Impact of Dialysis Adequacy on Patient Outcomes

Faculty of Health Sciences, Degree of Master in Medicine. 9713161hIntroduction: Numerous studies have confirmed the association between the delivered dose of haemodialysis and patients outcomes. There is thus some evidence regarding the relationship between dialysis dose and quality of life. Objective: The study was designed to assess dialysis adequacy using urea kinetic modelling parameters and to determine the association between dialysis dose and patient outcomes. Methods: A retrospective review of the demographic and biochemical data of 61 patients on chronic haemodialysis in the year 2003 was performed and a prospective component was added to the study for quality of life and evaluation of cardiovascular comorbidity. Results: The mean delivered dose Kt/V was 1.34 ± 0.25. There was a statistically significant correlation (p<0.05) between dialysis dose and the following parameters: haemoglobin, physical dimension and its 3 scales, the SF-36 overall score, as well as between dialysis dose and sepsis. Conclusion: The dialysis dose correlated with a significant number of parameters including Hb and the physical components of the SF-36; hence, the importance of measuring the delivered dialysis dose of patient on maintenance dialysis in accordance with DOQI guidelines for improved patient outcomes is confirmed

Secondary Data Use in Rwanda: Leveraging OpenMRS for Global HIV Research

The Rwandan Ministry of Health supports a countrywide installation of the Open Medical Record System (OpenMRS) to improve clinical recordkeeping and patient care. However, electronic medical records also can be a valuable source of data for observational and experimental studies. We describe the challenges and lessons learned when reusing OpenMRS data in Rwanda for global HIV epidemiology research

Improved quality of life following direct‐acting antiviral treatment for chronic hepatitis C infection in Rwanda: Results from a clinical trial in sub‐Saharan Africa (the SHARED study)

Around 71 million people are living with chronic hepatitis C virus (HCV) infection, with approximately 14% residing in Sub‐Saharan Africa. Direct acting anti‐viral (DAA) therapies offer clear benefits for liver‐related morbidity and mortality, and data from high‐income settings suggest that DAA treatments also provide significant benefits in terms of health‐related quality of life (HRQL). In this study, we assessed the effect of DAA treatment on HRQL for individuals treated for HCV in a clinical trial in Rwanda. We assessed the HRQL of participants using an 83‐question composite survey at Day 0 (‘baseline’) and Week 24 (‘endpoint’). Data were analyzed in R. 296 participants were included in this analysis. Their ages ranged from 19‐90 and 184 (62.2%) were female. There were significant improvements from baseline to endpoint median scores for all physical and mental quality of life sub‐scales. Additionally, a reduction – before and after treatment ‐ in the proportion of those classified as depressed and needing social support was statistically significant (both p<0.001). Economic productivity increased after treatment (p<0.001) and households classified as food secure increased from baseline to endpoint (p<0.001). These results demonstrate that Rwandans with chronic HCV infection experience both clinical and HRQL benefits, including household level benefits like substantial gains in workforce stability, economic productivity, and poverty alleviation, from DAA treatment. A stronger demonstration of accurate and broader household level benefits achieved through treatment of HCV with DAAs will help financing and investment for HCV in resource‐constrained settings become an urgent priority

“Waiting for DAAs”: A retrospective chart review of patients with untreated hepatitis C in Rwanda

BACKGROUND:Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs. METHODS AND FINDINGS:We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09-1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus. CONCLUSIONS:Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa