Causes and outcome of acute kidney injury amongst adults patients in two hospitals of different category in Cameroon; a 5 year retrospective comparative study.

BACKGROUND: Acute kidney injury (AKI) is an under-recognized disorder, which is associated with a high risk for mortality, development of chronic kidney disease (CKD). OBJECTIVE: We sought to describe and compare the causes and outcomes of AKI amongst adult patients in Douala general hospital (DGH) and Buea regional hospital (BRH). METHODS: A hospital-based retrospective cohort analytic study was carried from February to April 2021. Convenience sampling was used. We included Patient's files admitted from January 2016 to December 2020 aged > 18 years, with AKI diagnosed by a nephrologist and recorded values of serum creatinine (sCr) on admission and discharge. Data were analysed using SPSSv26. Chi-square, fisher, median mood's and regression logistic test were used, values were considered significant at p < 0.05. RESULTS: Of the 349 files included 217 was from DGH and 132 from BRH. Community acquired AKI were more present in BRH 87.12% (n = 115) than DGH 84.79% (n = 184) (p = 0.001). Stage III AKI was the most common presentation in both hospital. Pre-renal AKI was more common (p = 0.013) in DGH (65.44%, n = 142) than BRH (46.97%, n = 62). Sepsis and volume depletion were more prevalent in urban area with (64.51 and 30.41% vs. 46.21 and 25.75%) while severe malaria was more present in Semi-urban area (8.33% vs. 1.84%, p = 0.011). Complete and partial renal recovery was 64.97% (n = 141) in DGH and 69.69% (n = 92) in BRH (p = 0.061). More patients had dialysis in BRH 73.07% (n = 57) than in DGH 23.33% (n = 21). More patient died in DGH 33.18% (n = 72) died than in BRH 19.70% (n = 26) (p = 0.007). Stage III was significantly associated with non-renal recovery in both DGH (p = 0.036) and BRH (p = 0.009) while acute tubular necrosis was associated with non-renal outcome in DGH (p = 0.037). CONCLUSIONS: AKI was mainly due to sepsis, volume depletion and nephrotoxicity. Complete and partial recovery of kidney function were high in both settings. Patient outcome was poorer in DGH.

Markers and risk factors for chronic kidney disease in sub-Saharan Africans: baseline levels and 12-month trajectories in newly referred patients in Cameroon.

BACKGROUND: Little is known about the changes in disease makers and risk factors in patients with chronic kidney disease (CKD) under nephrological care in Africa. This study aimed to evaluate the baseline level of markers of CKD and their 12-month time-trend in newly referred patients in a tertiary hospital in Cameroon. METHODS: This was a retrospective cohort study including 420 patients referred for CKD between 2006 and 2012 to the nephrology unit of the Douala General Hospital in the littoral region of Cameroon. Their disease and risk profile was assessed at baseline and every 3 months for 1 year. Estimated glomerular filtration rate (eGFR) was based on MDRD and Schwartz equations. CKD was diagnosed in the presence of eGFR< 60 ml/min/1.73 m2 and/or proteinuria> 1+ and/or abnormal renal ultrasound persisting for ≥3 months. Data analysis used mixed linear regressions. RESULTS: Of the 420 patients included, 66.9% were men and mean age was 53.8 (15.1) years. At referral, 37.5% of the participants were at CKD Stage 3, 30.8% at stage 4 and 26.8% at stage 5. There was 168 (40%) diabetic and 319 (75.9%) hypertensive patients. After some improvement during the first 3 months, eGFR steadily decreased during the first year of follow-up, and this pattern was robust to adjustment for many confounders. Systolic and diastolic blood pressure levels significantly fluctuated during the first twelve months of follow-up. Changes in the levels of other risk factors and markers of disease severity over time were either borderline or non-significant. CONCLUSION: Patients with CKD in African settings are referred to the nephrologist at advanced stages. This likely translates into a less beneficial effects of specialised care on the course of the disease.

Factors associated with late presentation of patients with chronic kidney disease in nephrology consultation in Cameroon-a descriptive cross-sectional study.

BACKGROUND: Late presentation (LP) of chronic kidney disease (CKD) patients to nephrologist is a serious problem worldwide with persistent high prevalence despite known benefits of early nephrology care. OBJECTIVE: Determine the prevalence and factors associated with LP of CKD patients to nephrologists in Cameroon. METHODS: A cross-sectional study from October 2015 to May 2016 at the nephrology units of the Douala General and Laquintinie hospitals, including all consenting incident CKD patients. Data collected were: socio-demographic, search of CKD diagnostic criteria during prior follow up, therapeutic itinerary, clinical and biological parameters at presentation, knowledge on CKD and attitude towards dialysis. LP was defined as eGFR < 30 ml/min/1.73 m2. It was physician-related whenever no CKD screening was done in the presence of risk factor or no referral to nephrologists at early stages; patient-related whenever patients did not have recourse to hospital care while symptomatic or disrespected a referral decision. p value <.05. RESULTS: We included 130 patients, mean age 53.10 ± 14.66 years, 60.77% males, 58.70% were referred by internal medicine physicians and 10% had recourse to complementary and alternative medicine (CAM). At presentation, 70.80% were symptomatic, 53% had CKD stage five, 86.12% were poorly graded on knowledge and 49% had a negative attitude towards dialysis. The prevalence of LP was 73.90%, 50% was physician-related, 44.79% patient-related and 5.21% both. Being accompanied (p = .038), a low level of education (p = .025) and recourse to CAM (p = .008) were associated with LP. CONCLUSION: LP is high in Cameroon, attributed to physician's practical attitudes and patient's socio-cultural behaviors and economic conditions.

[Burnout syndrome in hemodialysis health workers in Cameroon: Prevalence and associated factors]. / Prévalence et facteurs associés au syndrome d'épuisement professionnel chez le personnel de santé des centres d'hémodialyse au Cameroun.

BACKGROUND: Hemodialysis medical staffs usually work in a stressful environment. In low resource countries, professional conditions are worse and can lead to burnout syndrome. The aim of this study was to determine the prevalence of burnout syndrome and its associated factors in hemodialysis health care workers in Cameroon. PATIENTS AND METHODS: We conducted a cross sectional study in all hemodialysis centers from Cameroon between January to August 2017. The Maslach Burnout Inventory was used for assessment of burnout level. Burnout syndrome was defined as the presence of emotional exhaustion, depersonalization or decreased professional achievement. RESULTS: A total of 92 health workers (women 60%; n=55) among 105 identified were recorded. The median age was 42 years. Most of the workers were nurses (78.5%) and 8.5% were nephrologists. Burnout syndrome was found in 76 (82.6%) workers, 35 (38%) had emotional exhaustion, 44 (48%) depersonalization and 57 (62%) decreased professional achievements. Burnout was significantly more prevalent in overcrowded centers (100% vs. 47%; P<0.001). Hemodialysis position<5 years was less prevalent in participants with emotional exhaustion and depersonalization. Desire to change position (OR 19.61 [2.074-185.4]; P=0,009) was associated with burnout syndrome. CONCLUSION: Burnout syndrome is very common among Cameroonian hemodialysis medical staff. Improvement of work conditions, limiting posting in hemodialysis to less than 5 years and change of position when requested may be potential preventive measures.

Intradialytic hypotension and associated factors among patients on maintenance hemodialysis: A single-center study in cameroon.

Intradialytic hypotension (IDH), one of the most frequent acute complications of hemodialysis (HD), is associated with increased patient's morbidity and mortality. The aim of this study was to determine its prevalence and associated factors among patients on maintenance HD in Cameroon. This was a prospective longitudinal study carried out from June 20, to July 30, 2016 (5 weeks), including adult patients on HD >3 months at a tertiary hospital in Douala. During this period, patients were followed up at each HD session, and their blood pressure and occurrence of clinical events possibly related to IDH were recorded. In this study, IDH was defined as a decrease in systolic BP by >20 mm Hg or a decrease in mean arterial pressure by >10 mm Hg, associated to a clinical event. Logistic regression analysis was used to determine associated factors. We included 104 patients (69 males) with a mean age of 50.74 ± 15.18 years and a median duration on HD of 30.5 (interquartile range: 12.25-58.75) years. Hypertension 99/104 (95.2%) and diabetes 32/104 (30.8%) were the main comorbidities encountered. A total of 1032 HD sessions were followed up with an average of 9.88 ± 1.57 sessions per patient. IDH occurred in 11.6% of HD sessions. Associated factors were age, female sex, HIV infection, feeding during dialysis, and use of antihypertensive drug during or within 2 h before dialysis. The prevalence of IDH in our study was low. Associated factors were mainly related to patient's characteristics and comorbidities.