OBJECTIVETo evaluate day-to-day variations of insulin needs in type 2 diabetic patients with end-stage renal disease (ESRD) on maintenance hemodialysis.RESEARCH DESIGN AND METHODSWe developed a 24-h euglycemic clamp in patients who received an average of 2,200 calories in a standardized three-meal and two-snack regimen per day, adjusted to body size and sex. Intravenous insulin was adjusted every 30 min to achieve 5.5 ± 1.1 mmol/l glycemia over 24 h prehemodialysis, during hemodialysis session, and 24 h posthemodialysis in 10 type 2 diabetic patients, aged 55.7 ± 8.7 years with 11.9 ± 4.5 years diabetes duration, undergoing maintenance hemodialysis for 2.3 ± 2.3 years. Insulin requirements were derived from the dose of insulin administered to maintain euglycemia per period of time and day-to-day comparisons performed.RESULTSMean capillary glycemia was 5.5 ± 0.3 mmol/l prehemodialysis and 5.3 ± 0.2 mmol/l posthemodialysis (P = 0.39). Pre- and posthemodialysis areas under the glucose curve were comparable. This was achieved by infusing 23.6 ± 7.7 IU/24 h prehemodialysis vs. 19.9 ± 4.9 IU/24 h posthemodialysis, indicating a 15.3% decrease posthemodialysis (P = 0.09). Basal insulin needs decreased from 0.4 ± 0.1/h prehemodialysis to 0.3 ± 0.1/h posthemodialysis (P = 0.01). Total boluses were decreased by 2.2 ± 3.1 IU (P = 0.15). Changes in blood urea did not correlate with changes in insulin needs (r = 0.1, P = 0.79).CONCLUSIONSThe present study has demonstrated a significant 25% reduction in basal insulin requirements the day after dialysis compared with the day before. No significant change in boluses was observed, and overall the reduction of total insulin requirements was −15% equivalent to −4 IU/day posthemodialysis of marginal statistical significance.

Objective: There are limited data on AKI in sub-Saharan Africa. We aim to determine the incidence, characteristics and prognosis of AKI in Cameroon.Patients and methods: A prospective study including all consenting acute admissions in the internal medicine and the ICU of a tertiary referral hospital in Cameroon from January 2015 to June 2016. Serum creatinine assay was done on admission, days 2 and 7 to diagnose AKI. For patients with AKI, serum creatinine was done on discharge, days 30, 60 and 90. AKI was defined according to the modified KDIGO 2012 criteria as an increase or decrease in serum creatinine of 3 mg/l or greater, or an increase of 50% or more from the reference value obtained at admission or the known baseline value. AKI severity was graded using KDIGO2012 criteria. Outcome measures were renal recovery, mortality and causes of death. Renal recovery was complete if serum creatinine between the first 90 days was less than baseline or reference, partial if less than diagnosis but not baseline or reference, no-recovery if creatinine did not decrease or if the patient remained on dialysis.Results: Of the 2402 patients included, 536 developed AKI giving a global incidence of 22.3% and annual incidence of 15 per 100 patients-years. Of the 536 patients with AKI, 43.3% were at stage 3, 54.7% were males, median age was 56 years. Pre-renal AKI (61.4%) and acute tubular necrosis (28.9%) were the most frequent forms. Main etiologies were sepsis (50.4%) and volume depletion (31.6%). Renal outcome was unknown in 34% of patients. Of the 354 patients with known renal function at 3 months, 84.2% recovered completely, 14.7% partially and 1.1% progressed to CKD. Global mortality rate was 36.9% mainly due to sepsis.Conclusions: AKI is frequent in our setting, mainly due to sepsis and hypovolemia. It carries a poor prognosis.

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Purpose of The Study:The aim of this study was to describe sexual function disorders and investigate associated factors in women on maintenance hemodialysis in Cameroon. Methods:This was a cross-sectional study of three months duration (August-October 2014) in adult women on maintenance hemodialysis (HD) at three HD facilities in Cameroon. Patients with active psychiatric disease, infection or uncontrolled congestive heart failure were excluded. We use the Rosen questionnaire for evaluating female sexual function (FSFI), the Beck depression Inventory (BDI) and the short form (SF-36) of WHOQOL-BREF questionnaire to evaluate the quality of life (QOL). Logistic regressions were used to investigate the predictors of sexual function disorders. Results:We included 52 women with the mean age of 38±13 years (min-max: 18-69), with 31 (62%) being of child-bearing age (18-44 years). All participants had at least one sexual function abnormality including sexual dysfunction (75%), abnormalities of the menstrual cycle (83%), and sexual inactivity (30%). In women of child-bearing age, reported menstrual disorders were: irregular menses (45%), non-gravid amenorrhea (40%), oligo-menorrhea (25%), poly-menorrhea (25%), metrorrhagia (6%), and menorrhagia (3%). Ten of the 31 women had more than one menstrual disorder. Sexual dysfunction included: decreased sexual desire (56%), decreased sexual arousal (39%), decreased vaginal lubrication (49%), and failure to achieve orgasm (46%), sexual dissatisfaction (51%), and dyspareunia (36%). Advanced age (p = 0.0046), depression (p<0.0001), anemia (p=0.0005) and poor quality of life were negatively associated with sexual dysfunction. Sexual inactivity (p = 0.035) was equally associated with poor quality of life. Conclusion:Our results suggest that disorders of sexual function are common in women on maintenance hemodialysis, and are associated with depression, poor quality of life, advanced age, and anemia.

The MDRD equation seems to have a modest advantage over CKD-EPI and CG in estimating GFR and detecting impaired renal function in sub-Saharan African patients with Type 2 diabetes. The overall relatively modest correlation with CrCl, however, suggests the need for context-specific estimators of GFR or context adaptation of existing estimators.