Clinical characteristics and outcomes of hemodialysis in a new center in Northern Nigeria

Abstract

Background: Hemodialysis is the most common renal replacement therapy (RRT) modality in Africa and few countries enjoy reimbursement from the government to fund it. Africa contributes <10% of the total RRT patients worldwide this is mainly due to high cost. Aims and Objectives: We aimed to review the clinical characteristics and outcomes of patients requiring hemodialysis in our center over a 7 years period, to highlight the enormous challenges encountered. Materials and Methods: This is a retrospective study of patients aged 15 years and above that was seen between April 2010 and March 2017 at the Hemodialysis unit of Abubakar Tafawa Balewa University Teaching Hospital. Information was extracted from the patient's case folders and dialysis charts. Results: In total, 226 patients had hemodialysis over the period, 124 (54.9%) were male and 102 (49.1%) were female. Sixty-one (27%) patients had acute kidney injury (AKI), 143 (63.3%) had chronic kidney disease (CKD), whereas 22 (9.7%) had acute-on-CKD. A total of 2215 sessions of hemodialysis were done in the period, of which 782 (35.3%) were for AKI and 469 (21.2%) for acute on CKD. A total of 138 (60.6%) patients were discharged and 58 deaths were recorded. Conclusion: Although there is rapid proliferation of hemodialysis facilities in the country, many patients could not afford adequate hemodialysis. Inadequate dialysis due to finances was the main cause of death in these category of patients.

Demographic Pattern and Clinical Characteristics of Patients Undergoing Haemodialysis in a Tertiary Centre of a Developing Country: A Review of 280 Cases

“…The higher mean age of males mirrors previous findings in Nigeria and Ethiopia ( 7 - 8 , 10 ). This is similar to previous findings in this facility and other Southern states although higher compared with observations in the Northern part of the country ( 7 , 8 , 12 , 13 , 14 ). The mean age of patients with ESRD was lower compared to CKD and AKI patients giving further credence to the effect of foreign diets, greater stress involved in attaining higher standards of living resulting in elevated blood pressures, and a greater use of nephrotoxins (creams, soaps and eye lashes/creams) in the development and progression of CKD in the young.…”

“…In North-Eastern part of Nigeria, a total of 226 patients underwent HD over a 7-year period compared to this study where 280 patients had HD over a 4-year period further giving credence to the rising burden of renal diseases locally as well as globally occasioned by the interplay between various factors underlying NCD accentuation ( 4 - 6 , 12 ). The male preponderance in our study population is in agreement with previous findings, largely attributable to socioeconomic and cultural biases against women in our clime as well as lopsided referral practices ( 13 - 16 ).…”

“…The distance between some communities and dialysis facilities, dwindling renal care experts, coupled with bad road network, could only worsens this pattern. These factors could also contribute to the higher prevalence of temporal dialysis vascular access, particularly femoral in our center for dialysis commencement as they are cheaper and require less expertise in their placement as opposed to artero-venous fistula (AVF) creation ( 4 , 8 - 12 , 20 ).…”

Challenges in Diagnosis and Management of Glomerular Disease in Resource-Limited Settings

“…9). This reduction took place in the background of an incremental improvement of kidney replacement therapy (10). The authors postulated out-of-pocket expense and lack of skilled workforce as the main cause for the decline in kidney biopsies (9).…”

Comparison of Clinical and Biochemical Variables Between Patients on Twice a Week Dialysis Regime Having Different Residual Renal Function – A Jack in the Box

“…Owing to the highly specialized and expensive machinery, high labour expenses, the requirement for particularly trained physicians, nurses, and paramedical staff, and the long-term nature of the therapy, dialysis may be rather costly and not in access to everyone easily (Maake, 2017). With limited resources in government dialysis centres providing free dialysis facilities, it is not possible to entertain all CKD patients on recommended frequencies of dialysis (Abdu et al, 2019;Abdu et al, 2020;Gordon et al, 2015;Siddique et al, 2019). Lee et al, believe that thrice-weekly dialysis is recommended as minimum frequency in the initial weeks regardless of renal function test (Lee et al, 2018).Recently the Work Group recommended that thrice-weekly hemodialysis as a minimum frequency level was no longer applicable but clinical Practice Guidelines assert that twice-weekly hemodialysis is not suggested for patients with renal urea clearance (Kr) <2 mL/min/1.73 m 2 (Ndinya, 2016).…”