4 research outputs found

    Impact of Hypertension on the Survival of chronic hemodialysis patients in Kinshasa: A Historical Cohort Study: Impact de l’Hypertension sur la survie des patients hémodialysés chroniques à Kinshasa : Etude de cohorte historique

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    Context and objective. The relationship between hypertension and mortality among hemodialysis patients remains controversial. This study aimed to identify independent predictors of mortality and assess the impact of hypertension on the survival among Congolese chronic hemodialysis patients. Methods. This historical cohort study concerned Congolese chronic hemodialysis patients followed in two hemodialysis centers in Kinshasa between 2010 and 2013. The end point was survival (time-to-death). Patient and dialysis-related parameters were introduced in the Cox regression to identify independent predictors of mortality. We use Kaplan Meier method to describe survival. Survival curves based on the presence or not of Hypertension were assessed using the Log-Rank test. Results. 191 patients (mean age 52.3±12.3 years; men -68%; hypertensive 85 %), were included. Among them, 88 patients died (46 %) Independent predictors of all-cause mortality were: temporary catheter use [aHR 7.72; 95% CI 1.84-32.45;  p=0.024], low Socioeconomic Status (SES) [aHR 2.57; 95% CI 1.06-6.27; p=0.038], being non-hypertensive [aHR 2.38; 95% CI 1.35-3.04; p=0.003], presence of perdialytic complications [aHR 2.28; 95% CI 1.12-4.66; p=0.024] and non EPO use [aHR 2.23; 95% CI 1.32-3.74; p=0.038]. Compared to non-hypertensive, hypertensive patients had significantly better median survival (4 vs 16 months; Log rank p ≤0.001). Conclusion. Despite the very high mortality in the study population, Congolese chronic hemodialysis hypertensive patients had better survival compared to nonhypertensive patients. This paradox already reported in other studies can be explained by reverse epidemiology. Contexte et objectif. La relation entre l’hypertension et la mortalitĂ© chez les patients hĂ©modialysĂ©s est très controversĂ©e. L’objectif de la prĂ©sente Ă©tude Ă©tait d’identifier les prĂ©dicteurs indĂ©pendants de la mortalitĂ© en hĂ©modialyse chronique et d’évaluer l’impact de l’hypertension sur la survie des patients congolais hĂ©modialysĂ©s. MĂ©thodes. Cette Ă©tude de cohorte historique a concernĂ© les patients hĂ©modialysĂ©s chroniques congolais traitĂ©s dans deux centres d’hĂ©modialyse Ă  Kinshasa entre 2010 et 2013. Les courbes de survie de Kaplan Meier basĂ©es sur la prĂ©sence ou non d’hypertension ont Ă©tĂ© comparĂ©es Ă  l’aide du test de Log-Rank. RĂ©sultats. 191 patients (âge moyen de 52,3 ± 12,3 ans; hommes 68%; hypertendus 85%) ont Ă©tĂ© inclus. Parmi eux, 88 Ă©taient dĂ©cĂ©dĂ©s (46%). Les prĂ©dicteurs indĂ©pendants de la mortalitĂ© toutes causes confondues Ă©taient les suivants : utilisation de cathĂ©ters provisoires [aHR 7,72; IC Ă  95%: 1,84 Ă  32,45; p = 0,024], statut socioĂ©conomique faible (SSE) [aHR 2,57; IC Ă  95% 1,06-6,27; p = 0,038], l’absence d’hypertension artĂ©rielle [aHR 2,38; IC 95% 1,35-3,04; p = 0,003], prĂ©sence de complications per dialytiques [aHR 2,28; IC Ă  95% 1,12-4,66; p = 0,024] et la non utilisation de l’ EPO [aHR 2,23; IC 95% 1,32-3,74; p =0,08]. ComparĂ©s aux patients normotendus, les hypertendus avaient significativement une meilleure survie mĂ©diane (4 versus 16 mois ; Log Rank p ≤0,001). Conclusion. MalgrĂ© une mortalitĂ© très Ă©levĂ©e dans la population d’étude, les patients hypertendus congolais en hĂ©modialyse chronique avaient une meilleure survie par rapport aux patients normotendus. Ce paradoxe dĂ©jĂ  signalĂ© dans d’autres Ă©tudes peut s’expliquer par l’épidĂ©miologie inverse. &nbsp

    Recommandations de la Société Congolaise de Néphrologie (SOCONEPH) pour la Prise en Charge des Patients en Dialyse dans le contexte de Pandémie à COVID-19 : Recommendations of the Congolese Society of Nephrology for the Management of Dialysis Patients in the Context of a COVID-19 Pandemic

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    Patients on haemodialysis are likely to be at increased risk of novel coronavirus disease (COVID-19). Preventive strategies must be implemented to minimize the risk of disease transmission in dialysis facilities, including education of staff and patients, screening for COVID-19 and separation of infected or symptomatic and non-infected patients. Les patients en hémodialyse présente un risqué élevé d’infection à SARS-Cov-2. Les stratégies préventives doivent donc être mises en place pour réduire le risque de transmission de la maladie en hémodialyse parmi lesquelles, l’éducation du staff médical ainsi que des patients, le screening de la maladie à COVID-19 ainsi que la séparation des patients infectés ou symptomatiques des non infectés. &nbsp

    Frequency and factors associated with proteinuria in COVID-19 patients: a cross-sectional study

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    Proteinuria is a marker of severity and poor outcome of patients in intensive care unit (ICU). The objective of this study was to determine the frequency of proteinuria and the risk factors associated with proteinuria in Congolese COVID-19 patients. The present cross sectional study of proteinuria status is a post hoc analysis of data from 80 COVID-19 patients admitted at Kinshasa Medical Center (KMC) from March 10th to July 10th, 2020. The population under study came from all adult inpatients (≥18 years old) with a laboratory diagnosis by polymerase chain reaction (PCR) of COVID-19 were selected and divided into two groups (positive proteinuria and negative proteinuria group). Logistic regression models helped to identify the factors associated with proteinuria. The P value significance level was 0.05. Among 80 patients who tested positive for SARS-CoV-2 RT-PCR, 55% had proteinuria. The mean age was 55.2 ± 12.8 years. Fourty-seven patients (58.8%) had history of hypertension and 26 patients (32.5%) diabetes. Multivariable analysis showed age ≥65 years (aOR 5,04; 95% CI: 1.51-16.78), diabetes (aOR 3,15 ;95% CI :1.14-8.72), ASAT >40 UI/L (aOR 7,08;95% CI:2.40-20.87), ferritin >300 (aOR 13,47 ;95% CI :1.56-26.25) as factors independently associated with proteinuria in COVID-19 patients. Proteinuria is common in Congolese COVID-19 patients and is associated with age, diabetes, ferritin and aspartate aminotransferase (ASAT)

    Prevalence and determinants of Hepatitis C Virus Infection and Genotypes in Chronic Hemodialysis Patients in Kinshasa: Prévalence et déterminants de l’infection par le virus de l’hépatite C et génotypes chez les hémodialysés chroniques, à Kinshasa

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    Contexte et Objectifs. Le nombre des patients hémodialisés en Afrique subsaharienne en constante augmentation ; justifiant de ce fait une meilleure prise en charge de ces patients. La présente étude détermine la prévalence de l’infection par le virus de l’hépatite C en en determinant les génotypes ainsi que les facteurs y associés dans ce groupe de patients. Méthodes. 127 patients hémodialisés chroniques ont subis des tests sérologiques à la recherche des anticorps anti-VHC dans plusieurs centres de Kinshasa de février à juin 2018. Le génotype viral a été déterminé par la RT-PCR. Résultats. La fréquence des anticorps anti-VHC a varié de 0 à 52,9 % dans ce groupe. Les génotypes le plus fréquents ont été le 4 (18/22) et le 2 (2/22) ; étant sumultanément rétrouvé chez un patient, et indéterminé chez un autre sujet. Avoir reçu au moins 4 transfusions [7,21 (1,09-10,61; p=0.040)], ne pas être sous EPO [5,81(1,47-12,96); p=0.012)], être en hémodialyse depuis au moins 14 mois [3,63(1,60-5,05); p=0.035)] et être dialysé dans un centre surchargé [2,06 (0,83-5,86); p=0.073)] étaient associés à un risque plus élevé d’infection par le VHC. Conclusion. Ses principaux déterminants sont : le nombre des transfusions sanguines et la durée d'HD ; d’où la nécessité de réduire les transfusions sanguines chez les sujets dialysés par l'administration d'EPO, étant donné le coût prohibitif du traitement contre le VHC dans notre contexte. Context and objective. The steady increase in the number of chronic hemodialysis patients in sub-Saharan Africa (SSA) calls for improved management of those patients. The present study aimed to determine the frequency of hepatitis C virus (HCV) infection, the prevalent genotypes, and the risk factors associated with HCV in hemodialysis patients in Kinshasa (DR Congo). Methods. A cross-sectional study was conducted from February to June 2018 in all hemodialysis centers in Kinshasa. Blood samples were collected from 127 chronic hemodialysis patients and tested for the presence of antibodies against HCV. The HCV genotype was identified by real-time polymerase chain reaction (RT- PCR). Results. Twenty-two (17.3 %) patients were positive for anti-HCV antibodies, ranging from 0 % to 52.9 % in different centers. Genotype 4 was detected in 18/22 (81.8 %), followed by genotype 2 in 2/22 (9.1%), and both genotypes 2 and 4 in one patient (4.5%). One patient had an undetermined genotype (4.5 %). Having received at least 4 transfusions [7,21 (1,09-10,61); p=0.040)], not being under EPO treatment [5,81(1,47-12,96); p=0.012)], being on hemodialysis for at least 14 months [3,63(1,60-5,05); p=0.035)]and being dialyzed in an overloaded center [2,06(0,83-5,86); p=0.073)] were associated with a greater risk of HCV infection. Conclusion. This high HCV prevalence (17.3 %) represents a substantial health burden in HD patients from Kinshasa, DR Congo. It is largely driven by the number of blood transfusions, the duration time in hemodialysis. Observations from the present study underscore the need of reducing the number of blood transfusions in people on dialysis through the administration of erythropoietin, given the unaffordable cost of HCV therapy for most individuals in DR Congo
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