Prevalence and determinants of chronic kidney disease in rural and urban Cameroonians: a cross-sectional study

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem that disproportionally affects people of African ethnicity. We assessed the prevalence and determinants of CKD and albuminuria in urban and rural adults Cameroonians. METHODS: This was a cross-sectional study of 6-month duration (February to July 2014), conducted in the health district of Dschang (Western Region of Cameroon), using a multistage cluster sampling. All adults diagnosed with albuminuria ([greater than or equal to]30mg/g) and/or decreased estimated glomerular filtration rate (eGFR) (<60ml/min/1.73m 2 ) were re-examined three months later. Logistic regression models were used to relate baseline characteristics with prevalent CKD. RESULTS: We included 439 participants with a mean age of 47+/-16.1years; with 185 (42.1%) being men and 119 (27.1%) being urban dwellers. There was a high prevalence of hypertension (25.5%), diabetes (9.8%), smoking (9.3%), alcohol consumption (59.7%), longstanding use of herbal medicine (90.9%) and street medications (87.5%), and overweight/obesity (53.3%) which were predominant in rural area. The prevalence of CKD was 13.2% overall, 14.1% in rural and 10.9% in urban participants. Equivalents figures for CKD stages G3-G4 and albuminuria were 2.5%, 1.6% and 5.0%; and 12.1%, 14.1% and 6.7% respectively. Existing hypertension and diabetes were associated with all outcomes. Elevated systolic blood pressure and the presence of hypertension and diabetes were the predictors of albuminuria and CKD while urban residence was associated with CKD stages G3-G4. CONCLUSION: The prevalence of CKD and albuminuria was high in this population, predominantly in rural area, and driven mostly by the commonest risk factors

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

Comparison of different blood pressure indices for the prediction of prevalent diabetic nephropathy in a sub-Saharan African population with type 2 diabetes

Background: The association between blood pressure (BP) and diabetic kidney diseases in Africans has been less well investigated. We assessed and compared the strength of the association and discriminatory capability of systolic (SBP), diastolic (DBP) BP, pulse pressure (PP) and mean arterial blood pressure (MAP) for nephropathy risk in sub-Saharan Africans with type 2 diabetes. Methods: Participants were 420 consecutive individuals (49% men) with type 2 diabetes receiving chronic care in two main referral centres in the two major cities of Cameroon. Logistic regression models were used to compute the odd ratio (OR) and 95% confidence interval (95% CI) for a standard deviation (SD) higher level of SBP (25 mmHg), DBP (13), PP (18) and MAP (16) with nephropathy risk. Discrimination was assessed and compared with c-statistics and relative integrated discrimination improvement (RIDI, %). Results: The adjusted OR (95% CI) for nephropathy with each SD higher BP variable were: 1.45 (1.15-1.84) for SBP, 1.33 (1.06-1.66) for DBP, 1.35 (1.06-1.71) for PP and 1.42 (1.13-1.78) for MAP. C-statistic comparison showed no difference in discrimination of models with each of the BP variables (p-values B 0.69 for c-statistics comparison). However, RIDI statistic always showed and enhancement in models discrimination when other BP variables were replaced with SBP, although such an enhancement was marginal for MAP. Using BP combination modestly improved models? discrimination. Conclusion: SBP was the best predictor of prevalent nephropathy in this population, while DBP was the less effective. This may have implication for kidney disease risk stratification and protection

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.    

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

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

Agreement between home and ambulatory blood pressure measurement in non-dialysed chronic kidney disease patients in Cameroon

Introduction: home blood pressure measurement (HBPM) is not entirely capable of replacing ambulatory blood pressure (BP) measurement (ABPM), but is superior to office blood pressure measurement (OBPM). Although availability, cost, energy and lack of training are potential limitations for a wide use of HBPM in Sub-Saharan Africa (SSA), the method may add value for assessing efficacy and compliance in specific populations. We assessed the agreement between HBPM and ABPM in chronic kidney disease (CKD) patients in Douala, Cameroon. Methods: from March to August 2014, we conducted a cross sectional study in non-dialyzed CKD patients with hypertension. Using the same devices and methods, the mean of nine office and eighteen home (during three consecutive days) blood pressure readings were recorded. Each patient similarly had a 24-hour ABPM. Kappa statistic was used to assess qualitative agreement between measurement techniques. Results: fortysix patients (mean age: 56.2 ± 11.4 years, 28 men) were included. The prevalence of optimal blood pressure control was 26, 28 and 32% for OBPM, HBPM and ABPM respectively. Compared with ABPM, HBPM was more effective than OBPM, for the detection of non-optimal BP control (Kappa statistic: 0.49 (95% CI: 0.36 - 0.62) vs. 0.22 (95%CI: 0.21 - 0.35); sensitivity: 60 vs 40%; specificity: 87 vs. 81%). Conclusion: HBPM potentially averts some proportion of BP misclassification in non-dialyzed hypertensive CKD patients in Cameroon

Pattern and correlates of cardiac lesions in a group of sub-Saharan African patients on maintenance hemodialysis

Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in patients on  maintenance hemodialysis. We investigated the pattern and correlates of cardiac lesions in a group of Cameroonians on chronic hemodialysis. Methods: This was a cross-sectional study conducted at the Yaoundé General Hospital's hemodialysis  unit, involving 45 patients (29 men, 64%) on maintenance hemodialysis for at least three months using a native arterio-venous fistula. Cardiovascular risk factors, biological, electrocardiographic and  echocardiographic data were collected. Results: Hypertension (29%), chronic glomerulonephritis (24%) and diabetes mellitus (24%) were the main etiological factors of chronic kidney disease. Blood pressure was controlled in 14 (31%) patients. Nineteen (42%) patients had anemia and 5 (14%) had a calciumphosphorus product &gt;55 mg2/dl2. All patients had at least one cardiovascular risk factors with hypertension (95%), anemia (42%) and highcalcium-phosphorus product (42%) being the most frequent. Thirty-eight (84%) patients had at least one cardiac lesion and 11 (29%) had three or more lesions. The cardiac lesions were left ventricular  hypertrophy (60%), valvular calcifications (38%), heart failure (36%), conduction disorders (33%),  pericardial effusion (13%), valvular diseases (11%) and ischemic heart diseases (2%). Left ventricular hypertrophy was significantly associated with a longer duration on dialysis and low hemoglobin level (both p&lt;0.047) while cardiac failure and valvular calcifications were associated with advanced age and high interdialytic weight gain (both p &lt;0.05). Conclusion: Cardiac lesions and cardiovascular risk factors are frequent in these patients receiving  sub-optimal dose maintenance hemodialysis despite their younger age, suggesting an increased susceptibility to cardiovascular complications.Key words: Cardiac lesions, chronic hemodialysis, Cameroon, Sub-Saharan Afric

Determinants of hyperuricemia in non-dialysed chronic kidney disease patients in three hospitals in Cameroon

Abstract Background Chronic kidney disease (CKD) poses a substantial health burden in sub-Saharan Africa, with risk factors ranging from communicable to non-communicable diseases. Hyperuricemia has been recently identified as a factor of progression of CKD. Identifying factors associated with hyperuricemia in CKD patients would help determine interventions to reduce CKD mortality, particularly in resources limited countries. We sought to determine the prevalence and factors associated with hyperuricemia in non-dialysed CKD adult patients in Cameroon. Methods This was a cross-sectional study of non-dialysed CKD patients, conducted in 3 referral nephrology units in Cameroon. Relevant clinical and laboratory data were collected using interviewer-administered questionnaires. Serum uric acid, spot urine protein and spot urine creatinine were assessed. Associations between variables were assessed using multivariate analysis. Level of statistical significance was set at α < 0.05. Results A sample of 103 participants was included. Mean age of study participants was 55.78 ± 12.58 years, and 59.3% were men. Sixty-nine (67%) had hyperuricemia. Patient’s age (OR: 1.08, 95% CI: 1.03–1.13), estimated glomerular filtration rate (OR: 0.94, 95% CI: 0.90–0.98), spot urine protein-creatinine ratio (OR: 1.83, 95% CI: 1.07–3.12), no hypertension (OR: 0.09, 95% CI: 0.02–0.46), urate lowering therapy (OR: 4.99, 95% CI: 1.54–16.16), loop diuretics (OR: 3.39, 95% CI: 1.01–11.42), obesity (OR: 6.12, 95% CI: 1.15–32.55) and no anaemia (OR: 0.04, 95% CI: 0.00–0.29) were independently significantly associated with hyperuricemia. Conclusions In this sample of non-dialysed CKD patients in Cameroon, about 7 out of 10 had hyperuricemia. Hyperuricemia was independently associated with patient’s age, estimated glomerular filtration rate, spot urine protein-creatinine ratio, hypertension, urate lowering therapy, loop diuretics, obesity and anaemia. More studies are required to establish causal relationships between these associations