hospital Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon

Introduction: Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Objective: To evaluate the burden of CVD and audit the management of cardiovascular risk factors (CVRF) in patients with non-dialysis (ND) dependent CKD in Cameroon. Patients and Methods: A cross-sectional study in the Douala general hospital was conducted from January to March 2016, including CKD patients’ stages 3 - 5 ND. Socio-demographic data, comorbidities, medications and biological data were extracted from patient’s records. For each participant, lipid profile and urinary protein excretion were measured;a resting electrocardiogram was done. Hypertension, diabetes, dyslipidemia, obesity, smoking, alcohol consumption, anemia, hyperuricemia, proteinuria and high calcium-phosphorus product were considered as CVRF. CVD was defined as a history of stroke, peripheral artery disease, coronary heart disease (CHD), left ventricular hypertrophy (LVH), heart failure (HF) and arrhythmia. We used KDOQI 2003, KDIGO 2012 and JNC 8 guidelines for definition and evaluation of the management of lipid abnormalities, proteinuria and hypertension respectively. Results: A total of 83 patients (45 males) were included;mean age was 56 ± 15 years. Mean number of CVRFs per patient was 5.19 ± 1.64;hypertension (90.3%), obesity (79.5%), anemia (78.3%), dyslipidemia (69.8%) and hyperuricemia (69.8%) were the most frequent. Mean number of CVD per patient was 1.5 ± 0.63 with an overall prevalence of 69.8%;LVH (48.2%) and CHD (30.1%), were the most frequent and prevalence increased significantly with CKD stage. Treatment rate of hypertension was 100%, 53.4% for dyslipidemia and 75.3% for anemia. Target values were achieved in 50% of participants for LDL-cholesterol and phosphorus levels, 26.6% for blood pressure and 6% for hemoglobin levels. Conclusion: CVRF are highly preva

关键词： Cardiovascular Disease Risk Factors Chronic Kidney Disease 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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Assessing the impact of heat mitigation measures on thermal performance and energy demand at the community level:A pathway toward designing net-zero energy communities

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Building Simulation 2024年第8期17卷 1379-1400页

作者： Khan Rahmat Ullah Veljko Prodanovic gloria Pignatta Ana Deletic Mattheos Santamouris School of Built Environment Faculty of ArtsDesign&ArchitectureUniversity of New South WalesSydney2052 NSWAustralia School of Civil and Environmental Engineering University of New South WalesSydney2052 NSWAustralia Institute for Artificial Intelligence Research and Development of Serbia 21000 Novi SadSerbia Institute for Multidisciplinary Research University of BelgradeKneza Višeslava 111000 BelgradeSerbia School of Civil and Environmental Engineering Engineering FacultyQueensland University of TechnologyQLD 4001Australia

In the context of escalating global energy demands,urban areas,specifically the building sector,contribute to the largest energy consumption,with urban overheating exacerbating this *** urban modelling for heat-mitigation and reduction of energy demand is crucial steps towards a sustainable built-environment,complementing onsite energy generation in the design and development of Net-zero Energy(NZE)Settlement,especially in the context of Australian weather *** a significant gap in existing literature,this study offers empirical analysis on the climate and energy efficacy of integrated heat mitigation strategies applied in 14 neighbourhood typologies located in Sydney,*** the application of cool materials on roads,pavements,and rooftops,alongside urban vegetation enhancement,the analysis demonstrates scenario effectiveness on heat mitigation that leads to reduce ambient temperature and energy demands along with CO_(2)emissions within the *** building arrangement,built-area ratio,building height,and locations,ENVI-met and CitySim are utilized to assess the heat-mitigation and the energy demand of neighbourhoods,*** indicate that mitigation measures can lead up to a 2.71℃reduction in ambient temperature and over 25%reduction in Cooling Degree Hours,with a 34.34%reduction in cooling energy demand and overall energy savings of up to 12.49%.In addition,the annual energy-saving yields a CO_(2)reduction of approximately 141.12 tonnes,where additional vegetation further amplifies these reductions by enhancing CO_(2)*** study showcases the pathway towards achieving NZE goals in climates similar to that of Australia,highlighting significant benefits in heat-mitigation,environmental impact,and energy-savings.

关键词： urban overheating cool materials vegetation,heat mitigation energy savings CO_(2)reduction

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