Acquired cystic kidney disease in patients on maintenance hemodialysis, prevalence and associated factors: a cross-sectional study.

Introduction: Acquired Cystic Kidney Disease (ACKD) is a known complication in patients on maintenance hemodialysis, and it is associated with a high risk of malignant transformation. There is a paucity of data on ACKD in sub-Saharan Africa. Objectives: To determine the prevalence and factors associated with acquired cystic kidney disease in patients on maintenance hemodialysis. Methods: patients on maintenance hemodialysis were screened for ACKD. Patients with hereditary cystic kidney disease were excluded. Renal ultrasounds were performed by two radiologists. ACKD was defined as 3 or more bilateral renal cysts in a small or normal size kidney. Associated factors were determined using logistic regression. A p-value <0.05 was significant. Results: a total of 158 participants were enrolled and 61.4% (97) were male. Their mean (SD) age was 45.8 (14.9) years. The median dialysis vintage was 33.5 [10.7-63.2] months. The mean (SD) length of the kidneys was 85.1 (17.5) mm on the left and 81.2 (17.1) mm on the right. The prevalence of ACKD was 31.6% (n=50). Septated cysts (4), calcification of the wall of the cysts (2), irregular thick calcified wall (1), septated cysts with calcification (1) and hemorrhagic cyst (1) cysts were also observed. Dialysis vintage > 36 months (OR 7.1, 95% CI: 3.3 - 15.5) and male sex (OR 2.6, 95% CI: 1.2-5.6) were independently associated with ACKD. Conclusion: the prevalence of ACKD is high in a population of Cameroonians on maintenance. This result calls for the implementation of strategies to screen for the condition and its complications.

Spontaneous Twin Pregnancy: A Challenging and Exceptional Scenario in a Patient on Maintenance Hemodialysis in Sub-Saharan Africa.

Chronic hemodialysis is associated with reduced fertility. Hence, pregnancy remains rare, challenging, and deleterious when unplanned, especially in low-resource countries. Contraception and births are very important in these settings. Though the main modes of contraception have been proposed in the chronic kidney disease (CKD) population, contraception still remains challenging in patients on maintenance hemodialysis. Most doctors, however, overlook contraception because of the low fertility, high rate of amenorrhea, and low libido. Furthermore, patients are less receptive to contraceptive counseling either because of a high desire to give birth or due to amenorrhea and low libido. Management of unplanned pregnancies is therefore very challenging and a multidisciplinary approach is the rule; however, it does not guarantee a good prognosis for both the mother and child. Very few cases of multiple pregnancies without induction of ovulation have been reported in patients with severe renal failure, especially those on maintenance dialysis. A 32-year-old multiparous woman with end-stage kidney failure (ESKF) and a residual diuresis of 700 mL per day who had been on inadequate maintenance hemodialysis for 36 months, presented with abdominal distension, which was confirmed on abdominal ultrasound to be a twin pregnancy at 22 weeks of gestation. Thereafter, we intensified hemodialysis (3 sessions/week), managed hypertension and anemia. The obstetrical course was uneventful until the 25th week of gestation when she developed grade 3 (WHO) hypertension and peripheral fluid overload. At the 29th week, she had a spontaneous vaginal preterm delivery of 2 babies weighing 1,350 g and 1,000 g, with an Apgar score of 8 and 7, respectively. Babies, however, died on day 1 and day 5 postpartum, respectively, from respiratory distress and early neonatal infection. The evolution of the mother was uneventful as she continued with her hemodialysis sessions. Twin pregnancies are a rare and very high-risk condition in end-stage renal disease and require multidisciplinary management.

Prevalence of unrecognized or "silent" myocardial ischemia in chronic kidney disease patients: Protocol for a systematic review and meta-analysis.

INTRODUCTION: Chronic kidney disease (CKD) patients are at an extremely high risk of silent myocardial ischemia (SMI). However, there is a dearth of evidence on the worldwide prevalence of this very lethal and yet unrecognizable complication of CKD. The proposed systematic review and meta-analysis aims to estimate the global prevalence of SMI among CKD patients. METHODS AND ANALYSES: This protocol was conceived according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The systematic review will involve all observational studies and clinical trials published until April 30, 2021, and reporting on the prevalence of SMI in CKD patients. Electronic sources including MEDLINE, Embase, Web of Science, and Cochrane database of systematic reviews will be perused for potentially eligible studies, restricted to only studies published in English or French. Two investigators will independently select studies and use a pre-pilot tested form to extract data. Further, they will independently perform a qualitative assessment of the risk of bias and overall quality of the selected studies, followed by a quantitative assessment using funnel plots and Egger's tests. The heterogeneity between studies will be assessed with the Cochrane's Q statistic, and the I2 statistic will measure the percentage of variation across studies that is due to their heterogeneity rather than chance; the I2 will decide if a meta-analysis can be conducted. In case it cannot be conducted, a descriptive analysis will be performed. Otherwise, study-specific estimates will be pooled using either a fixed-effects or a random-effects model, depending on the value of the I2 statistic. Subgroup and random effects meta-regression analyses will further investigate the potential sources of heterogeneity. Finally, sensitivity analyses will be performed to measure the impact of low-quality studies on the results of the meta-analysis, and power calculations will determine the probability that we will detect a true effect if it does exist. PROSPERO REGISTRATION NUMBER: CRD42020211929. STRENGTHS AND LIMITATIONS OF THIS STUDY: The intended systematic review and meta-analysis will fill the knowledge gap on the global prevalence of silent myocardial ischemia (SMI) in CKD patients. The eligible studies will be identified through a methodic literature search followed by a rigorous screening process; we will then use robust meta-analysis tools to pool the data and provide reliable estimates of the global prevalence of SMI in CKD patients. Two major limitations could be: the predominance of clinical trials that might limit the generalizability of the findings, given that some informative patients might have been sidelined by the strict inclusion criteria of these studies; the high probability of type 1 error originating from the important number of subgroup and sensitivity analyses.

Prevalence and determinants of chronic kidney disease in urban adults' populations of northern Cameroon.

BACKGROUND: Chronic kidney disease (CKD) is a major health problem with growing prevalence in sub-Saharan Africa. AIM: Assess the prevalence and determinants of CKD in Garoua and Figuil cities of the North region of Cameroon. METHODS: A cross-sectional survey was conducted from January to June 2018 in the two cities, using a multi-level cluster sampling. All adults with low estimated glomerular filtration rate (eGFR) (< 60 ml/min/1.73 m2) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albuminuria (≥ 30 mg/g) were reviewed three months later. Logistic regression models (accounting for the sampling strategy) were used to investigate the predictors of the outcomes. RESULTS: A total of 433 participants were included, with a mean age (95%CI) of 45.0 (43.4-46.6) years, 212 (48.7%) men, 294 (67.9%) from Garoua and 218 (45.6%) with no formal education. Risk factors for chronic nephropathy were highly prevalent including longstanding use of street medications (52.8%), herbal medicines (50.2%) and non-steroidal anti-inflammatory drugs (50%), alcohol consumption (34.4%), hypertension (33.9%), overweight/obesity (33.6%), hyperuricemia (16.8%), smoking (11.3%) and hyperglycemia (6.5%). The prevalence of CKD was 11.7% overall, 10.7% in Garoua and 13% in Figuil participants. Equivalents figures for CKD G3-5 and albuminuria were 2.8%, 2.0% and 4.5%; and 9.1%, 9.3% and 8.5%, respectively. History of diabetes, increase systolic blood pressure, hyperglycemia and hyperuricemia were predictors of CKD. CONCLUSION: The prevalence of CKD is as high in these northern cities as previously reported in southern cities of Cameroon, driven mostly by known modifiable risk factors of chronic nephropathy.

Birth weight and renal markers in children aged 5-10 years in Cameroon: a cross-sectional study.

BACKGROUND: A relationship exists between birth weight (BW) and glomerular filtration rate (GFR) in postnatal kidney. Willing to fill a gap of knowledge in sub-Saharan Africa, we assessed the effect of BW on blood pressure (BP), proteinuria and GFR among Cameroonians children. METHODS: This was a cross-sectional hospital-based study from January to April 2018 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH). We recruited low BW (LBW) [< 2500 g], normal BW (NBW) [2500-3999 g] and high BW (HBW) [> 4000 g] children, aged 5-10 years, born and followed-up at YGOPH. We collected socio-demographic, clinical (weight, height, BP), laboratory (proteinuria, creatinine), maternal and birth data. The estimated GFR was calculated using the Schwartz equation. RESULTS: We included 80 children (61.2% boys) with 21 (26.2%) LBW, 45 (56.2%) NBW and 14 (15.5%) HBW; the median (interquartile range) age was 7.3 (6.3-8.1) years and 17 (21.2%) were overweight/obese. Two (2.5%) children, all with a NBW (4.4%), had an elevated BP whereas 2 (2.5%) other children, all with a LBW (9.5%), had hypertension (p = 0.233). Seven (8.7%) children had proteinuria with 19, 2.2 and 14.3% having LBW, NBW and HBW, respectively (p = 0.051). Equivalent figures were 18 (22.5%), 14.3, 24.2 and 28.6% for decreased GFR, respectively (p = 0.818). There was a trend towards an inverse relationship between BW and BP, proteinuria and GFR (p > 0.05). CONCLUSION: Proteinuria is more pronounced in childhood with a history of LBW and HBW while LBW children are more prone to develop hypertension. Regular follow-up is needed to implement early nephroprotective measures among children with abnormal BW.

Monthly direct and indirect costs of management of CKD 3 - 5 non-dialysis patients in an out-of-pocket expenditure system: The Case of Yaoundé.

Chronic kidney disease (CKD) affects ~ 10% of the world population. In most developing nations, the costs for the treatment of CKD are met by patients. Data on the economic burden of early stages of CKD are scarce; few studies have evaluated the cost of management of CKD stages 3 - 5 in non-dialysis (ND) patients in an out-of-pocket expenditure system. This study estimated the direct, indirect, and global economic cost of management of CKD stages 3 - 5 ND patients in Yaoundé, Cameroon. It was 1-month retrospective cost analysis. Sampling was consecutive and exhaustive of CKD 3 - 5 ND patients. We evaluated direct medical, direct non-medical, and indirect costs. 69 patients were included in the study, and the mean age was 55 years. The median monthly salary of the population was USD 162. Only 1.4% of patients had 100% health insurance coverage. The total cost of management was ~ USD 163. Direct medical, direct non-medical, and indirect costs accounted for 86.4%, 7.1%, and 6.3%, respectively. That global cost was prohibitive to Cameroonians and was tantamount to 2.7 times the minimal wage in Cameroon.

Exercise-induced albuminuria and circadian blood pressure abnormalities in type 2 diabetes.

AIM: To investigate the relationship between circadian variations in blood pressure (BP) and albuminuria at rest, and during exercise in non-hypertensive type 2 diabetes (T2D) patients. METHODS: We conducted a cross-sectional study in well controlled T2D patients, non-hypertensive, without clinical proteinuria and normal creatinine clearance. In each participant, we recorded the BP using ambulatory blood pressure monitoring (ABPM) for 24-h, and albuminuria at rest and after a standardized treadmill exercise. RESULTS: We enrolled 27 type 2 patients with a median age of 52; and a mean duration of diabetes and HbA1c of 3.6 ± 0.8 years and 6.3% ± 0.5% respectively. Using a 24-h ABPM, we recorded a mean diurnal systolic blood pressure (SBP) of 128 ± 17 mmHg vs nocturnal of 123 ± 19 mmHg (P = 0.004), and mean diurnal diastolic blood pressure (DBP) of 83 ± 11 mmHg vs nocturnal 78 ± 14 mmHg (P = 0.002). There was a significant difference between albuminuria at rest [median = 23 mg, interquartile range (IQR) = 10-51] and after exercise (median = 35 mg, IQR = 23-80, P < 0.001). Patients with exercise induced albuminuria had an increase in nocturnal BP values on all three components (128 mmHg vs 110 mmHg, P = 0.03 for SBP; 83 mmHg vs 66 mmHg, P = 0.04; 106 vs 83, P = 0.02 for mean arterial pressure), as well as albuminuric patients at rest. Moreover, exercise induced albuminuria detect a less increase in nocturnal DBP (83 vs 86, P = 0.03) than resting albuminuria. CONCLUSION: Exercise induced albuminuria is associated with an increase in nocturnal BP values in T2D patients.

Assessment of the 10-year risk of cardiovascular disease among a group of patients on maintenance hemodialysis: A cross-sectional study from Cameroon.

OBJECTIVE: To assess the 10-year risk of cardiovascular disease and potential impacting factors among patients undergoing hemodialysis in Yaoundé, Cameroon. DESIGN: A cross-sectional study in January 2016. SETTING: Patients were recruited at the dialysis unit of the Yaoundé University Teaching Hospital, Cameroon. PARTICIPANTS: These were hemodialysis patients aged 20 years and above, dialyzing in the above unit since at least 3 months and volunteering to be enrolled in the study. MAIN OUTCOME MEASURES: The risk of cardiovascular disease was assessed using the Framingham risk score. RESULTS: We included 44 patients. The risk of cardiovascular disease ranged from less than 1% to more than 30% with a median of 12.3% (interquartile range 4.9-24.4). Twenty hemodialysis patients (45.5%) had a low risk of cardiovascular disease (<10%), 10 (22.7%), a moderate risk (10-20%), and 14 (31.8%) presented a high risk of cardiovascular disease (>20%). In multivariable linear regression analysis, duration on dialysis (adjusted ß = 0.11; p = 0.003), number of weekly sessions of physical activity (adjusted ß = -1.35; p = 0.018), fasting serum glucose levels (adjusted ß = 4.22; p = 0.022), serum triglycerides levels (adjusted ß = 5.94; p = 0.033), and serum urea levels (adjusted ß = -2.08; p = 0.039) were independently impacting our patients' risk of cardiovascular disease. CONCLUSION: Around 55% of our study population presented a moderate or high risk of cardiovascular disease. Duration on dialysis, number of physical activity sessions per week, fasting serum glucose, serum triglycerides, and serum urea levels may impact our hemodialysis patients' risk of cardiovascular disease.

Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon.

BACKGROUND: End-Stage Renal disease (ESRD) is associated with increased morbidity and mortality. We assessed the occurrence, time-trend and determinants of fatal outcomes of haemodialysis-treated ESRD patients over a 10-year period in a major referral hospital in Cameroon. METHODS: Medical records of ESRD patients who started chronic haemodialysis at the Douala General Hospital between 2002 and 2012 were reviewed. Baseline characteristics and fatal outcomes on dialysis were recorded. Accelerated-failure time and logistic regression models were used to investigate the determinants of death. RESULTS: A total of 661 patients with 436 (66 %) being men were included in the study. Mean age at dialysis initiation was 46.3 ± 14.7 years. The median [25th-75th percentiles] duration on dialysis was 187 [34-754] days. A total of 297 (44.9 %) deaths were recorded during follow-up with statistical difference over the years (p < 0.0001 for year by year variation) but not in a linear fashion (p = 0.508 for linear trend), similarly in men and women (p = 0.212 for gender*year interaction). The death rate at 12 months of follow-up was 26.8 % (n = 177), with again similar variations across years (p < 0.0001). In all, 34 % of deaths occurred within the first 120 days. Year of study and background nephropathies were the main determinants of mortality, with the combination of diabetes and hypertension conveying a 127 % (95 % CI: 40-267 %) higher risk of mortality, relative to hypertension alone. CONCLUSION: Mortality in dialysis is excessively high in this setting. Because most of these premature deaths are potentially preventable, additional efforts are needed to offset the risk and maximise the benefits from the ongoing investments of the government to defray the cost of haemodialysis. Potential actions include sensitisation of the population and healthcare practitioners, early detection and referral of individuals with CKD; and additional subsidies to support the cost of managing co-morbidities in patients with CKD in general.

Hepatitis B, Hepatitis C, and Human Immune deficiency Virus Seroconversion Positivity Rates and Their Potential Risk Factors Among Patients on Maintenance Hemodialysis in Cameroon.

INTRODUCTION: Maintenance hemodialysis is a high-risk environment for transmission of blood-borne viruses. We aimed to assess the seroconversion rates of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immune deficiency virus (HIV) infections in patients on maintenance hemodialysis in a tertiary care hospital in Cameroon. MATERIALS AND METHODS: Patients with serology records at initiation of hemodialysis, and a minimum duration on hemodialysis of 4 months were included. Baseline demographic and clinical data were recorded. Patients were tested with a third and fourth generation immune-enzymatic assay for hepatitis B surface antigen and anti-HCV antibodies, respectively. For HIV, a rapid Ag/Ab combo test and an ImmunoComb II HIV (for confirmation) were used. RESULTS: Ninety-seven patients, 66% men, mean age of 51 ± 14 years and mean duration on hemodialysis of 32.8 ± 27.5 months, were included. Seroprevalence at dialysis initiation was 6.2%, 20.6%, and 9.3%, respectively, for HBV, HCV, and HIV. Ninety patients (92.8%) received blood transfusions while on hemodialysis. Seroconversion rates were 1.1% for hepatitis B surface antigen, 11.8%, for anti-HCV antibodies, and 0.0% for HIV. Longer duration on dialysis was associated with HCV seroconversion (62.7 months versus 29.2 months, P < .001). CONCLUSIONS: Seroconversion rate in hemodialysis was high for HCV, low for HBV, and nil for HIV. Longer duration on dialysis was associated with HCV seroconversion. Our study suggests an urgent need to lay emphasis on universal precaution measures in order to reduce the risk of hepatitis seroconversion in the unit.

A practical approach to low protein diets for patients with chronic kidney disease in Cameroon.

Cameroon is a low-middle income country with a rich diversity of culture and cuisine. Chronic kidney disease (CKD) is common in Cameroon and over 80 % of patients present late for care, precluding the use of therapies such as low protein diets (LPDs) that slow its progression. Moreover, the prescription of LPDs is challenging in Cameroon because dieticians are scarce, there are no renal dieticians, and people often have to fund their own healthcare. The few nephrologists that provide care for CKD patients have limited expertise in LPD design. Therefore, only moderate LPDs of 0.6 g protein per kg bodyweight per day, or relatively mild LPDs of 0.7-0.8 g protein per kg bodyweight per day are prescribed. The moderate LPD is prescribed to patients with stage 3 or 4 CKD with non-nephrotic proteinuria, no evidence of malnutrition and no interrcurrent acute illnesses. The mild LPD is prescribed to patients with stage 3 or 4 CKD with nephrotic proteinuria, non-symptomatic stage 5 CKD patients or stage 5 CKD patients on non-dialysis treatment. In the absence of local sources of amino and keto acid supplements, traditional mixed LPDs are used. For patients with limited and sporadic access to animal proteins, the prescribed LPDs do not restrict vegetable proteins, but limit intake of animal proteins (when available) to 70 % of total daily protein intake. For those with better access to animal proteins, the prescribed LPDs limit intake of animal proteins to 50-70 % of total daily protein intake, depending on their meal plan. Images of 100 g portions of meat, fish and readily available composite meals serve as visual guides of quantities for patients. Nutritional status is assessed before LPD prescription and during follow up using a subjective global assessment and serum albumin. In conclusion, LPDs are underutilised and challenging to prescribe in Cameroon because of weakness in the health system, the rarity of dieticians, a wide diversity of dietary habits, the limited nutritional expertise of nephrologists and the unavailability of amino and keto acid supplements.

Effect of low-dose spironolactone on resistant hypertension in type 2 diabetes mellitus: a randomized controlled trial in a sub-Saharan African population.

BACKGROUND: Low-dose spironolactone has been proven to be effective for resistant hypertension in the general population, but this has yet to be confirmed in type 2 diabetic (T2DM) patients. We assessed the efficacy of a low-dose spironolactone on resistant hypertension in a sub-Saharan African population of T2DM patients from Cameroon. METHODS: This was a four-week single blinded randomized controlled trial in 17 subjects presenting with resistant hypertension in specialized diabetes care units in Cameroon. They were randomly assigned to treatment with a daily 25 mg of spironolactone (n = 9) or to an alternative antihypertensive regimen (n = 8), on top of any ongoing regimen and prevailing lifestyle prescriptions. They were seen at the start of the treatment, then 2 and 4 weeks later. The primary outcome was change in office and self-measured blood pressure (BP) during follow-up, and secondary outcomes were changes in serum potassium, sodium, and creatinine levels. RESULTS: Compared with alternative treatment, low-dose spironolactone was associated with significant decrease in office systolic BP (-33 vs. -14 mmHg; p = 0.024), and in diastolic BP (-14 vs. -5 mmHg; p = 0.006). After 1 month of spironolactone, all the patients were controlled based on BP below 130/80 mmHg, with significant office BP reduction from 158 ± 17/86 ± 11 to 125 ± 11/72 ± 8, vs. 158 ± 8/94 ± 8 to 144 ± 17/89 ± 12 mmHg in the alternative treatment group. There was no significant variation in sodium and creatinine levels in both groups, but a mild increase of potassium levels in the spironolactone group. INTERPRETATION: Add-on low-dose spironolactone was effective in reducing BP to optimal levels in T2DM Cameroonian patients despite mild increase in serum potassium. Trial registration ClinicalTrials.gov Identifier NCT02426099. Date of registration April 2015.

Prevalence and Determinants of Chronic Kidney Disease Among Hypertensive Cameroonians According to Three Common Estimators of the Glomerular Filtration Rate.

Hypertension is a risk factor for renal diseases, which, in turn, are precursors of hypertension. The authors assessed the prevalence and determinants of chronic kidney disease (CKD) among 336 hypertensive adult Cameroonians (mean age, 60.9±11.3 years; 63.4% women) at Yaoundé. Any participant with an estimated glomerular filtration rate <60 mL/min/1.73 m(2) regardless of the equation used (Cockcroft-Gault [CG], Modification of Diet in Renal Disease [MDRD], and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and/or dipstick proteinuria was reviewed 3 months later. Participants presented a high prevalence of diabetes (18.5%), dyslipidemia (17.6%), gout/hyperuricemia (10.7%), overweight/obesity (68.8%), self-medication (37.5%), and alcohol consumption (33.3%). Hypertension was uncontrolled in 265 patients (78.9%). The prevalence of CKD was 49.7%, 50.0%, and 52.1% according to MDRD, CKD-EPI, and CG equations, respectively. Advanced age, adiposity, and severity of hypertension were determinants of CKD. Nearly half of the hypertensive patients had CKD regardless of the estimators used, predicted by well-known risk factors.

The clinical pattern of renal diseases in the nephrology in-patient unit of the Yaounde General Hospital in Cameroon: a five-year audit.

INTRODUCTION: Kidney diseases are a growing worldwide problem and one of the major public health threats. We analyzed the spectrum of kidney diseases seen over a five-year period in the nephrology in-patient unit of the Yaounde general hospital. METHODS: This was a retrospective analysis of 225 medical records of patients admitted from January 2005 to December 2009 in the unit with a discharge diagnosis of kidney and urinary tract diseases. The first hospitalization was considered for patients admitted several times for the same disease. Socio-demographic and clinical patient data were recorded. RESULTS: The patients mean age was 44.8±16 years with 135 (60%) males and 211 (93.8%) emergency admissions. All 139 (61.8%) patients with chronic kidney disease (CKD) had chronic renal failure. Acute kidney injury (AKI) (28%), nephrotic syndrome (7.6%), renal colic (1.3%) and acute pyelonephritis (1.3%) were other patterns observed. Chronic glomerulonephritis (25.9%), hypertension (22.3%) and diabetes (20.1%) were the main etiological factors of CKD. All AKI patients were in stage RIFLE-F. AKI was secondary to parenchymal (58.7%), functional (25.4%) and obstructive (15.9%) etiologies. Black water fever (36.4%), sepsis (22.7%), drugs (18.2%), eclampsia (13.6%) and herbal concoctions (9.1%) were the etiologies of acute tubular necrosis while enterocolitis (56.2%), heart failure (31.3%) and digestive hemorrhage (12.5%) were the etiologies of functional AKI. CONCLUSION: The clinical pattern of renal diseases is dominated by advanced CKD and AKI secondary to preventable causes. This study suggests a need for an array of actions including sensitization, continuous medical education and strengthening of the health system.

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 (≥ 30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR) (< 60 ml/min/1.73 m(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 ± 16.1 years; 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.

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 Cité 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 ± 13.2 years 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 ± 31.4 ml/min respectively with the MDRD, CG and CKD-EPI equations. The prevalence of albuminuria was 7.2 % while the prevalence of decreased GFR (eGFR < 60 ml/min) and CKD (any albuminuria and/or eGFR < 60 ml/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.

Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting.

BACKGROUND: Anemia is a common complication of chronic kidney disease. We investigated the prevalence, characteristics and management of anemia in patients on chronic hemodialysis and assessed the response to blood-transfusion based management in Cameroon. METHODS: This was a cohort study of five months' duration (August-December 2008) conducted at the Yaoundé General Hospital's hemodialysis center, involving 95 patients (67 men, 70.5%) on chronic hemodialysis by a native arteriovenous fistula. A monthly evaluation included full blood counts, number of pints of red cell concentrates transfused, and vital status. RESULTS: At baseline, 75 (79%) patients had anemia which was microcytic and hypochromic in 32 (43%). Anemia was corrected in 67 (70.5%) patients using blood transfusion only, while 28 (29.5%) patients were receiving erythropoietin (11 regularly, 39%). Only 77.2% of 342 pints (median 3.0, range 0-17 per patients) of red cell concentrates prescribed were effectively received during the follow-up at an unacceptably high cost to patients and families. Mean hemoglobin and mean corpuscular hemoglobin levels remained stable during follow-up, while mean corpuscular volume increased. Erythropoietin treatment was the main determinant of favorable trajectories of hematological markers. CONCLUSIONS: Patients on chronic hemodialysis have predominantly microcytic hypochromic anemia, with limited capacity for correction using blood transfusion.

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 calcium-phosphorus product >55 mg(2)/dl(2). 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 < 0.047) while cardiac failure and valvular calcifications were associated with advanced age and high interdialytic weight gain (both p <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.

Outcomes of non-tunneled non-cuffed hemodialysis catheters in patients on chronic hemodialysis in a resource limited sub-Saharan Africa setting.

The aim of the present study was to investigate the adverse outcomes of non-tunneled hemodialysis catheters and determinants in chronic hemodialysis patients receiving care at the Yaoundé General Hospital hemodialysis center, Cameroon. This was a prospective study of 11 months duration (February-December 2008) involving 81 non-tunneled non-cuffed catheters (63 femoral, 18 internal jugular) placed in 72 adults (47 men, 65.3%) on chronic hemodialysis. Baseline clinical and laboratory parameters associated with catheter-related complications during follow-up were investigated. The difference between variables was assessed using the χ(2) test and equivalents. Sixty-five (80.2%) catheters were inserted for emergency dialysis, 11 (13.6%) for a failed native arteriovenous fistula and five (6.2%) for a failed prior catheter. The mean time-to-catheter removal was 35 ± 28 days. Catheter-related complications accounted for a third of catheter removals. The main catheter-related complications were infections (17/27, 62.9%) and bleeding (6/27, 22.2%), which were associated with unemployment (P = 0.0002) and longer duration of catheter (P = 0.004). The catheter-related infections were sepsis (11.8%), exit-site (29.4%) and both (58.8%); leading to death in 11/17 (64.7%) cases. Fever (94.1%), pain (88.2%) and pus (70.6%) were the main infectious signs with Staphylococcus aureus involved in 70.6%. Unemployment was significantly frequent in patients with infectious complications (76.5% vs. 26.6%, P = 0.0004). Non-tunneled hemodialysis catheters are mainly used for emergency dialysis through the femoral vein in this setting. Catheter-related infections due to Staphylococci are the leading complications associated with unemployment and longer utilization. Efforts are needed to improve early transfer of patients to nephrologists for better preparation for renal replacement therapy.