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

Abstract

BackgroundEnd-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.MethodsMedical 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.ResultsA 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.ConclusionMortality 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.

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

“…Despite the benefit of early referral on CKD progression, the rate of late referral of patients to the nephrologist is extremely high in SSA [24,25], where access to RRT is limited [26]. Patients with CKD therefore face the problems of high out-of-pocket payment and poor outcome on RRT [27][28][29].…”

“…Few studies have reported the baseline profile of patients with CKD at referral and in SSA [23,24,28,29]. Little is known on the evolution of their kidney function, related risk factors and markers of CKD progression under nephrological care.…”

Fluid distribution timetable on adherence to fluid restriction of patients with end‐stage renal disease undergoing haemodialysis: Single‐blind, Randomized‐Controlled Pilot Study

“…In fact, it has been a leading cause of morbidity and mortality worldwide, afflicting approximately 8-16% of the global population (Jha et al, 2013) and ranking eighth among the leading causes of death. It has also been acknowledged as a troublesome disorder causing a myriad of health-related problems (Lowney et al, 2015), financial burden (Bavanandan, Ahmad, Teo, Chen, & Liu, 2016) and poor survival outcomes (Halle, Ashuntantang, Kaze, Takongue, & Kengne, 2016).…”

Chronic Kidney Disease in Cameroon: A scoping review

“…Over a quarter of patients starting hemodialysis die within the rst year with about half within the rst 6 months and those with co-existing hypertension and diabetes mellitus conveyed the poorest prognosis. Late presentation of CKD and affordability are were cited as major drivers of high early mortality [39]. The prevalence of CKD reported by studies with a single time-point assessment of kidney function or damage is likely to lead to errors in estimating of the true value.…”

“…The mortality rate of CKD in Cameroon ranged between 26.8% and 58.0% during a period of 1 to 10 years of follow up, Table 6 [39,48,49]. An audit of 661 medical records reported a 10-year mortality rate of 44.9% [39].…”