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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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Pediatric Nephrotic Syndrome in a Cameroonian Cohorte: The Beast to Slaughter

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Open Journal of Nephrology 2024年第3期14卷 386-396页

作者： maimouna mahamat Kalla Claude Diya Rahinatou Epee Ngoue Jeannette Gamarko Sossal Ousmane Kaze Folefack François Koki Ndombo Paul Olivier Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaound 1 Yaound Cameroon Haemodialysis Unit Yaound General Hospital Yaound Cameroon Department of Pediatrics Faculty of Medicine and Biomedical Sciences University of Yaound 1 Yaound Cameroon Hemodialysis Department University Teaching Hospital Yaound Cameroon Mother and Child Center of Chantal Biyas Foundation Yaound Cameroon

Background: Idiopathic nephrotic syndrome (INS) is a frequent pathology in children. There is little data on the future of NS in children in sub-Saharan Africa, particularly Cameroon. The aim of our study is to report the prognosis of children treated for nephrotic syndrome in the city of Yaoundé. Method: This was an analytical cross-sectional study with retrospective collection in 4 reference hospitals in the Cameroonian capital over a period of five years from January 1, 2018 to December 31, 2022. We included all medical records of patients treated for idiopathic INS. We excluded incomplete records and those with a history of chronic kidney disease. The sociodemographic, clinical, paraclinical, and therapeutic data, as well as the short-term evolution were collected in the files. Data was analysed using the software statistical package for social sciences version 25.0. Statistical significance was set at a p-value Results: A total of 131 children (58% boys) were included in our study over a period of 5 years. The median age was 8 [6 - 11] years. Median proteinuria was 5 g/24h [3 - 8.4], median serum protein was 39 [34 - 46] g/l and median estimated glomerular filtration rate was 130.36 [68 - 174.6] ml/min/1.73m2. During steroid therapy, 45.07% were in partial remission at 2 months, 16.9% were in complete remission at 4 and 6 months, and 37.25% had relapsed. Steroid sensitivity was reported in 28.17% of cases, steroid resistance in 64.78% of cases and steroid dependent in 7.04% of cases. The mortality rate was 12.97%. Survival time averaged 48.2 months, with an overall crude survival rate of 99.2% at 3 and 6 months and 98.4% at 1 year. Regarding renal survival, renal function was impaired in 8.33% of patients at 6 months and 9% at 12 months. Conclusion: Idiopathic nephrotic syndrome is a common disease in children. Its evolution depends on corticosteroid therapy. The long-term prognosis is dominated by the risk of progression to end-stage kidney disease or even dea

关键词： Idiopathic Nephrotic Syndrome Outcome Mortality End-Stage Kidney Disease Children Cameroon

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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 Acute Kidney Injury in Elderly Adults in a Tertiary Hospital in Cameroon

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Open Journal of Nephrology 2020年第4期10卷 311-322页

作者： Fouda Menye Epse Ebana Hermine Danielle Ladze Clavis Berinyuy mahamat maimouna Nzana Victorine Bandolo Ndjong Emmanuel Kaze Folefack Francois Faculty of Medicine and Biomedical Sciences of Yaoundé Yaoundé Cameroon Douala General Hospital Douala Cameroon Yaoundé General Hospital Yaoundé Cameroon Yaoundé Teaching Hospital Yaoundé Cameroon

Background: Elderly patients have a high risk of acute Kidney Injury (AKI) due to aging, decreased renal function and the presence of comorbidities. There is limited data on AKI in elderly patients in low income regions, especially in Sub-Saharan Africa. We therefore sought to describe the clinical profile and outcome of AKI in elderly in a tertiary hospital in Cameroon. Methods and Materials: We reviewed the medical records of all patients admitted with the diagnosis of AKI in the internal medicine unit of the Yaounde University Teaching Hospital, from January 2015 to February 2018. Records of elderly patients (≥65 years) were retrieved and analysed. AKI was diagnosed and classified using the KDIGO (Kidney Disease Improving Global Outcomes) 2012 classification. The diagnosis, aetiologies and mechanisms of AKI were clinical. Renal outcomes were evaluated on day 7, 14, 28, 60 and 90 of hospital stay. Results: We included 76 elderly (66% males) patients with a median [interquartile rate—IQR] age of 69 [65 - 75] years. Hypertension (60.5%), diabetes mellitus (36.8%) and heart failure (26.3%) were the most common comorbidities. The median [IQR] Charlson index was 4 [3 - 5]. Infections (47.4%) and hypovolemia (69.7%) were the most frequent risk factors for AKI. AKI was mainly community acquired (89.5%) and most of the patients were in stage 2 (34.2%) or 3 (29%). Pre-renal AKI (58%) was the leading mechanism involved. Hypovolemia and sepsis were the most common aetiologies. Of the 14.5% with indication for dialysis, only 2.6% had access to it. The overall prognosis was good with a mortality rate of 2.6%, complete and partial renal recovery at 3 months of 70%, and 26.3% respectively. Conclusion: AKI in the elderly, in our setting was community-acquired and affected mainly those with comorbidities. Pre-renal AKI was the main mechanism;hypovolemia and sepsis were the major aetiologies. Most participants had

关键词： AKI Elderly Community Acquired Hypovolemia Sepsis

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Hematological Disorders during Chronic Kidney Disease Stages 3 to 5 Non-Dialysed in Cameroon

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Open Journal of Nephrology 2020年第2期10卷 61-72页

作者： Francois Folefack Kaze Mathurin Pierre Kowo Irene Nintcheu Wagou mahamat maimouna Hermine Danielle Menye Ebana Fouda Marie Patrice Halle Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Higher Institute of Health Sciences Bangangté Cameroon Department of Clinical Sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon

Introduction: Haematological disorders are common complications of chronic kidney disease (CKD) leading by anemia which increase with the severity of the disease. Objective: Assess the haematological profile of CKD patients stages 3 to 5 non-dialysed seen at the first nephrology consultation in Cameroon. Patients and Methods: A hospital-based cross-sectional study was conducted from February to July 2018 at the nephrology unit of the Yaounde University Teaching Hospital and Douala General Hospital. All adults’ (≥18 years old) patients who provided a written informed consent and attended their first nephrology consultation with a nephrologist diagnosis of CKD stages 3 to 5 non-dialysed were included. Clinical and paraclinical data (serum creatinine, full blood count, reticulocytes count, iron status, vitamin B12 and folates count, and bleeding time) were collected. Parametric, non-parametric and correlations tests were used to compare variables. Results: We included 105 (59% males) participants with a mean age of 55.2 ± 13.6 years divided into 20 (19%), 36 (34.3%) and 49 (46.7%) respectively in stage G3, G4 and G5 of CKD. The profile of hematological abnormalities was anemia (86.7%), leucopenia (15.2%), hyperleucocytosis (6.7%), thrombopenia (23.8%), thrombocytosis (3.8%) and prolonged bleeding time (13.3%) without any association with the stage of CKD (p > 0.05). The pattern of anemia was mainly normocytic and normochromic (59.3%) and aregenerative (92.3%) with iron deficiency found in 23 (21.9%) participants. There was no case of vitamin B12 and folates deficiency. Prolonged bleeding time was observed in 14 (13.3%) participants with a weak correlation between platelets count and bleeding time (r = 0.122). Conclusion: We observed that aregenerative normocytic normochromic anemia is the leading haematological abnormality during CKD in this setting. None of the full blood count parameters was associat

关键词： Hematologic Disorders 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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