[Out-of-center blood pressure measurements in dialysis patients: Feasibility and comparison of methods]. / Mesures hors centre de la pression artérielle chez les hémodialysés chroniques : faisabilité et comparaison des méthodes.

The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA)/European Society of Hypertension (ESH) recommends out-of-center blood pressure measurements, self-blood pressure measurement or ambulatory blood pressure measurement in dialysis patients. However, the feasibility of out-of-center blood pressure measurements in routine care is not known. The objective of our study was to quantify it as "a priori" i.e. the percentage of hemodialysis to whom out-of-center blood pressure measurements can be proposed and who accept it, as "a posteriori", i.e. the percentage of out-of-center blood pressure measurements made and valid. A systematic out-of-center blood pressure measurements program was implemented from April to October 2019 in our chronic hemodialysis structures. It was proposed to each dialysis patient to carry out after education, an self-blood pressure measurement (Omron M3®), from 2 measurements, to 1 to 2minutes interval, mornings and evenings of 6days without dialysis (validity: 15 measures). Apart from arrhythmic patients, to all patients "not eligible" for self-blood pressure measurement (visually impaired, hemiplegic, neuropsychological disorders, language barrier), a 44-hour ambulatory blood pressure measurement (Microlife WatchBP 03®) was proposed separating 2 hemodialysis sessions; measures every 15minutes from 7 a.m. to 10 p.m. and 30minutes from 10 p.m. to 7 a.m. (validity: 40 measurements/day and 14/night). This is a study evaluating practices recommended for routine care in 18-year-old hemodialysis, having given their consent to the collection and analysis of the data. One hundred twenty nine patients were treated with chronic hemodialysis in our structures during the out-of-center blood pressure measurements campaign. Out-of-center blood pressure measurements could not be done in 21 patients (4 deceased, 2 transplanted and 4 absent before evaluation; 7 arrhythmics; 3 refusals and 1 multiple-disabled). Of these 108 patients (sex ratio 1.25; 69.3±13.5 years), 23 were ineligible for self-blood pressure measurement (visually impaired, neuro- and/or psychological disorders, language barrier). Due to 4 self-blood pressure measurement failures, the feasibility of the self-blood pressure measurement (n=81/129) is 62.8 % (CI95% 54.2-70.7). Of the 24 ambulatory blood pressure measurements performed (23 among those not eligible for self-blood pressure measurement and 1 failure of self-blood pressure measurement), 19 were valid. The "a posteriori" feasibility of out-of-center blood pressure measurements (n=100/129) is 77.5 % (CI95% 69.6-83.4). The feasibility of out-of-center blood pressure measurements in hemodialysis patients is good, making the application of the recommendations possible.

Insuffisance rénale chronique: aspects épidémiologique, diagnostique, thérapeutique et évolutif au CHU de Bouaké de 2016 à 2020 / Epidemiological aspects, diagnosis features and therapeutic outcome of chronic kidney disease at the Teaching Hospital of Bouake from 2016 to 2020

Le profil épidémiologique de l'insuffisance rénale chronique (IRC) varie d'un pays à un autre et d'une région à une autre dans un même pays. L'objectif de la présente étude était de décrire les cas d'IRC observés dans la ville de Bouaké. Méthodes : il s'agissait d'une étude rétrospective réalisée dans le service de Médecine Interne du CHU de Bouaké durant la période allant du 1er Janvier 2016 au 31 Décembre 2020. L'IRC était définie par un DFG inférieur à 60 ml/minute évoluant depuis plus de trois mois et/ou une atrophie rénale. Résultats : nous avons recensé 150 cas donnant une prévalence hospitalière de 3,6%. L'âge moyen était de 38,8±10 ans avec une prédominance masculine. Les antécédents étaient dominés par l'automédication traditionnelle et l'hypertension artérielle dans 68% des cas chacun. Dans 91% des cas, l'IRC était classée grade 5. Les étiologies étaient dominées par l'hypertension artérielle (34%). Le traitement symptomatique était la transfusion dans 73% et l'usage des antihypertenseurs dans 73%. Le traitement de suppléance était indiqué dans 91% et réalisé dans 3%. La mortalité était de 25%. Les facteurs associés à la survenue du décès étaient une altération de l'état général, une hypercréatininémie, une hyperphosphorémie, des reins atrophiés et le recours à la transfusion sanguine. Conclusion: l'IRC était diagnostiquée à un stade sévère. La principale cause était l'hypertension artérielle. La mortalité demeure élevée, faute d'accès au traitement de suppléance. L'accent doit être mis sur la prévention de l'IRC au cours des pathologies à risque.

Background: The epidemiological profile of chronic kidney disease (CKD) varies from country to country and from region to region within, even in the same country. The objective of this study was to describe the cases of CKD found in the city of Bouake (Ivory Coast). Methods: We proceeded to a retrospective study carried out in the Internal Medicine department of the Bouake University Hospital from January 1, 2016 till December 31, 2020. CKD was defined by a GFR (Glomerular Filtration Rate) at less than 60 ml/ minute and small kidneys. Results: In all , we identified 150 cases corresponding to 3.6% as hospital prevalence . The mean age was 38 .8 ± 10 years with a male predominance. The history was dominated by traditional self-medication and high blood pressure (HBP) for respectively 68% of cases. In 91% of cases , the CKD was classified as grade 5. The etiologies were dominated by HBP (34%). The care was a symptomatic one using transfusion in 73% and antihypertensive medication was prescribed for 73% of the patients. The substitution treatment was indicated in 91% of cases and carried out in 3%. The rate of mortality was 25 % and factors associated with death were a deterioration of the general condition, increased of blood level of creatininemia, hyperphosphatemia, small size of kidneys and the use of blood transfusion. Conclusion: CKD was diagnosed at a severe stage. The main cause was high blood pressure. Mortality remains high due to lack of access to replacement therapy . Emphasis should be placed on the prevention of CKD in high-risk pathologies

[Chronic renal failure in sickle cell disease: A retrospective analysis of 100 adults sickle cell patients from black Africa]. / Insuffisance rénale chronique au cours de la drépanocytose : une analyse rétrospective de 100 patients adultes drépanocytaires majeurs d'Afrique noire.

The prevalence of chronic renal failure (CRF) in sickle cell disease (SCD) patients could vary from one country to another depending on the modalities of management. The aim of the present study was to appreciate the epidemiology of CRF in SCD patients from black Africa in order to search for promoting factors. One hundred SCD adult patients have been considered for the study. The glomerular filtration rate (GFR) has been estimated according to the CKD-EPI formula. Three groups of patients have been identified according to the value of their GFR. The mean age of the patients was 30.84±8.26 years. Male gender has represented 51% of the study population. The mean GFR value was 175.4±86.2 mL/min/1.73 m(2). The prevalence of CRF was 11%. About 3% of them had severe CRF. Subjects with normal GFR were 20%. Subjects with glomerular hyperfiltration (HF) were 69%. By univariate analysis, when subjects with HF were compared with those presenting normal GFR, the following factors have appeared to be significantly associated: female gender (female 60.9% versus male 39.1%; P<0.01), weight <60 kg (weight <60 kg; 53.67±9.45 kg versus weight >60 kg; 59.9±9.41 kg; P<0.008), age <30 years (younger age 29.36±7.9 years versus older age 35.14±8.02 years; P<0.001), lower hemoglobin value (9.38±2,3 g/dL versus 10.33±2.61 g/dL; P<0.04). By logistic regression analysis, age <30 years (age >30 years; OR=0.12 [CI95% 0.03-04]; P<0.001), female gender (male gender; OR=0.17 [0.04-0.64]; P<0.01), weight <60 kg (weight >60 kg; OR=0.19 [CI95% 0.05-0.72]; P<0.01) were associated with HF. By univariate analysis, when subjects with CRF were compared with those presenting normal GFR, a lower hemoglobin value was significantly associated with CRF (7.92±2.7 g/dL versus 10.43±2.5 g/dL; P<0.009). There was a trend for subjects not being under maintenance therapy to more experience CRF (36.4% versus 70%; P<0.07). By logistic regression analysis, only a low hemoglobin value was associated to CRF (higher hemoglobin level; OR=0.55 [0.20-6.3]; P<0.01). In total, CRF and HF are frequent complications in SCD adult patients from black Africa.

Characteristics and outcome of living kidney donors after donation: A report from Cote d'Ivoire.

Kidney transplantation from living kidney donors (LKDs) because of its good results represents a good option for the treatment of patients with the end-stage renal disease. Kidney donation is a relatively safe procedure according to several studies. We conducted this cross-sectional study in order to describe the demographic, clinical, and renal outcome of LKD in Côte d'Ivoire. From March to November 2014, LKD residing in Côte d'Ivoire at the time of investigation and having donated the kidney more than one year ago were considered for the study. They were evaluated through a questionnaire. Of the 29 LKD listed in Côte d'Ivoire, only 14 responded to the questionnaire. The mean age at donation was 43.29 ± 9.12 years (27-59) and 10 of the LKD were women. Eight were related to the recipients, and the remaining were spouses. Laparoscopic nephrectomy was performed in nine LKD. The left kidney was harvested in ten cases. The main motivation for donation in all donors was the desire to save a life. At the time of the survey, the average duration after the donation was 4.57 ± 2.56 years (1-8). Only five donors had a regular nephrological follow-up. Hypertension was observed in one donor, seven had significant proteinuria, and six had glomerular filtration rate <60 mL/min but >30 mL/min. Significantly higher proteinuria was noted in donors under 45 years as compared to those over 45 years (0.43 ± 0.17 g/24 h vs. 0.22 ± 0.03 g/24 h, P = 0.01). Our study suggests that renal disease in LKD in Côte d'Ivoire is low after a mean follow-up period of four years. A donor registry is essential to ensure better follow-up of donors in order to detect potential adverse effects of kidney donation in the medium as well as in the long-term.

[Hemorrhagic cystitis due to adenovirus in a renal transplant recipient: the first reported case in black Africa in a setting of a very beginning of a kidney transplantation program and review of the literature]. / Cystite hémorragique à adénovirus chez le transplanté rénal: à propos d'un premier cas en Afrique noire survenu dans un tout débutant programme de greffe rénale et revue de la littérature.

Viral infections are an important complication of transplantation. Polyomavirus are the commonest viruses that infect the renal allograft. Herpes virus nephropathy has also been described. In the past 15 years, adenovirus nephritis has emerged as a potentially life-threatening disease in renal transplant patients in developed countries. Most of the papers devoted to adenovirus nephritis are reported cases. The fate of such patients in resources-limited countries is not known. Herein, we describe the clinical, biological and prognostic findings of a black African transplanted patient with adenoviral hemorrhagic cystitis. This case is the very first of its kind reported in black Africa in a setting of a start of a renal transplantation pilot project. The patient is a 54-year-old man admitted at the nephrology service for gross haematuria and fever occurred 1 month after kidney transplantation. The diagnosis of adenoviral hemorrhagic cystitis has been suspected because the patient has displayed recurrent conjunctivitis and gastroenteritis well before transplantation, which was then confirmed by the real-time polymerase chain reaction performed on the blood. Conservatory measures associated with immunosuppression reduction have permitted the discontinuation of haematuria. This case has been discussed in regard of the epidemiology, the diagnosis, the treatment, the evolution and the prognosis of the adenoviral infection in the renal transplant patient. A review of the literature has been performed subsequently.

[Uncontrolled hypertension in chronic kidney disease in patients from black Africa admitted in a renal unit: a retrospective analysis]. / Épidémiologie de l'hypertension artérielle non contrôlée au cours des maladies rénales chroniques chez des patients admis dans une unité de néphrologie d'Afrique noire : une étude rétrospective de 479 patients.

The incidence of uncontrolled hypertension (HTN+) in CKD in nephrology could reflect the quality of the management of the patients in a primary care setting. The aim of the present study was to identify factors associated with HTN+ in CKD in order to elaborate a prevention strategy for the health professionals. A retrospective analysis of 479 incidents patients has been performed from 2012/1st to 2012/12th. Sixty-two percent had CKD HTN+. Eighty percent were at stages 4 and 5. Mean value of SBP was 166.5±32 mmHg and 96±27.3 mmHg for DBP. Mean age was 48.2±14.6 years. Mean GFR was 17.4±17.1 mL/min and no difference found between groups (17.4±17.6 mL/min in CKD HTN+ versus 17.5±16.3 mL/min in CKD HTN-, P < 0.9). Alcohol consumption was more in CKD HTN+ as compared to CKD HTN-, but not different between groups (37.2% in CKD HTN+ versus 27.6% in CKD HTN-; P < 0.09). Patients who were taking antihypertensive drugs were significantly more in the CKD HTN- than CKD HTN+ (22% in CKD HT+ versus 41.1% in CKD HTN-; P < 0.0001). Factors associated with HTN+ in CKD were antihypertensive therapy (OR = 0.39; CI 0.20-0.75; P < 0.005); alcohol (OR = 2.19; CI 1.09-4.37; P < 0.02). BP was similar in HN and non-HN patients (173.0±26.9 mmHg versus 174.7±33.7 mmHg; P = 0.75). But kidney function was a little better in HN (16.9±17.7 mL/min and 20.95±18.5 mL/min; P < 0.1). Factors associated positively with HN/HTN+ were: history of HTN and age. Factors associated negatively with HN/HTN+ were: history of diabetes and CKD stage.