Marie-Patrice Halle

Acute pulmonary oedema in chronic dialysis patients admitted into an intensive care unit

BACKGROUND Acute pulmonary oedema (APO) in patients undergoing chronic dialysis (CD), a common cause of hospital admission in this population, is poorly documented. The objective of this study was to determine the causes, profile, clinical course and outcomes of APO in CD patients admitted in an intensive care unit (ICU). METHODS Medical charts of all CD patients consecutively admitted for APO in the renal ICU of the Tenon Hospital (Paris, France) between January 2000 and December 2007 were considered. Data collection included patient characteristics, etiologic factors for chronic renal failure and co-morbidities, past history of APO, precipitating factors, clinical evolution and outcomes. RESULTS Of the 112 files considered, 102 (65% men) were included in the final analysis. Patients were aged 20-88 years and had been dialysed for a median duration of 2 years. Hypertension (36.3%), chronic glomerulonephritis (25.5%) and diabetes mellitus (17.6%) were the main etiologic factors of chronic renal failure; 38.2% had a past history of APO. Acute pulmonary infection (26%), excessive interdialytic weight gain (25%) and inappropriate dry weight prescription (23%) were the leading causes of APO. The duration of hospitalization was <4 days in 60% of participants. Nine deaths (four being of cardiac origin) were recorded. Being referred from another hospital service was the main predictor of death. CONCLUSIONS APO fuelled in part by chest infection, excessive interdialytic weight gain and inappropriate dry weight are important causes of hospitalization in CD patients. Mortality is high among those referred from other services usually in critical conditions.

Prevalence and Determinants of Chronic Kidney Disease Among Hypertensive Cameroonians According to Three Common Estimators of the Glomerular Filtration Rate

Hypertension is a risk factor for renal diseases, which, in turn, are precursors of hypertension. The authors assessed the prevalence and determinants of chronic kidney disease (CKD) among 336 hypertensive adult Cameroonians (mean age, 60.9±11.3 years; 63.4% women) at Yaoundé. Any participant with an estimated glomerular filtration rate <60 mL/min/1.73 m2 regardless of the equation used (Cockcroft‐Gault [CG], Modification of Diet in Renal Disease [MDRD], and Chronic Kidney Disease Epidemiology Collaboration [CKD‐EPI]) and/or dipstick proteinuria was reviewed 3 months later. Participants presented a high prevalence of diabetes (18.5%), dyslipidemia (17.6%), gout/hyperuricemia (10.7%), overweight/obesity (68.8%), self‐medication (37.5%), and alcohol consumption (33.3%). Hypertension was uncontrolled in 265 patients (78.9%). The prevalence of CKD was 49.7%, 50.0%, and 52.1% according to MDRD, CKD‐EPI, and CG equations, respectively. Advanced age, adiposity, and severity of hypertension were determinants of CKD. Nearly half of the hypertensive patients had CKD regardless of the estimators used, predicted by well‐known risk factors.

Kidney function, urinalysis abnormalities and correlates in equatorial Africans with sickle cell disease

Background Little is known about the renal profiles of individuals with sickle cell disease (SCD) in equatorial Africa, the global epicenter of SCD. We evaluated the kidney function, urinalysis abnormalities and their correlates in a group of Cameroonians homozygous for SCD. Methods This was a cross-sectional study of 4-month duration involving 72 homozygous SCD patients (39 men, 54%), recruited during routine visit or vaso-occlusive crisis at the Yaoundé Central Hospital in Cameroon. Clinical and laboratory data were used to evaluate the renal and urinalysis parameters, and potential effects of SCD-related clinical and hematological variables on those parameters investigated through linear and logistic regression models. Results The mean serum creatinine increased with increasing age, translating into a decreasing estimated glomerular filtration rate (eGFR) with age (P < 0.001). One patient (1.4%) had an eGFR of <60 mL/min and nine others (12.5%) had 60 ≤ eGFR ≤ 90 mL/min. The eGFR was lower in women and decreased with increasing systolic blood pressure. The prevalence of proteinuria (>200 mg/g) was 93% and the main urinalysis abnormalities were leukocyturia (77.8%), albuminuria (40.3%), hematuria (13.9%) and cristalluria (9.7%). None of the predictive clinical, hematological and urinary factors studied was associated with proteinuria or albuminuria, while hematuria and leukocyturia were associated with increasing age and male gender. Conclusions Cameroonians homozygous for SCD present a high prevalence of proteinuria and urinalysis abnormalities, and a slight renal impairment. Age, blood pressure variables and gender seem to be the main determinants. Urinalysis abnormalities and kidney function assessment should be an active pursuit in women with SCD.

The Epidemiology of Acute Kidney Injury in a Tertiary Hospital in Cameroon: A 13 Months Review

Background: The etiologies and outcome of Acute Kidney injury (AKI) in resource-limited countries are largely related to poverty. Outcome is marred by limited access to renal replacement therapy. Recently, partial government funding for hemodialysis in Cameroon and the SYL program have increased access to RRT for AKI in Cameroon. Data on AKI is sparse in Cameroon. We sought to describe the epidemiology of diagnosed AKI amongst patients in a tertiary hospital. Method: We retrospectively reviewed records of patients seen by the nephrology department for AKI over a 13 months period in a tertiary Hospital in Cameroon. Diagnostic of AKI was done using usual criteria. We evaluated access to dialysis, renal recovery at hospital discharge and at 3 months and patient survival at hospital discharge. Results: A total of 108 (61 males, 12 children) patients with AKI were identified among 303 nephrology in-patient consults or admissions during the study period. The mean age was 45.65± 21.23 years. Community acquired AKI was most common (70.4%). Pre-renal, renal and obstructive causes accounted for 26.9%, 62% and 11.1% patients respectively. Infections (n=36, 33.34 %) and toxins (n=21, 19.4 %) were most frequent causes. AKI was pregnancy related in 12 (11%), and malaria-related in 10 (10 %) cases. AKI was multifactorial in 21.3% of patient. Dialysis was indicated in 55 (50.9%) patients but only 30 (27.8%) patients effectively underwent the therapy. Reasons for no access to dialysis were lack of appropriate material and lack of funds. At 3 months, 34 (31.5%) were known dead, 41 (38%) complete renal recovery, 25 (23%) partial recovery and 8 (7.5%) loss to follow-up. No patient was dialysisdependent. Conclusion: Infection and nephrotoxins are the main etiologic factor of AKI. Its prognostic is severe: half of patients need dialysis and third die.

La survie en hémodialyse chronique au Cameroun

INTRODUCTION Haemodialysis is the only renal replacement therapy available in Cameroon; 95% of patients has received subsidies by the State since 2002 and the number of dialysis centers is growing. However, since the opening of the first center in 1990, there are no data on survival in chronic dialysis patients. METHODS We conducted a multicenter prospective cohort study of 15 months in order to assess mortality rates and factors that influence the survival of chronic hemodialysis patients in Cameroon. RÉSULTS We followed 197 patients of whom 109 were incident patients. The average age was 47,97± 13.19 years and 55% were male. The mean duration of dialysis in prevalent patients was 12.5 months. The mortality rate was 57,58%, 50% of which occurred the first 3 months and abandonment rate was 8.6%. Uremia and catheter-related sepsis were the main causes of death. At a median follow up of 15 months, the overall survival was 30.77%, with an average duration of life of 8 months. Prevalent patients, patients place of residence where the dialysis center is located, nonfamily management, predialysis follow up > 3 months, blood cholesterol when patient first started on dialysis> 1.5g/l, a mental test score > 25 were associated with a better survival. CONCLUSION In Cameroon, mortality rate in hemodialysis patients is high, with a mean survival time of 8 months; most patients die within the first 3 months.

Incidence and factors associated with seroconversion to hepatitis C virus seropositivity amongst patients on maintenance hemodialysis, douala-cameroon

Hepatitis C virus (HCV) infection one of the most common blood-borne infections is endemic in Cameroon and a serious problem in hemodialysis (HD). We aimed to determine the annual incidence and factors associated with seroconversion to hepatitis C positivity amongst patients on maintenance HD after an exposition of two years in a center with a high prevalence of hepatitis C (20.6%) and where no isolation policy is practiced. This was a retrospective cohort study carried out in January 2015 in the HD unit of Douala General Hospital in Cameroon including 71 patients on maintenance HD who tested negative for HCV in January 2013. Socio-demographic characteristics and clinical data were recorded, while for each patient 10 mL of blood was collected and patients retested for HCV using a fourth-generation ELISA test (BIOREXR BXEO781A). Fishers exact test was used for dichotomous variables and using Mann Whitneys test for quantitative variables. Statistical significance was set at P <0.05. Mean age was 47 ± 13 years with 60.6% male. Blood transfusion was the main means for anemia management (85.9%) with a median number of blood units received of 5 (1-44). Facility HCV prevalence was 19.3% in January 2015. Five out of the 71 patients developed anti-HCV antibodies giving us a seroconversion rate of 7.1% and an incidence of 3.6/100 patient years. There was no significant association between age (P = 0.4), number of blood units received (P = 0.8) origin of blood units (P = 0.8), scarifications (P = 0.09) and seroconversion. After two years of exposure seroconversion to HCV positivity was 7.1% in our center with no associated factors. In a setting with high prevalence of HCV, isolation of positive patient may help to reduce the rate of transmission.