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

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 mortalité chez les patients hémodialysés est très controversée. L’objectif de la présente étude était d’identifier les prédicteurs indépendants de la mortalité en hémodialyse chronique et d’évaluer l’impact de l’hypertension sur la survie des patients congolais hémodialysés. Méthodes. Cette étude de cohorte historique a concerné les patients hémodialysés chroniques congolais traités dans deux centres d’hémodialyse à Kinshasa entre 2010 et 2013. Les courbes de survie de Kaplan Meier basées sur la présence ou non d’hypertension ont été comparées à l’aide du test de Log-Rank. Résultats. 191 patients (âge moyen de 52,3 ± 12,3 ans; hommes 68%; hypertendus 85%) ont été inclus. Parmi eux, 88 étaient décédés (46%). Les prédicteurs indépendants de la mortalité toutes causes confondues étaient les suivants : utilisation de cathéters provisoires [aHR 7,72; IC à 95%: 1,84 à 32,45; p = 0,024], statut socioéconomique faible (SSE) [aHR 2,57; IC à 95% 1,06-6,27; p = 0,038], l’absence d’hypertension artérielle [aHR 2,38; IC 95% 1,35-3,04; p = 0,003], présence de complications per dialytiques [aHR 2,28; IC à 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]. Comparés aux patients normotendus, les hypertendus avaient significativement une meilleure survie médiane (4 versus 16 mois ; Log Rank p ≤0,001). Conclusion. Malgré une mortalité très élevée dans la population d’étude, les patients hypertendus congolais en hémodialyse chronique avaient une meilleure survie par rapport aux patients normotendus. Ce paradoxe déjà signalé dans d’autres études peut s’expliquer par l’épidémiologie inverse. &nbsp

Human Immunodeficiency Virus Nephropathy in Central Africa: The Value of Renal Ultrasound

Introduction: HIV-Associated Nephropathy may shorten the life expectancy of affected patients. Its early detection is beneficial for the indication of treatment and hence prevention of progression to the end-stage of renal failure. The final diagnosis requires renal biopsy which may be difficult in some African area; clinical and ultrasound criteria may be helpful. The aim of this study was twofold: to characterize renal sonographic changes in HIV-positive patients with HIV associated Nephropathy and to investigate the correlation between renal sonographic changes and histological lesions in central Africa.Methods: A prospective and multi-center study conducted from January 2013 to July 2015 included, for renal ultrasound evaluation of the length, thickness and echogenicity, forty two of the 334 biologically confirmed HIV-positive patients who presented with significant proteinuria suggestive of HIV associated Nephropathy. And transcutaneous renal biopsy with histopathology has been performed in 16 patients of them. Statistical analyzes were used.Results: There were 100 men and 234 women; proteinuria was positive in 42 patients, (12.6%). The average length of the kidneys was 111 ± 8 mm (normal), with 10% of patients with pathological values (5% with kidneys of reduced size and 5%, increased size). The kidneys had an average thickness of 44 ± 5 mm (normal), with 21% of patients presenting an increase in renal thickness. Quantitative echogenicity was calculated at 1.492 ± 0.793 (normal), with 79% of patients with increased quantitative echogenicity. Of the 16 patients biopsied, all had tubulo-interstitial lesions, and 75% of them associated with glomerular lesions. In simple correlation analysis, tubular dilatation was positively and significantly related to quantitative echogenicity (r = 0.67, p < 0.01) and to renal parenchyma thickness (r = 0.67; 0.85, p ? 0.05). The relationship between the other parameters studied did not reach statistical significance. In multiple linear regression, glomerular hyalinosis, glomerular proliferation, tubular dilatation, tubular atrophy, interstitial fibrosis, and interstitial inflammation emerged as the main determinants of quantitative echogenicity; however, the relationship was statistically significant only for tubular dilatation (? = 0.305, p = 0.034).Conclusion: The present study showed the characteristic of renal change and the relation with histology found in central Africans patients

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

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

En mémoire du Professeur François LEPIRA BOMPEKA Juin 1954- Juin 2020: In Memoriam Professor François LEPIRA BOMPEKA June 1954 – June 2020

En mémoire du Professeur François LEPIRA BOMPEKA Juin 1954- Juin 2020 Dans leur livre «&nbsp;L’art de Mourir&nbsp;», Marie de Hennezel et Jean-Yves Leloup écrivaient à juste titre: «&nbsp;Nous sommes mortels. Nous essayons de l’oublier. Inévitablement, de temps à autre, la mort se rappelle à notre bon souvenir et nous enlève l’un de nos proches. Un ami, un parent, un amour». Un pur hasard du calendrier a coïncidé à un même mois, le mois de juin, les deux événements essentiels de la vie du Professeur François LEPIRA BOMPEKA&nbsp;: sa naissance et sa mort. En effet, François est né le 10 juin 1954 de Antoine LEPYRA, son père, et de Joséphine MANKAKA, sa mère, tous deux d’heureuse mémoire. Il nous quitte le 25 juin 2020, à 66 ans. L’histoire de la vie de François commence dans la Ville de Bandundu, son lieu de naissance qu’il abandonne tôt pour Kinshasa, à la suite de la mutation de son père pour cette ville. Agent de l’ONATRA à cette époque, il y est appelé à la tête du bureau de l’armement de cet office des transports. C’est donc dans la Capitale que François accomplit son cycle maternel et primaire à l’École Saint Jean Berckmans, puis ses humanités commerciales et administratives au Collège Saint Raphaël, qu’il achève en 1973. Malgré son pré-requis en sciences commerciales, il choisit de s’inscrire à la Faculté de Médecine à l’Université Nationale du Zaïre dénommée plus tard&nbsp; Université de Kinshasa – UNIKIN. Il termine ses études de Médecine en 1981, avec la mention, Distinction. François n’a pas été seulement un brillant étudiant, mais également un excellent joueur de football dans l’équipe de l’Université. Son diplôme de&nbsp;Médecine obtenu, il entreprend sa spécialisation en Médecine Interne qu’il parachève en 1985 par un travail de mémoire portant sur l’Évaluation&nbsp;de l’Efficacité et la Tolérance de l’acebutolol chez l’hypertendu Zaïrois aux Cliniques Universitaires de Kinshasa. Il obtient la mention Grande Distinction. Très intéressé à l’hypertension artérielle, il passe un stage de perfectionnement à l’Unité d’hypertension du Feu le Prof Antoon Amery de la KU Leuven. Il décroche en 2006 le titre de&nbsp;PhD&nbsp;après avoir brillamment défendu sa thèse sur les&nbsp;Lipides Sériques, Risque cardiovasculaire chez l’Hypertendu Congolais, sous la Direction du Professeur Jean René M’Buyamba, lui-même sorti de l’école de la KU Leuven. Plusieurs formations complémentaires et stages viendront renforcer les connaissances et ses compétences médicales. Un personnage affable, généreux et pétillant de vie, toujours élégant et marchant d’un pas décisif, d’une voix qui porte avec un timbre dynamique très caractéristique facilitant la reconnaissance de sa présence même au loin; d’un abord facile et toujours disposé à rendre service.&nbsp;Homme des relations, son carnet d’adresses était bien rempli. Tel était François dans la société. Des expériences acquises lors des mandats à la tête de Programme de Sida, de la Direction des Cliniques et ainsi son séjour dans un Cabinet ministériel ont fortifié sa maturité humaine. Rien d’étonnant qu’il ait été très apprécié des partenaires belges dans la coopération interuniversitaire entre les universités flamandes et l’Unikin. En effet, il a été un précieux partenaire du Conseil interuniversitaire flamand (VLIR) à travers deux importants projets portant sur l’implémentation d’un programme de dialyse péritonéale pédiatrique à l’Unikin et à travers les autres provinces de la RDC, à savoir «&nbsp;VLIR TEAM project&nbsp;» et «&nbsp;VLIR JOINT project&nbsp;», dont il était le Promoteur local. En tant que scientifique, il est arrivé à se forger une solide stature nationale et internationale. Grâce à ses facultés intellectuelles, avivées par un travail assidu, doté d’une grande curiosité intellectuelle, entretenant une soif inextinguible du savoir et animé d’une passion particulière pour la physiopathologie, il est devenu une personne ressource dans la direction des thèses et mémoires. Ses prises de positions dans les réunions de faculté et de département, comme celles tenues au service de néphrologie étaient très respectées pour leur grande pertinence. Chercheur obstiné, il compte à son actif une impressionnante production scientifique surtout dans le domaine des facteurs de risque cardiovasculaire dans la maladie rénale chronique. Il a été très actif dans&nbsp;notre revue, les Annales Africaines de Médecine à la fois comme membre du comité de rédaction, lecteur critique et auteur. A cet égard, il a publié dans cette revue 44 articles. Ses dernières publications ont planché sur l’infection au syndrome respiratoire aigu sévère à Coronavirus-2 (SARS-Cov-2), appelée&nbsp;COVID-19 (volume 13 n°3 juin 2020). Le présent volume contient également son 45e&nbsp;article dans le présent volume des AAM. Son apport dans la visibilité et le rayonnement de la néphrologie dans le monde a été évident. Membre actif du Service de Néphrologie, le Prof François Lepira a significativement contribué à son développement, à y entretenir la cohésion, l’esprit d’équipe au sein du groupe, ainsi que l’ambiance de bonne humeur grâce à son talent de conteur disposant d’une réserve presque inépuisable d’anecdotes. Excellent clinicien, il a su allier les qualités humaines d’empathie, d’attention, de présence auprès des malades et celles de grandes compétences médicales. Il a été membre cofondateur de la Société Congolaise de Néphrologie, Soconeph en sigle, dont il était le Vice-Président. Enseignant de qualité et très apprécié, il transmettait avec passion aux étudiants tant under que postgraduate un savoir bien maîtrisé. D’où sa grande popularité et son aura auprès de ces derniers. J’en ai été témoin à la séance d’attribution du titre de&nbsp;Doctor Honoris Causa&nbsp;au prix Nobel de la Paix, le Professeur Denis Mukwege par l’Université Protestante du Congo, et dont le Professeur Lepira était membre du jury. L’immense estime dont jouissait François était relayée par de nombreux messages de sympathie reçus à l’occasion de son décès. Certains imploraient le Dieu Éternel de pourvoir la Faculté de Médecine d’autres enseignants de même nature. Enfin le dernier aspect et non le moindre&nbsp;: son engagement chrétien et sa dévotion mariale. Certes François a grandi dans un environnement familial chrétien au sein duquel on retrouve&nbsp; un Monseigneur, mais une expérience personnelle vécue durant l’enfance a été déterminante dans l’affermissement de sa foi. Au cours de cette période, François contracta la variole et fut hospitalisé. L’équipe soignante ayant constaté que les soins administrés n’amélioraient pas&nbsp;&nbsp; l’état du malade, qu’au contraire tout espoir de guérison semblait perdu, songea à le renvoyer de l’hôpital et le voir plutôt mourir à domicile. Mais pendant ce temps, une sœur religieuse qui venait de faire connaissance avec la mère du jeune patient continuait, à l’insu de l’équipe soignante, à procurer des soins qui finirent par le sauver. L’expérience du dévouement inconditionnel de la religieuse et la guérison d’une maladie mortelle qui s’ensuivit affermirent sa foi chrétienne et fini par germer en lui ce sentiment qui deviendra plus tard son amour pour les malades. A son mariage avec madame Cécile TSHIBANDA, le couple plaça le foyer sous la bienveillante garde de la Sainte Vierge Marie de perpétuel secours. C’est la raison de la présence de la grotte mariale dans leur parcelle. Mais hélas, c’est au moment où rien ne présageait une quelconque infortune dans sa paisible vie familiale et professionnelle que la mort intervint pour arracher François à notre affection. Puissions-nous trouver un tant soit peu de consolation en méditant cette réflexion de l’écrivain autrichien Rilke&nbsp;: «&nbsp;C’est à tort, quelquefois, si l’on s’imagine qu’une mort est prématurée. Certains êtres sont marqués par le destin de manière que la vie, pour brève qu’elle paraisse, est pourtant complète, achevée&nbsp;». La jeunesse congolaise, victime des valeurs négatives dans lesquelles elle baigne depuis bien longtemps, désespérément en quête de modèle, devrait s’approprier l’héritage moral du défunt Professeur. Dans immense œuvre de l’éducation de cette jeunesse, voie obligée pour un nouveau Congo prospère, le Professeur François LEPIRA BOMPEKA a pris sa part. Kinshasa, Juillet 2020 In Memoriam Professor François LEPIRA BOMPEKA June 1954 – June 2020 In “L’art de Mourir”, Marie de Hennezel and Jean-Yves Leloup rightly wrote: We are mortal. We very often try to forget it. Inevitably, from time to time, death recalls this reality to our good memory and takes away one of our beloved. A friend, a relative, a loved one”. It was by chance of the calendar that the month of June corresponded to the birth and death of Professor Francois Lepira. Born on June 10th, 1954 by Daddy Antoine Lepyra and Mom Joséphine Mankaka, François Lepira left us on June 25th, 2020 at age of 66. Lepira’s life story begins in the city of Bandundu, his birthplace which he left early for Kinshasa following the transfer of Daddy Antoine Lepyra, an employee at the ONATRA, named of former Congolese company, as he was to take care of its equipment office. In Kinshasa, Lepira completed both his primary school and high school education in Commercial and Administrative Sciences at Saint Jean Berckmans Primary School, and Saint Raphaël High school (1973), respectively. In spite of a pre-requisite in commercial sciences, it is rather in Medicine that he enrolled at the National University of Zaire which later became the University of Kinshasa UNIKIN. In 1981, he completed his studies in medicine with Distinction. He was a brilliant student and an excellent soccer player in the University team. After his degree in medicine, he specialized in Internal Medicine in 1985 with Great Distinction (Magna Cum Laude). He wrote a brilliant dissertation on “The Evaluation of Acebutolol Efficicacy and Tolerance in Zairean Hypertensive Patients at the University Hospital of Kinshasa”. Highly interested in arterial hypertension, he followed a training program in the Hypertension Unit of Prof. Antoon Amery from the Catholic University of Leuven (KU Leuven). In 2006, he obtained his Ph.D. degree with a thesis on “Serum Lipids, Cardiovascular Risk in Congolese Hypertensive Patients”, under the supervision of Professor Jean René M’Buyamba, a former KU Leuven graduate. Several additional training courses and internships enriched his knowledge and skills in medicine. Friendly, generous and sparkling with life, always elegant and walking with a resolute step, Lepira had a particular dynamic voice tone easy to identify even from distance. Easy to approach and always ready to help, Lepira was a man of relations with a well-stocked address book.&nbsp; So was the man in society. Various experiences gathered during his professional life confirmed his maturity, such as the supervision of the National AIDS Program, the Directory of Kinshasa University Hospital and his expertise in a political cabinet office. Lepira was highly appreciated by Belgian partners in Flemish Universities and UNIKIN Inter-university Cooperation Program. Indeed, he was a precious partner of the Flemish Inter-University Council (VLIR). He was the local promoter of two important projects implementing a pediatric peritoneal dialysis program at UNIKIN and in other DRC provinces, i.e. the “VLIR TEAM project” and “VLIR JOINT project”. As a scientist, Lepira managed to build a solid national and international reputation. A hardworking man, Lepira was endowed with great intellectual faculties and curiosity, maintaining an unquenchable thirst for knowledge and a particular passion for physiopathology. He soon became a resource person for PhD students. His views during faculty and departmental meetings as well as in the Nephrology Department were highly appreciated for their relevance. An assiduous researcher, he has an abundant scientific output to his credit, especially in the field of cardiovascular risk factors in chronic kidney disease. He has been very active in our journal, the African Annals of Medicine (AAM), as a member of the editorial board, reviewer, and author. In this regard, he published 44 articles in this journal. His most recent publications were on the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS –Cov-2), known as COVID-19 (volume 13 issue 3, June 2020). Even the present volume contains his 45th&nbsp;article. His contribution to the reputation and influence of nephrology around the world is evident. Prof. Lepira was an active member who significantly contributed to the development of the Nephrology Division. Endowed with good humor, storyteller’s talents and full of inexhaustible supply of anecdotes, he worked to maintain the team spirit and the group cohesion. An excellent clinician, he combined human qualities of empathy, attention and presence with the medical skills of rigorous clinical reasoning and rational therapeutic decision-making. A co-founding member of the Congolese Society of Nephrology (SOCONEPH), he served as its Vice-President. A highly qualified and appreciated teacher, Lepira transmitted his knowledge with passion. This obviously contributed to his great fame among his undergraduate and postgraduate students. I witnessed his aura when the Protestant University of Congo invited him as a member of the jury that awarded the honorary doctorate to the Nobel Peace Prize winner, Professor Denis Mukwege. Finally, many testimonies and messages of sympathy during his funeral, implored God to endow the Faculty of Medicine with many other teachers like Lepira. Last but not least, his Christian commitment and devotion to Virgin Maria deserve to be mentioned. Lepira grew up in a Christian family environment. A childhood personal experience strengthened his faith. Indeed, during the period of his life in the countryside, he contracted smallpox. The treatment he received did not improve the young man’s health state. According to the hospital team, the young patient’s case was desperate. They decided to send him back home to die. But bypassing this medical decision, a nursing nun, acquainted with the young man’s mother, continued to provide treatment with determination, and his health finally improved. The hospital nursing team was surprised and astonished to meet the condemned young patient in better shape. This healing experience from a declared fatal illness together with the Good Sister’s unconditional devotion gave a boost to his Christian faith and love for sick persons. His wedding with Mrs. Cecile Tshibanda and his family are under the benevolent care of the Blessed Virgin Mary of Perpetual Relief. Hence the presence of the grotto in their residence. At a time when there was no sign of any misfortune in his peaceful family and professional life, death came to steal Professor Lepira from our affection. We might find some consolation by meditating on this reflection by the Austrian writer Rilke (Rainer Maria): “It is sometimes wrong to think that someone’s death is premature. Some beings are marked by destiny in such a way that their life, as brief as it may seem, is yet complete, accomplished. Victims of negative values they have long lived in and desperate to find a model, Congolese youth is advised to&nbsp;appropriate&nbsp;the&nbsp;late&nbsp;Professor’s moral legacy. Obviously, in the immense work of educating young people, a must towards a prosperous Congo, Professor François Lepira did fulfill his role

Prevalence of microalbuminuria and diagnostic value of dipstick proteinuria in outpatients from HIV clinics in Bukavu, the Democratic Republic of Congo.

BACKGROUND: Microalbuminuria is a marker of early kidney disease and high cardiovascular risk in various populations, including HIV positive patients. However, the diagnostic value of qualitative (dipstick) proteinuria and the burden of microalbuminuria in HIV positive patients living in sub-Saharan Africa are relatively unclear. METHODS: In a cross-sectional study, 235 HIV- positive outpatients were screened for proteinuria in 3 HIV-clinics in Bukavu. A spot urine sample from each subject was tested both by a dipstick and albumin-creatinine-ratio (ACR) assay. The performance of dipstick proteinuria exceeding 1+ was compared with that of microalbuminuria (≥ 30 mg/g creatinine). RESULTS: The prevalence of microalbuminuria and dipstick proteinuria ≥ (1+), ≥ (2+) and ≥ (3+) was 11%, 41%, 3.5% and 0.7%, respectively.Compared to microalbuminuria, the dipstick (proteinuria of 1+ or greater) had an overall sensitivity of 60% and a specificity of 61%. The positive predictive value was 15.4% and the negative predictive value 92.8%. CONCLUSION: Proteinuria is highly prevalent in HIV positive patients. The limited sensitivity and specificity of the dipstick to detect significant microalbuminuria make it unattractive as a screening tool in HIV positive patients

Characteristics of the population of the study.

<p>*Age range: 2–13 years.</p

Blood pressure according Hb status and sex.

<p>Blood pressure according Hb status and sex.</p

Biological profile of renal function in studied population.

<p>*GFR: Glomerular filtration rate.</p

Circulating Proprotein Convertase Subtilisin/Kexin type 9 level independently predicts incident cardiovascular events and all-cause mortality in hemodialysis black Africans patients.

Cardiovascular (CV) disease is the leading cause of mortality in patients with end-stage kidney disease (ESKD). The aim of the present study was to determine whether Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) could be an independent predictor of CV events and all-cause mortality in black African haemodialysis patients. We carried out a prospective cohort study of all consecutive hemodialysis (HD) patients between August 2016 and July 2020, admitted in six hemodialysis centers of Kinshasa, Democratic Republic of Congo. Independent determinants of plasma PCSK-9 measured by ELISA were sought using multiple linear regression analysis. Kaplan-Meier's method described the incidence of CV events while competitive and proportional risk models looked for independent risk factors for death at the .05 significance level. Out of 207 HD patients, 91 (43.9%) died; 116 (56.1%) have survived. PCSK9 level was significantly higher in deceased patients compared to survivors: 28.0 (24.0-31.0) ng/l vs 9.6 (8.6-11.6) ng/ml (p <  0.001). Patients with plasma PCSK9 levels in tertile 3 had a higher incidence of CV events and mortality compared to patients with plasma PCSK9 levels in tertile 2 or tertile 1 (p <  0.001). Tertile 3 negatively influence survival rates (26.6%) compared to tertile 2 (54.7%) and tertile 1 (85.3%). Patients in tertile 3 and tertile 2 had a 4-fold higher risk of death than patients in tertile 1. After adjustment for all parameters, competitive risk analysis showed that mortality was 2 times higher in patients with stroke. Similarly, serum albumin < 3.5 g/dL or PCSK9 in tertile 3 were respectively associated with 2 or 6 times higher rates of deaths. Elevated plasma PCSK9 level is an independent major predictor of incident CV events and all-cause mortality in black African HD patients