Serigne Gueye

Prevalence of Chronic Cardiovascular and Metabolic Diseases in Senegalese Workers: A Cross-Sectional Study, 2010

Introduction Noncommunicable diseases (NCDs) are a major public health threat, particularly in developing countries. In sub-Saharan Africa, the scarcity of reliable data on NCDs in the general population makes it difficult to develop efficient prevention strategies. The objective of this cross-sectional study was to assess the prevalence of 4 cardiometabolic NCDs among 402 private-sector workers in Dakar, Senegal: high blood pressure (HBP), diabetes, obesity, and chronic kidney disease (CKD). Methods We collected demographic, clinical, and biological data for each worker during routine occupational health visits between September 1 and November 30, 2010. Multivariate analyses were performed to identify risk factors associated with NCDs. Results Among the 402 study participants, 24.1% had HBP, 9.7% had diabetes, 16.7% were obese, and 22.4% had CKD. About half of participants (48.5%) were not aware of their diseases before the screening. Univariate analysis showed that age was significantly associated with blood pressure, fasting blood glucose, and renal function. After adjusting for age and sex, systolic blood pressure was correlated with renal function, and physical inactivity was significantly associated with obesity. Conclusion Despite its small sample size, our study provides a perspective on the extent of cardiometabolic NCDs in Senegalese workers. Our study also suggests that targeted screening activities focusing on socio-professional groups may be helpful in the absence of national integrated prevention programs.

Trends in hepatitis C infection among hemodialysis patients in Senegal: Results of a decade of prevention

Chronic kidney disease is an emerging public health issue in Africa. At end-stage renal disease (ESRD), patients need hemodialysis (HD), which may expose them to blood transmitted infections, such as the hepatitis C virus (HCV). Sub-Saharan Africa has the highest HCV prevalence in the world, but data on HD patients is scarce and shows an exceptionally high rate in Senegal. To assess the efficacy of preventive measures in reducing HCV infection among dialysis patients, we retrospectively conducted a cross-sectional study in three Senegalese HD centers, including all HD patients who performed HCV serology between 1 st and 31 st August 2011. The demographical, clinical, and biological data were collected for each patient. We included 106 patients with a mean age of 43.4±15.8 years (range from 18 to 80 years), with 52.8% males. HD vintage was 60.5±15 months (range from six to 206 months). The main causes of kidney disease included nephrosclerosis (36%) and diabetes (24%). The prevalence of HCV was 5.6%, with one patient co-infected with the hepatitis B virus. After adjusting for age and sex, HD vintage was the only risk factor for HCV infection, while nutritional status and the number of blood transfusions did not significantly correlate with HCV infection. We conclude that during the past decade, the prevalence of HCV infection in HD patients living in Senegal has declined considerably, mainly because of improved transfusion measures and better clinical practice in the HD centers. Such efforts should be maintained and reinforced to reduce the seroprevalence of HCV infection.

The burden of erectile dysfunction in dialysis patients in Senegal.

Erectile dysfunction (ED) is very common in dialysis patients because of organic and psychological risk factors. It has a negative impact on patients quality of life. In Senegal, ED is assumed to be frequent in the general adult population but its prevalence in dialysis patients is unknown. This cross‐sectional study aimed to assess the prevalence and risk factors associated with ED in Senegalese dialysis patients. Seventy dialyzed men >18 years old were included. Erectile dysfunction was assessed using the abridged version of International Index of Erectile Function already validated in dialysis patients. Multivariate analysis was performed to identify the factors associated with ED in patients. The mean age of the patients was 52±11.3 years (21–70 years) and the median dialysis vintage was 39.4 months (interquartile range 9–51 months). The prevalence of ED was 81.5% for all patients (80% in hemodialysis and 81.75% in peritoneal dialysis). Severe ED was found in 11.5% of patients. The prevalence of ED was 74.5% in patients younger than 50 years and 86.6% in those 50 years or older. Marital status, comorbidity, hemoglobin level, and use of antihypertensive drugs were not different between patients with and without ED. Libido was conserved in 77% of patients and 44.7% were not satisfied during sexual intercourse. Multivariate analysis identified age and dialysis vintage as risk factors of ED in our patients. Only 7 patients received treatment for ED and 22% sought a consultation with a specialist (urologist and psychologist).

Hypertension in Black Africans with Autosomal Polycystic Kidney Disease

Introduction: High blood pressure (HBP) that is a leading cause of end-stage renal disease (ESRD) in black African populations and is frequently associated to autosomal polycystic kidney disease (ADPKD). This study aimed to describe prevalence and severity of HBP in black Africans with ADPKD and to identify associated risk factors. Patients and methods: We performed a retrospective study of 65 ADPKD patients regularly followed in outpatient nephrology clinic between 1995 and 2009. ADPKD was diagnosed according to recent unified criteria (2009). Statistical analyses were done with SPSS 16.0. Results: We included 65 patients (36 males and 29 females) with a mean age of 47 ± 5 years. Hypertension was found in 73.8 % of patients and it preceded diagnosis of ADPKD in 23 patients (median delay of 28 months). Mean systolic/diastolic blood pressure was 168 ± 30 /96 ± 16 mm Hg respectively. All hypertensive patients presented retinopathy and left ventricular hypertrophy. Two patients presented stroke. Fifty one percent of patients were treated with angiotensin converting enzyme inhibitors alone and 29% received combinations of anti-hypertensive drugs. One third of them had their blood pressure normalized. Patients with HBP at diagnosis showed a similar proportion of ESRD in comparison with normotensive patients (p=0.12). At univariate analysis, HBP was correlated with age, gender, BMI, GFR and proteinuria. Multiple regression analysis identified age (OR=1.95, p=0.05) and glomerular filtration rate (OR=2.33, p=0.001) as independently associated to HBP. Conclusion: Hypertension with organ damage is frequent in Senegalese patients with ADPKD. Age and glomerular filtration rate at diagnosis were the main risk factors of HBP identified in our patients.

Encapsulating peritoneal sclerosis

Encapsulating peritoneal sclerosis (EPS) is a rare but potentially lethal complication of peritoneal dialysis (PD). Peritoneal tuberculosis is considered an etiologic factor. We report a case of EPS in a 40-year-old man who was switched to hemodialysis because of peritoneal tuberculosis after 2 years of PD. Because of the persistence of gastrointestinal symptoms and cachexia, laparoscopic exploration was performed, which revealed an important thickening of the peritoneal membrane sheathing the intestinal loops. Accordingly, a diagnosis of EPS was made. Anti-tuberculosis treatment associated with a low dose of corticosteroids stabilized the disease.

A New PKD-1 Mutation Discovered in a Black African Woman With Autosomal Polycystic Kidney Disease

Autosomal polycystic kidney disease (ADPKD) is a genetic disorder with two causal PKD-1 and PKD-2. Genetic studies have demonstrated an important allelic variability between patients but few data are known about genetic variants in African populations. We report a new mutation found in a 41-year old women with mild chronic kidney disease secondary to ADPKD. Molecular genetic testing found a deletion of 2 nucleotides A and C at positions 7290 and 7291 followed by insertion of a 5-base pair (CTGCA) located in exon 18 of the PKD1 gene. This newly identified frame shifting was compared to the PKD gene database but no similar mutation was yet reported. Other screened family members did not present any mutation.

Impact of Integrating Chronic Kidney Disease Screening in Occupational Medicine Visits: A Pilot Experience in Senegalese Private Sector Workers

Introduction : Chronic kidney disease (CKD) represents an important cause of death and a burden on health systems particularly in low-income countries. To fight this epidemic early detection and primary prevention in at-risk population are recommended but in many African countries, they are inexistent. In this study we assessed the interest of integrating CKD screening in routine medical visits of private sector workers in Dakar. Methods : We conducted a cross-sectional survey in two major private companies who provided regular medical check-up to their employees. Data were collected during annual medical visits. Prevalence of chronic kidney disease (CKD) and additional costs related to renal screening were calculated. Statistical analyses were performed with SPSS 16.0. Results : We included 402 adults (266 men and 136 women) with a mean age of 46.2 ±7.6 (23-75). The mean estimated glomerular filtration rate was 99.8±23.5 ml/min/1.73m² (ranges 35.7-133.5 ml/min/1.73m²). Prevalence of CKD was 22.4% (22.2 % in women versus 22.8 % in men). Albuminuria was present in 5.5% of them. Hypertension was found in 12.1% of patients and prevalence of diabetes was 9.7% and 16.8% for obesity. Introduction of systematic renal screening helped to detect 90% CKD patients who had no clinical symptom even in those with diabetes and/or high blood pressure. Additional cost of the renal tests was estimated to 03 USD per worker yearly. Risk factors associated with low eGFR were age (OR= 1.15, 95% CI= 1.02 - 2.45; p=0.02) and systolic blood pressure (OR= 1.82, 95% CI=1.10 - 4.36; p=0.03). Conclusion : Despite limited sample size, this study demonstrates that opportunistic screening activities in specific socio-professional groups are helpful alternative in absence of national screening and prevention program.