Case report: 11 years on hemodialysis with a 4-year-old baby girl: A success story

Despite advances in clinical management and dialysis care, the outcome of unplanned pregnancy in women on maintenance hemodialysis (MHD) remains a difficult journey for the patient, fetus, and healthcare staff, particularly in low-resource countries. We report the successful outcome of a pregnancy in an anuric woman on twice-weekly maintenance hemodialysis for chronic glomerulonephritis since November 2012 in Cameroon. She was discovered pregnant at 18 weeks of gestation. The pregnancy was maintained until 36 weeks when a healthy 2,270 g female baby was delivered by elective cesarean section for tight nuchal cords and intrauterine growth retardation. The mother’s post-partum period was uneventful. Except for hypoglycemia shortly after birth, the baby was fine. The patient is still on hemodialysis after 4 years, and the child is healthy and attending school

Survival in elderly patients with kidney failure starting haemodialysis in Cameroon

Introduction: Elderly patients have an increased risk of kidney failure due to ageing and comorbidities. This study assessed survival among elderly patients starting maintenance haemodialysis at the Buea and Bamenda regional hospitals in Cameroon. Methods: We conducted a retrospective cohort study of elderly patients (65 years of age and older) who began maintenance haemodialysis between January 2016 and December 2020. The primary outcome of interest was survival at one year. Results: The proportion of elderly patients starting dialysis was 11%. There were 81 patients included in the study. Their median age at dialysis initiation was 70 years [interquartile range (IQR) 66–73 years] and 90% had high comorbidity scores according to the Charlson Comorbidity Index. The median survival time was 7.5 months (IQR 0.7–12.0 months) and the survival rate at one year was 41%. The most common causes of death were sudden death (42%), infection/sepsis (21%) and dialysis withdrawal (17%). The lowest survival time (median 6.5 days) was observed in patients older than 85 years, with a high comorbidity index. Emergency start to dialysis [hazard ratio (HR) 1.434, P = 0.032), age ≥75 years (HR = 19.384, P = 0.001), refractory hyperkalaemia as an indication for starting dialysis (HR = 1.244, P = 0.02) and high comorbidity index (HR = 2.819, P = 0.014)] were associated with poorer survival. Conclusions: Only half of the elderly patients were still alive one year after starting maintenance haemodialysis. Comorbidity score, age, refractory hyperkalaemia and emergency start to dialysis were associated with survival

Incidence, risk factors, and outcomes of acute kidney injury among hiv positive medical admissions at the Bamenda Regional Hospital

Background: There is a paucity of data on the burden of acute kidney injury (AKI) in hospitalized HIV-infected patients in Sub-Saharan Africa in the “test and treat” era.Objectives: To study the incidence, risk factors, and outcomes of AKI among HIV-positive medical admissions in a secondary hospital.Materials and methods: We prospectively screened adult HIV-positive patients who gave their informed consent and were admitted to the Bamenda Regional Hospital for AKI from February to June 2020. We excluded participants with Chronic Kidney Disease (CKD) Stage 5 and those with confounders of serum creatinine. On admission and after 2-7 days, we extracted a venous blood sample from each participant to evaluate serum creatinine and diagnose AKI. The participants were then followed up on until they were discharged or died. We measured the need for dialysis, access to dialysis, and renal recovery at three months for patients with AKI. The amended KDIGO 2012 criteria were used to define and classify AKI. The University of Bamenda’s institutional review board provided ethical approval.Results: A total of 206 participants (39.8% men) were enrolled, with a mean (SD) age of 45.71(13.13) years. On enrolment, 89.8% (n = 185) of the participants were on combination antiretroviral therapy (c-ART), with 81.6% (n = 151) on tenofovir-containing regimens. The WHO HIV clinical stages 3 and 4 were present in 81.5% (n = 168) of the individuals. The most common reason for hospitalization was opportunistic infections (69.8%; n = 142). AKI was found in 30.6% (n = 63) of the patients, with 58.7% (n = 37) of them being classified as KDIGO stage 3. A total of 12 (42.9%) participants out of the 28 in need, were dialyzed. AKI was independently associated with use of traditional medicines (aOR = 2.9; 95% CI 1.4-6.3; p = 0.006), WHO HIV stages 3 and 4 (aOR = 4.1; 95% CI 1.1-15.7; p = 0.038), hypotension (aOR = 3.3; 95% CI 1.4-7.8; p = 0.008) and low haemoglobin level ≤ 8.0 g/dl (aOR = 3.5; 95% CI 1.7-7.4; p = 0.001). The AKI group used to have a significantly higher mortality rate (42.9% vs. 16.1%; p < 0.001). Renal recovery was complete in 66.7% of the 30 survivors at three months, partial in 13.3%, and no recovery in 20% of the survivors.Conclusion: Despite the growing use of combination antiretroviral medication, significant immunosuppression is still common in hospitalized HIV-positive patients, increasing the risk of AKI and worsening prognosis. In this high-risk population, early detection of AKI with renal function monitoring may improve results