Prevalence and risk factors of chronic kidney disease in urban adult Cameroonians according to three common estimators of the glomerular filtration rate: a cross-sectional study

BACKGROUND: Chronic kidney disease (CKD) is a major threat to the health of people of African ancestry. We assessed the prevalence and risk factors of CKD among adults in urban Cameroon. METHODS: This was a cross-sectional study of two months duration (March to April 2013) conducted at the Cite des Palmiers health district in the Littoral region of Cameroon. A multistage cluster sampling approach was applied. Estimated glomerular filtration rate (eGFR) was based on the Cockcroft-Gault (CG), the four-variable Modification of Diet in Renal Disease (MDRD) study and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Logistic regression models were used to investigate the predictors of CKD. RESULTS: In the 500 participants with a mean age of 45.3+/-13.2years included, we observed a high prevalence of overweight and obesity (60.4%), hypertension (38.6%) and diabetes (2.8%). The mean eGFR was 93.7+/-24.9, 97.8+/-24.9 and 99.2+/-31.4ml/min respectively with the MDRD, CG and CKD-EPI equations. The prevalence of albuminuria was 7.2% while the prevalence of decreased GFR (eGFR<60ml/min) and CKD (any albuminuria and/or eGFR<60ml/min) was 4.4 and 11% with MDRD, 5.4 and 14.2% with CG, and 8.8 and 10% with CKD-EPI. In age and sex adjusted logistic regression models, advanced age, known hypertension and diabetes mellitus, increasing body mass index and overweight/obesity were the predictors of albuminuria, decreased GFR and CKD according to various estimators. CONCLUSION: There is a high prevalence of CKD in urban adults Cameroonian, driven essentially by the commonest risk factors for CKD

Cost of care for patients on maintenance haemodialysis in public facilities in Cameroon

Background: The management of end-stage kidney disease constitutes a heavy burden on communities worldwide due to the high cost of renal replacement therapy (RRT). Data on the cost of RRT are scanty in low-income countries. This study aimed to evaluate the global cost of haemodialysis in Cameroon, an emerging economy in Central Africa. This will provide data to help healthcare planners develop more cost-effective strategies for the care of these patients.Methods: A prospective cost analysis of chronic haemodialysis care in three public-sector facilities was conducted in Cameroon. Both incident and prevalent patients were enrolled and followed up for 6 months. Patient data and costs were collected from patient interviews, medical records, bills, hospital price-lists and the procurement departments of the hospitals. Direct medical costs included outpatient consultation fees, dialysis consumables, dialysis session fees, drugs, laboratory and radiological tests. Non-medical direct costs included the cost of transport, feeding, water and electricity. Indirect costs related to the monthly loss of productivity for patients and their caretakers. The annual costs were calculated as the median costs for 6 months multiplied by 2 and were expressed in the local currency, the Central African franc (XAF), and US dollars ($).Results: A total of 154 patients (62.3$ 13 581). Out-of-pocket payments amounted to XAF 2 420 300 ($4 114), accounting for 30$ 12 679) and indirect cost XAF 530 600 ($902). Direct medical costs accounted for 88$ 754 were incurred. The cost of hospitalization, laboratory and radiology tests, feeding, consultation fees and some drugs varied significantly among facilities.Conclusions: Compared to the national gross domestic product per capita in Cameroon, the cost of care of patients on haemodialysis is high. Out-of-pocket payments are out of the reach of most patients and there is a need for implementing other cost-effective strategies to prevent and manage end-stage kidney disease in our setting.Key words: cost analysis, haemodialysis, peritoneal dialysis, Cameroon.    

The profile of patients with obstructive uropathy in Cameroon: case of the Douala General Hospital

Introduction: Obstructive uropathy can lead to irreversible kidney damage. The etiology largely determined by the patient's age can be benign or malignant. This study aimed at determining the profile and outcome of patients with obstructive uropathy in Cameroon. Methods: A cross sectional study carried out in the urology unit of the Douala General Hospital, including patients with a diagnosis of obstructive uropathy seen from January 2004 to December 2013. Clinical profile, treatment and outcome data were obtained from patients records. Results: Of the 229 patients included 69% were men, mean age 50 ±18 years. Associated comorbidities were hypertension, diabetes, and HIV. Mean haemoglobin 8,40±2,4g/dl, mean GFR 10,3 ±10ml/min, 94 (41%) patients needed emergency dialysis. Symptoms at presentation: asthenia (57%), anorexia (55%), loin pain (37%), vomiting (28%), oedema (20%), and anuria (15%). Urinary tract infection was present in 33 patients. Main aetiologies of obstruction: urolithiasis (35%), begnin prostatic hypertrophy (27%), prostatic cancer (12%), cervical cancer (16%), and congenital malformations (5%). Drainage was effective in 102 (45%) patients, 63 (28%) recovered completely, 91 (41%) were loss to follow up, 49 (22%) died and more women (p=0.02). Mortality was associated with prostatic cancer (p=0.000), cervical cancer (p=0.004) and radiotherapy (p=0.03). Conclusion: Patients with obstructive uropathy presented with significant impaired renal function. Main causes were urinary stones, prostatic hypertrophy, prostatic and cervical cancers. Renal recovery was poor, loss to follow up and mortality high. Specific strategies to target improvement in renal recovery and patient's survival are needed in this patient's group.Pan African Medical Journal 2016; 2

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). Fisher's exact test was used for dichotomous variables and using Mann Whitney's 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

The practices of anaesthesiologists in the management of patients with sickle cell disease: Empirical evidence from cameroon

Patients with sickle cell disease are more likely to undergo surgery during their lifetime, especially given the numerous complications they may develop. There is a paucity of data concerning the management of patients with sickle cell disease by anaesthesiologists, especially in Africa. This study aimed to describe the practices of anaesthesiologists in Cameroon concerning the perioperative management of patients with sickle cell disease. A cross-sectional study was carried out over four months and involved 35 out 47 anaesthesiologists working in hospitals across the country, who were invited to fill a data collection form after giving their informed consent. The data were analysed using descriptive statistics and a binary logistic regression model. Among the 35 anaesthesiologists included in the study, most (29 (82.9%)) had managed patients with sickle cell disease for both emergency and elective surgical procedures. Most of them had never asked for a haematology consultation before surgery. Most participants (26 (74.3%)) admitted to having carried out simple blood transfusions, while 4 (11.4%) carried out exchange transfusions. The haemoglobin thresholds for transfusion varied from one practitioner to another, between <6 g/dL and <9 g/dL. Only 6 (17.1%) anaesthesiologists had a treatment guideline for the management of patients with sickle cell disease in the hospitals where they practiced. Only 9 (25.7%) prescribed a search for irregular agglutinins. The percentage of haemoglobin S before surgery was always available for 5 (14.3%) of the participants. The coefficient (0.06) of the occurrence of a haematology consultation before surgery had a significant influence on the probability of management of post-operative complications (coefficient 0.06, 10% level of probability). This study highlights the fact that practices in the perioperative management of patients with sickle cell disease in Cameroon vary greatly from one anaesthesiologist to another. We disclosed major differences in the current recommendations, which support the fact that even in Sub-Saharan countries, guidelines applicable to the local settings should be published.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Factors associated with late presentation of patients with chronic kidney disease in nephrology consultation in Cameroon-a descriptive cross-sectional study

Background: Late presentation (LP) of chronic kidney disease (CKD) patients to nephrologist is a serious problem worldwide with persistent high prevalence despite known benefits of early nephrology care. Objective: Determine the prevalence and factors associated with LP of CKD patients to nephrologists in Cameroon. Methods: A cross-sectional study from October 2015 to May 2016 at the nephrology units of the Douala General and Laquintinie hospitals, including all consenting incident CKD patients. Data collected were: socio-demographic, search of CKD diagnostic criteria during prior follow up, therapeutic itinerary, clinical and biological parameters at presentation, knowledge on CKD and attitude towards dialysis. LP was defined as eGFR < 30 ml/min/1.73 m2. It was physician-related whenever no CKD screening was done in the presence of risk factor or no referral to nephrologists at early stages; patient-related whenever patients did not have recourse to hospital care while symptomatic or disrespected a referral decision. p value <.05. Results: We included 130 patients, mean age 53.10 ± 14.66 years, 60.77% males, 58.70% were referred by internal medicine physicians and 10% had recourse to complementary and alternative medicine (CAM). At presentation, 70.80% were symptomatic, 53% had CKD stage five, 86.12% were poorly graded on knowledge and 49% had a negative attitude towards dialysis. The prevalence of LP was 73.90%, 50% was physician-related, 44.79% patient-related and 5.21% both. Being accompanied (p = .038), a low level of education (p = .025) and recourse to CAM (p = .008) were associated with LP. Conclusion: LP is high in Cameroon, attributed to physician’s practical attitudes and patient’s socio-cultural behaviors and economic conditions

Risk Factors, Epidemiology and Outcome of Acute Kidney Injury among Pediatric Admissions in a Primary Health Facility in Cameroon

Background and aim: Little is known about what happens in primary health structures without nephrology care, especially in the paediatric population. We sought describe the epidemiology of AKI in children at risk in district hospitals in Cameroon. Methods: We prospectively screened consenting children aged 2-18 years of age in paediatric wards of 3 large urban district hospitals over a period of 4 months. Participants with AKI were then followed up till discharge. Outcomes of interest were need and access to dialysis, and renal recovery on hospital discharge. Written assent was obtained from parents or caregivers. Results: Among the 211 children admitted during the study period, 82% (n=173) were at risk of AKI, of whom 19 (11%) did not consent. Of the 154 children included 54.5% were males and the median age was 6 years [IQ 3-10]. Sepsis and volume depletion were the most common risk factors of AKI. The incidence of AKI was 12.3% (n=19). AKI was mostly community acquired and 47.4% (n=9) patients were in KDIGO stage 3. Pre-renal AKI and acute tubular necrosis accounted for 63.2% and 36.8% respectively. Gastro-intestinal losses, malaria, bacterial sepsis and nephrotoxins were the common aetiologies of AKI. On discharge, 71.7% of AKI had complete recovery renal function. Conclusion: Risk factors of AKI are very common in children on admission in general district hospitals in Cameroon. Efforts should be made to raise awareness of primary health caregivers about risk assessment, prevention, early recognition and management of AKI in children

Incidence, characteristics and prognosis of acute kidney injury in Cameroon: a prospective study at the Douala General Hospital

Objective: There are limited data on AKI in sub-Saharan Africa. We aim to determine the incidence, characteristics and prognosis of AKI in Cameroon. Patients and methods: A prospective study including all consenting acute admissions in the internal medicine and the ICU of a tertiary referral hospital in Cameroon from January 2015 to June 2016. Serum creatinine assay was done on admission, days 2 and 7 to diagnose AKI. For patients with AKI, serum creatinine was done on discharge, days 30, 60 and 90. AKI was defined according to the modified KDIGO 2012 criteria as an increase or decrease in serum creatinine of 3 mg/l or greater, or an increase of 50% or more from the reference value obtained at admission or the known baseline value. AKI severity was graded using KDIGO2012 criteria. Outcome measures were renal recovery, mortality and causes of death. Renal recovery was complete if serum creatinine between the first 90 days was less than baseline or reference, partial if less than diagnosis but not baseline or reference, no-recovery if creatinine did not decrease or if the patient remained on dialysis. Results: Of the 2402 patients included, 536 developed AKI giving a global incidence of 22.3% and annual incidence of 15 per 100 patients-years. Of the 536 patients with AKI, 43.3% were at stage 3, 54.7% were males, median age was 56 years. Pre-renal AKI (61.4%) and acute tubular necrosis (28.9%) were the most frequent forms. Main etiologies were sepsis (50.4%) and volume depletion (31.6%). Renal outcome was unknown in 34% of patients. Of the 354 patients with known renal function at 3 months, 84.2% recovered completely, 14.7% partially and 1.1% progressed to CKD. Global mortality rate was 36.9% mainly due to sepsis. Conclusions: AKI is frequent in our setting, mainly due to sepsis and hypovolemia. It carries a poor prognosis