Outcomes in medical admissions with hyponatraemia in Ghana – a single-centre study

Introduction: Hyponatraemia is the most common electrolyte abnormality in hospitalized patients and is associated with poor prognosis and high mortality. There is a paucity of data on hyponatraemia in Ghana. We set out to describe the prevalence of this condition, its associations and the outcomes in terms of in-hospital mortality and length of hospital stay.Methods: We conducted a retrospective study of all admissions from October 2017 to April 2018 on the medical ward at the Komfo Anokye Teaching Hospital (KATH). Demographic information, medical diagnoses as well as clinical and laboratory data were documented. Means (± standard deviation) were recorded for normally distributed data, whereas non-normally distributed data were recorded as medians [interquartile range (IQR)]. Chi-squared and Fisher’s exact tests were used to test categorical variables. ANOVA and Kruskal-Wallis tests were used for the analysis of hyponatraemia severity; a p value of < 0.05 was considered statistically significant.Results: Within the study period, 406 patients with hyponatraemia were identified in 1477 medical admissions, a prevalence of 27.6%. Their mean age was 51.5 ± 19.0 years. There were 217 males (53.5%). The mean serum sodium was 128.7 ± 6.5 mmol/L. Two hundred and forty (59%) had mild hyponatraemia, 106 (26%) had moderate hyponatraemia and 60 (15%) had severe hyponatraemia. The most common associated medical conditions were infections (26%), chronic liver disease (17%), hyperglycaemia (17%), chronic kidney disease (16%) and chronic heart failure (8%). In-hospital mortality was 31.8% and varied with the severity of the hyponatremia. The median length of hospital stay was 7 days (IQR 4–10 days) and did not vary with the severity of hyponatraemia. Mortality was associated with serum sodium concentration (p = 0.007) and lower levels of consciousness (Glasgow Coma Scale, GCS, ≤ 13) at presentation (p < 0.001).Conclusions: Hyponatraemia is common in medical admissions in Ghana, and is mostly associated with infections, and chronic liver, kidney and heart diseases. It is associated with high in-hospital mortality, especially when hyponatraemia is more severe or accompanied by relatively low GCS scores

Kidney Health for All – Bridging the gap to better kidney care in Africa

Introduction: The prevalence of chronic kidney disease (CKD) in Africa is generally higher than global averages. Moreover, the management of patients with CKD suffers huge disparities compared to the rest of the world. We reviewed the literature on the major challenges in the management of kidney disease in Africa and suggest ways to bridge the gap for better kidney care on the African continent. Results and recommendations: The prevalence of CKD in Africa is 15.8%. Kidney failure is associated with increased morbidity and mortality as a result of limited infrastructure and out-of-pocket payment for renal replacement therapy in most parts of the continent. The increasing prevalence of CKD results from  epidemiological transition with increasing non-communicable diseases (NCDs) and established communicable diseases. Furthermore, Africa has unique risk factors and causes of kidney disease such as sickle cell disease, APOL1 risk alleles, and chronic infections such HIV, and hepatitis B and C. Challenges facing kidney care in Africa include poverty, weak health systems, inadequate primary health care, misplaced priorities by political leaders, a relatively low nephrology workforce, poor identification of acute kidney injury (AKI), low  transplantation rates as well as a lack of sustainable prevention policies and renal registries. To bridge the gap to better kidney care, there should be more community engagement, advocacy for increased government support into kidney care, comprehensive renal registries, training of a greater nephrology workforce, task shifting of nephrology services to non-nephrologists, expanded access to renal replacement therapy and promotion of organ donation. Conclusion: Africa needs greater investment in kidney health

Capacity for the management of kidney failure in the International Society of Nephrology Africa region:Report from the 2023 ISN Global Kidney Atlas (ISN-GKHA)

The burden of chronic kidney disease (CKD) and associated risk of kidney failure are increasing in Africa. The management of people with CKD is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The healthcare workforce across Africa was sub-optimal and further challenged by the exodus of trained healthcare workers out of the continent. Medical products, technologies, and services for the management of people with non-dialysis CKD and for kidney replacement therapy (KRT) were scarce due to limitations in health infrastructure that was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared to the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on CKD prevention and early detection, improving the effectiveness of the available healthcare workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (KRT or conservative kidney management) for all people living with kidney failure

Fifty years of hemodialysis in Ghana-current status, utilization and cost of dialysis services

BACKGROUND Kidney failure is common in Ghana. Haemodialysis (HD) is the most common treatment modality for survival. Although, HD has been available in Ghana for 50 years, the majority of patients who develop kidney failure cannot access it. We describe the state of HD, dialysis prevalence, its utilization and cost of HD after fifty years of dialysis initiation in Ghana. METHODS A situational assessment of HDs centres in Ghana was conducted by surveying nephrologists, doctors, nurses and other health care professionals in HD centres from August to October 2022. We assessed the density of HD centres, number of HD machines, prevalence of nephrologists, number of patients receiving HD treatment and the cost of dialysis in private and government facilities in Ghana. RESULTS There are 51 HD centres located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning, as 11 had shut down or are yet to operate. Of the functioning centres most (n = 26, 65%) are in the Greater Accra region serving 17.7% of the population and 7(17.5%) in the Ashanti region serving 17.5% of the population in Ghana. The rest of the seven regions have one centre each. The private sector has twice as many HD centers (n = 27, 67.5%) as the public sector (n = 13,32.5%). There are 299 HD machines yielding 9.7 HD machines per million population (pmp) with a median of 6 (IQR 4-10) machines per centre. Ghana has 0.44 nephrologists pmp. Currently, 1195 patients receive HD, giving a prevalence of 38.8 patients pmp with 609(50.9%) in the private sector. The mean cost of HD session is US $53.9 ± 8.8 in Ghana. CONCLUSION There are gross inequities in the regional distribution of HD centres in Ghana, with a low HD prevalence and nephrology workforce despite a high burden of CKD. The cost of haemodialysis remains prohibitive and mainly paid out-of-pocket limiting its utilization

Acute kidney injury and in-hospital mortality among patients with COVID-19 in Ghana – a single centre study

Introduction: Acute kidney injury (AKI) occurs in patients with coronavirus disease 2019 (COVID-19) and is associated with high mortality, but this has not yet been described in Ghana. We therefore record here the proportion of COVID-19 patients with AKI, and determined the corresponding mortality, in a tertiary-level hospital in Ghana. Methods: We conducted a retrospective study of all patients admitted to the Komfo Anokye Teaching Hospital, with a diagnosis of COVID-19 proven by reverse transcriptase polymerase chain reaction (RT-PCR), from March 2020 to February 2021. Demographics, clinical findings and laboratory investigations were recorded and summary statistics used to describe the data. Predictors of mortality were established by multiple logistic regression. Results: The study involved 250 patients, of whom 129 (52%) were males, with a mean age of 56.3 ± 17.4 years. AKI occurred in 123 (49%). The most common causes of AKI were pre-renal AKI and ischaemic ATN – 65 (73%) and 37 (30%) cases, respectively. Haemodialysis was required in 6 (5%) cases. The in-hospital mortality of all the COVID-19 patients was 71 (31%). The predictors of in-patient mortality in multivariate analysis were hyperglycaemia (OR = 18.48 [95%CI (2.0 –165.2], P = 0.009), severe COVID-19 (OR = 31.3 [95% CI 1.53–635.5], P = 0.025), elevated white blood cell count (OR = 1.32 [95% CI 1.09–1.59], P = 0.004), lymphopenia (OR = 0.16. [95% CI 0.03–3.26], P = 0.027) and not AKI (OR = 0.79 [95% CI 0.45–1.34], P = 0.380). Stage 3 (severe) AKI, however, occurred in 39 (32%) cases and was significantly associated with mortality [OR = 2.41 (95% CI 1.05–5.49, P = 0.036)] as compared to those with mild–moderate AKI in a sub-analysis. Conclusions: AKI is common in hospitalized patients with COVID-19. Stage 3 AKI was associated with increased in-hospital mortality. Predictors of mortality were severe COVID-19 disease, lymphopenia and hyperglycaemia

The COVID-19 Pandemic Identifies Significant Global Inequities in Hemodialysis Care in Low and Lower-Middle Income Countries-An ISN/DOPPS Survey

INTRODUCTION It is unknown how the COVID-19 pandemic has affected the care of vulnerable chronic hemodialysis (HD) patients across regions, particularly in low and lower-middle income countries (LLMICs). We aimed to identify global inequities in HD care delivery during the COVID-19 pandemic. METHODS The ISN and the Dialysis Outcomes and Practice Patterns Study (DOPPS) conducted a global online survey of HD units between March and November, 2020, to ascertain practice patterns and access to resources relevant to HD care during the COVID-19 pandemic. Responses were categorized according to World Bank income classification for comparisons. RESULTS Surveys were returned from 412 facilities in 78 countries: 15 (4%) in low-income countries (LICs), 111 (27%) in lower-middle income countries (LMICs), 145 (35%) in upper-middle income countries (UMICs), and 141 (34%) in high-income countries (HICs). Respondents reported that diagnostic tests for SARS-CoV-2 were unavailable or of limited availability in LICs (72%) and LMICs (68%) as compared with UMICs (33%) and HICs (20%). The number of patients who missed HD treatments was reported to have increased during the COVID-19 pandemic in LICs (64%) and LMICs (67%) as compared with UMICs (31%) and HICs (6%). Limited access to HD, intensive care unit (ICU) care, and mechanical ventilation among hospitalized patients on chronic dialysis with COVID-19 were also reportedly higher in LICs and LMICs as compared with UMICs and HICs. Staff in LLMICs reported less routine testing for SARS-CoV-2 when asymptomatic as compared with UMICs and HICs-14% in LICs and 11% in LMICs, compared with 26% and 28% in UMICs and HICs, respectively. Severe shortages of personal protective equipment (PPE) were reported by the respondents from LICs and LMICs compared with UMICs and HICs, especially with respect to the use of the N95 particulate-air respirator masks. CONCLUSION Striking global inequities were identified in the care of chronic HD patients during the pandemic. Urgent action is required to address these inequities which disproportionately affect LLMIC settings thereby exacerbating pre-existing vulnerabilities that may contribute to poorer outcomes

The global impact of the Coronavirus 2019 pandemic on in-centre haemodialysis services: an International Society of Nephrology -Dialysis Outcomes Practice Patterns Study survey

Introduction To assess the impact of the COVID-19 pandemic impact on haemodialysis centres, The Dialysis Outcomes and Practice Patterns Study and International Society of Nephrology (ISN) collaborated on a web-survey of centres. Methods A combined approach of random sampling and open invitation was used between March 2020 and March 2021. Responses were obtained from 412 centres in 78 countries and all 10 ISN regions. Results In 8 regions, rates of SARS-CoV-2 infection were <20% in most centres, but in North East Asia and Newly Independent States and Russia rates were ≥20% and ≥30%, respectively. Mortality was ≥10% in most centres in 8 regions, though lower in North America and Caribbean and North East Asia. Diagnostic testing was not available in 33%, 37%, and 61% of centres in Latin America, Africa, and East and Central Europe, respectively. Surgical masks were widely available, but severe shortages of particulate-air filter masks were reported in Latin America (18%) and Africa (30%). Rates of infection in staff ranged from 0% in 90% of centres in North East Asia to ≥50% in 63% of centres in the Middle East and 68% of centres in Newly Independent States and Russia. In most centres <10% of staff died, but in Africa and South Asia 2% and 6% of centres reported ≥50% mortality, respectively. Conclusion There has been wide global variation in SARS-CoV-2 infection rates amongst haemodialysis patients and staff, PPE availability, and testing, and the ways in which services have been redesigned in response to the pandemic