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Background: Cost is a major limiting factor for dialysis in low-income countries. The objective of our study was to determine the economic cost of creating an arteriovenous fistula (AVF) for hemodialysis at the Douala General Hospital (DGH). Material and methods: We conducted a descriptive cross-sectional study including patients undergoing AVF creation at the DGH from January to April 2020. Costs were calculated using a bottom-up approach. The direct cost was composed of the sum of the cost of medical consultation, additional paraclinical tests, drugs, disposables, hotel services, food, transport and medical and nursing care. The indirect cost was calculated as the sum of the costs related to the temporary incapacity to work and the additional expenses of the families. The cost of temporary work incapacity was calculated according to human capital theory. The economic cost was the sum of the direct cost and the indirect cost. The costs were expressed as a mean with standard deviation. The calculated costs were expressed in US Dollars. Statistical significance was considered as p < 0.05. Results: A total of 44 patients were included of which 29/44 (65.9%) were male. The mean age of the study population was 49.1 ± 14.7 years. The median monthly income was $172 and only 6.8% of patients had health insurance. The average direct cost per patient was $327.3 ± $212.7, with hospitalization costs accounting for 59.6% of that cost. The average indirect cost per patient was $64.5 ± $50.3. The largest proportion of these costs was due to lost productivity related to temporary work disability (45.7%). The average economic cost per patient was $391.9 ± $219.5. Direct costs accounted for 83.54% of the economic cost. Re-operation (p = 0.039), age (p < 0.01) and number of hospitalization days (p < 0.01) significantly affected the cost Conclusion: The cost of creating an AVF for hemodialysis was high and represented more than 2 times the median monthly income of patients and was mainly due to hospitalization costs. Therefore, there is a need to implement strategies to reduce the financial burden of arteriovenous fistula creation in our setting.

Introduction : Les complications cardiovasculaires sont la première cause de mortalité chez les patients avec maladie rénale chronique (MRC). Notre but était de décrire les anomalies échocardiographiques chez les patients hémodialysés (HD) et rechercher leur association avec la dialyse.Matériel et méthodes : Il s’agissait d’une étude transversale et analytique menée à l’Hôpital Général de Douala de février à juin 2021. Les données sociodémographiques, cliniques et biologiques étaient recueillies. Nous avons ensuite réalisé une échocardiographie à 3 groupes de patients appariés selon l’âge et le sexe dont 50 sans MRC (Non MRC), 50 avec MRC non hémodialysés (MRC-ND) et 50 avec MRC hémodialysés (HD). Une valeur p < 0,05 était considérée significativeRésultats : Au total, sur 150 patients inclus, 93 (62%) étaient de sexe masculin et l’âge médian était de 56 ans, similaire dans les 3 groupes. Les anomalies échocardiographiques étaient significativement plus fréquentes chez les HD (90%) par rapport aux patients avec MRC non dialysés (72%) et ceux sans MRC (38%) (p < 0,001). Les anomalies fréquentes chez les HD étaient l’hypertrophie ventriculaire gauche (74%), la dilatation de l’oreillette gauche (70%), les calcifications valvulaires (46%), la dysfonction diastolique (40%) et les valvulopathies (38%). La dialyse augmentait significativement le risque de survenue d’une anomalie échocardiographique comparée aux patients MRC naïfs de dialyse (OR = 3.5; p = 0,027) ou sans maladie rénale (OR = 14,68 ; p = 0,001).Conclusion : Les anomalies échocardiographiques étaient significativement plus fréquentes chez les patients HD en particulier l’hypertrophie ventriculaire gauche, la dilatation de l’oreillette gauche, les calcifications valvulaires et la dysfonction diastolique. Ces résultats suggèrent qu’une intervention énergique doit être menée quant à la prise en charge spécifique des causes de ces anomalies morphologiques telles que l’hypertension artérielle.

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 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.

Anaesthetic modalities for arteriovenous fistula (AVF) creation include general (GA), local (LA) and regional anaesthesia (RA). Ultrasound guided regional anaesthesia (USRA) proved to have more benefits in AVF creation than the other two. This study conducted at the Douala General Hospital aimed to assess these benefits over GA and RA. A retrospective review was performed on 217 records of patients who underwent an AVF creation between January 2015 and December 2018. The socio-demographic and clinical characteristics of patients were recorded. Analysis of variance, Pearson’s chi-square test and binomial logistic regression were performed and a p value of

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

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 eGFR2 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.

Background: Depression is reported to be frequent in patients with chronic kidney disease and end stage kidney in high income countries. Little is known about depression in low income area such as Sub-Saharan Africa. Objective: Describe the epidemiology and factors associated with depression in patients with chronic kidney disease and in chronic haemodialysis in Cameroon. Methodology: We conducted a cross sectional study for 3 months in 2 nephrology services. Patients older than 18 years with CKD stage 3-5 and those on chronic haemodialysis who accepted to participate in the study were included. Depression was diagnosed using Beck Depression Inventory – Short Form (BDI -SF). A cut-off score ≥ 8 was used to diagnose depression. Results: Of the 196 patients included, 69 patients had CKD patients and 127 were on maintenance haemodialysis. Overall, depression was found in 40% (n=78) participants. Depression was less frequent in patients with CKD stage 3-4 (26%, n=12) and those who initiated dialysis ≤ 6 months (27%, n=6). Single/widow, unemployment, chronic pain and negative feeling about socio-familial life were common among depressed participants. Absence of chronic pain (OR 0.41[0.19-0.88], p=0.022), been socially active (OR 0.35[0.16-0.8], p=0.012) and good relationship with the spouse (OR 0.25[0.06-0.95], p=0.042) were independent factors associated with depression. Conclusion: Depression in frequent is chronic kidney disease and haemodialysis patients in Cameroon, affecting 2 patients out 5. Socio-demographic factors seems to be the main contributors. Psychological support should be proposed to these patients, especially among those who should initiated dialysis and with long haemodialysis stay.

Introduction: Pediatric Acute Kidney Injury (AKI) seems to be a major cause of morbidity and mortality in Subsahara Africa. However, data on its epidemiology are scare and mainly originate from tertiary and urban health facilities such as large university Teaching hospitals with a nephrology service. Objective: The aim of this study was to compare the epidemiology of pediatric AKI in urban and semi-urban health facility. Patients and method: We conducted a retrospective study of 16 months in a tertiary urban hospital (General Hospital of Douala) and a secondary semi-urban health facility (Region hospital of Buea). Diagnostic of AKI was done using usual criteria. Age, sex distribution, etiologies of AKI, access to dialysis, renal recovery at hospital discharge, at 1 and 3 months and patient survival at hospital discharge was compared. Results: A total of 31 patients were included (GD 17 and RHB 14). Boys were more prevalent in the semi-urban setting (86% Vs 47% p = 0.029). Median age was comparable in the both group although most semi-rural patient were older (6.5 Vs 10 years p = 0.093). Hospital acquired AKI was only found in urban setting and account for 40% of pediatric urban AKI. Malaria related AKI (mainly black water fever) and sepsis were the main etiologies of AKI in urban and semi-urban milieu. Dialysis access was the same but 30% of children could not access to it in urban setting compare to none in semi-urban area. Reasons of non-access to dialysis were lack of pediatric material and financial constraints. In Hospital mortality was the same but was more severe amount patient who could not receive dialysis. Among the survivor, CKD was only found in urban setting. Conclusion: Although mainly due to malaria, pediatric AKI differs from urban tertiary and semi-urban secondary health facility in Cameroon. Hospital acquired AKI is only found in urban setting where children are younger and less boys. AKI in urban setting seems to be more severe with less access to dialysis and more risks of CKD.

Background: Hemodialysis (HD) is a therapy during which complications such as intradialytic hypertension (IDH) are frequent. We aimed to determine the incidence of IDH and associated factors amongst patients on maintenance hemodialysis in Cameroon. Method: It was a prospective cohort study including end stage kidney disease patients on HD. Data collected were: socio-demographic, comorbidities, current medication, weight, heart rate ultrafiltration rate (UF), albuminemia and electrocardiogram. The first blood pressure (BP) measurement was obtained at the beginning of the session and the last at the end. IDH was defined as an increase in systolic BP ≥ 10 mmHg between the first and the last measurement. Logistic regression was used to look for associated factors, p-value < 0.05 was considered significant. Results: Mean age was 49.06 ± 13.97 years with 64.2% males. Mean number of dialysis session was 11.26 ± 2.49. Incidence of IDH was 48.36%. The median number of IDH episodes was 5 (Range 0 - 12). Factors increasing the risk were hypertension (p = 0.003), number of antihypertensive drugs ≥ 2 (p < 0.001), blood transfusion during the session (p < 0.001), male gender (p = 0.038) and a monthly income < 35000 XAF (p = 0.033). Factors lowering the risk were age ≥ 50 years (p = 0.012), longer duration on dialysis (p < 0.001), dry weight ≥ 67 kg (p < 0.001), UF ≥ 800 ml/h (p < 0.001) and a BP ≥ 140/90 mmHg at the beginning of the session (p < 0.001). Conclusion: IDH is frequent amongst patients on maintenance hemodialysis in our setting, with various patients related factors associated.

Background: Poor sleep quality is reported to be common in hemodialysis patients. However, limited data are available about its prevalence in sub-Saha-ran region. The aim of this study was to assessed sleep quality and its predictors among hemodialysis patients. Methods: We conducted a cross sectional study of 2 weeks in the Douala General Hospital hemodialysis center of Cameroon involving 46 chronic hemodialyzed patients for at least six months with arteriovenous fistula. Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and laboratory data were collected in patients’’ fields. Result: Thirty-five (76.1%) subjects reported poor sleep quality. The most frequent abnormal sleep components were subjective sleep quality, sleep disturbances and sleep latency (87%, 85% and 76% respectively). In univariate linear regression, hemoglobin level, sleep quality, sleep latency, sleep duration, habitual sleep efficiency and sleep disturbance were associated with poor sleep quality. In multivariate linear regression only hemoglobin level (p = 0.004) and sleep latency (p = 0.002) were associated with poor sleep quality. Conclusion: Poor sleep quality is frequent in our hemodialysis patients and hemoglobin seems to be a good predictor of sleep quality in these patients.

Background: With the improvement of life expectancy in developing countries, there is a growing population of elderly admitted on maintenance hemodialysis. This study assessed the survival among incident elderly patients on maintenance hemodialysis in Cameroon. Patients and method: We carried out a retrospective cohort study of 6.3 years in the main hemodialysis units of Cameroon. All incident chronic hemodialysis patients of at least 65 years of age at dialysis initiation were included. Participants were followed for a minimum of 4 months up until death or abandon of dialysis. Their baseline characteristics and survival outcome were assessed. Results: A total of 107 patients were included in this study, representing a cumulative incidence of hemodialysis among elderly patients of 10.9% during the study period. The median age at dialysis initiation was 68 years [IQR 66-72]. The median modified Charlson Comorbidity Index (mCCI) was 2 [IQR 2-5], and 35 (33%) patients had a comorbidity index greater than 3. Emergency dialysis at initiation was noted in 71 (69%) participants. Twenty four (22.5%) patients were hospitalized, mainly because of sepsis. The median survival time was 19.5 months [IQR 42-6]. Survival rates at 1 year and 2 year were 65.4% and 41.5%, respectively. The lowest survival time (4 months) was observed in the very elderly (> 80 years) with high comorbidity index. Patients with a history of hospitalization and those with emergency dialysis initiation also had low survival rates. Conclusion: In our setting, one out of ten incident hemodialysis patients is an elderly. Nearly two-thirds of elderly are still alive one year after hemodialysis initiation. Comorbidity, emergency dialysis initiation and hospitalization are the main factors associated with mortality.

Background: Increased augmentation index (AI), a surrogate measure of arterial stiffness (AS) and a direct index of wave reflection is an independent predictor of cardiovascular events in chronic kidney disease (CKD) patients. This study aimed to assess the patterns of wave reflection among blacks Cameroonian patients with CKD.Methods: 150 CKD patients (Mean age: 52±15 years, 57% males) were enrolled in this cross-sectional study performed at the Douala General Hospital, between November 2015 and May 2016. Sociodemographic, biologic variables, medical history and current medication, weight, height, waist circumference, blood pressures (BP), heart rate (HR) and AI corrected for HR (Aix) were recorded in all participants. Estimated brachial and aortic AIx, pulse pressure (systolic minus diastolic BP) (PP) were measured using a Mobil-O-Graph automatic brachial oscillometric device.Results: Age, sex and height-adjusted AIx was similar between in non-dialysed (n = 90) and in hemodialysed (n = 60) patients: 22.6 ±4.5% vs 22.2 ±3.7 (P = 0.51). AIx ≥ 30%, suggestive of subclinical aorta damage, was higher in non-dialysis than in hemodialysed patients, especially in post-dialysis: 27.8% vs 18.3%, P = 0.002. Importantly, hemodialysis acutely decreased markedly brachial PP, another surrogate measure of AS, by 6 mmHg (P = 0.008) in patients on maintenance dialysis. Multivariable regression analysis showed that male gender was inversely, while MAP and stage 5 CKD were positively associated with AIx in the whole study group (RR 0.230, P

Introduction: L’hémodialyse chronique (HC) est une modalité de suppléance rénale requérant un abord adéquat pour sa bonne réalisation. La fistule artério-veineuse (FAV) est l’abord idéal et devrait être créée4 à 6 mois avant l’initiation des séances de dialyse.. Le but de ce travail était d’évaluer le délai de création des FAV pour l’HC à l’Hôpital Général de Douala (HGD).Méthodologie: Il s’agit d’une étude rétrospective menée du 1er janvier 2014 au 31 octobre 2015 à l’HGD. Les dossiers de tous les patients hémodialysés suivis dans le service d’hémodialyse pendant la période de l’étude ont été analysés. Pour chaque patient, les données socio-démographiques, les informations sur le suivi avant la dialyse et les modalités de son initiation ont été recueillies. Les FAV confectionnées après le début de l’HC étaient définies comme à délai tardif, celles entre 1 et 30 jours comme à délai modéré et celles créés plus de 30 jours avant le début de l’HC comme à délai normal.Résultats: Au total 107 patients ont été inclus ; dont 63,6% d’hommes. L’âge moyen était 48±14 ans avec un suivi avant l’HC de moins de un an chez 72% d’entre eux. Dans 79,4% l’HC a été débutée en urgence sur un cathéter et 36% des patients étaient hospitalisés. Des 107 patients, le délai a pu être déterminé avec précision chez 88 d’entre eux. De ces derniers, le délai était tardif chez 58 (66%), modéré chez 4 (4,5%) et normal chez 26 (29,5%). Les déterminants du délai tardif étaient l’âge >36 ans, le non-emploi, l’hypertension artérielle et l’hospitalisation à l’initiation de la dialyse.Conclusion: Le délai de confection d’un accès vasculaire permanent pour l’HC est anormalement long pour la grande majorité des patients de l’HGD. La réduction du coût cette procédure pourrait être une des pistes à étudier pour améliorer la situation.Mots clés: Hémodialyse, fistule artério-veineuse, délai, hôpital général, DoualaEnglish Title: Determinants of delay of permanent vascular access for hemodialysis in Douala General Hospital English AbstractIntroduction: Chronic hemodialysis (CH) is a renal replacement therapy requiring an adequate vascular acess (VA) to be eficient. Native arteriovenous fistula (AVF) is the most recommended VA and should be created 4 to 6 months prior to dialysis initiation. In Cameroon, late referral of patients to the nephrologist is a major concern estimated at 82.5% of cases. The aim of this study was to evaluate the delay of AVF creation at the Douala General Hospital (DGH).Method: We conducted a retrospective study at the DGH from January 1st, 2014 to October 31st, 2015. Files of all patients followed in the hemodialysis unit during the study period with CH indication or already on CH were analyzed. For each patient, sociodemographic data, the modalities of CH initiation and follow up were collected. The delay of AVF creation was considered late if it was created after dialysis initiation, moderate if created between 1 and 30 days before dialysis initiation and normal if more than 30 days before the onset of HC.Results: A total of 107 patients were included, 63.6% were men. The mean age was 48 +/- 14 years, and 72% had a follow-up before dialysis initiation of less than one year. In 79.4% CH was started in emergency and 36% of the patients were hospitalized. The delay could be accurately determined in 88 patients The delay was late in 58 (66%), moderate in 4 (4.5%) and normal in 26 (29.5%) patients. The determinants of late delay were age> 36 years, non-employment, high blood pressure and hospitalization at dialysis initiation.Conclusion: Late creation of AVF is frequent amongst pat patients followed at the DGH, with various associated factors. Cost reduction of this procedure could be one of the solutions to improve this situation.Keywords: Hemodialysis, arteriovenous fistula, delay, Douala general hospital

Background: Acute kidney injury (AKI) is a common disorder with high morbi-mortality especially in developing countries. In contrast to high income regions, AKI in these areas tend to be more community-acquired and affect young people. As in most Subsahara countries, previous studies on AKI in Cameroon were carried out in urban tertiary hospitals. Data on the clinical pattern and outcomes in semi-urban is lacking and may be quite different of urban setting. Objective: To describe the clinical pattern and outcomes of AKI in Buea Regional Hospital. Methods: We conducted an 18 months’ hospital-based observational retrospective study in the regional hospital of Buea, a semi-urban second category health facility of the South-West region of Cameroon. We excluded patients with known CKD (Chronic Kidney Disease)and incomplete data. AKI was diagnosed and classify according to the 2012 KDIGO criteria. Renal outcome was evaluated at 1 month. Results: Of the 196 participants included, 57.7% were males and 10.7% children. The median age was 45 years. HIV infection, hypertension and diabetes were the main comorbidities. AKI was community-acquired in 95% and stage 3 was found in 59%. Sepsis (37.2%), volume depletion (25%) and nephrotoxicity from herbal remedies (15.3%) were the main etiologic factors. Renal AKI was found in 72% of patient and was mostly due to ATN (56.6%). Obstetrical AKI was mainly due to post-abortum sepsis and AKI related malaria were the main etiology of pediatric AKI. In all, 71 (36%) participants had indications for dialysis but only 52 (73%) accessed it. Lack of appropriate dialysis technique and lack of funds were the main reasons for dialysis non-access. In-hospital mortality was 37.2%. Among survivors, renal recovery was complete in 65%, partial in 21%, and no recovery in 3%. Stage 3 disease was the only predictor of poor renal recovery at one month. Conclusion: AKI in this semi-urban hospital setting is community acquired and affected young individual with previous comorbidities such as HIV/AID, hypertension and diabetes. It is mainly caused by infections, volume depletion and herbal toxins.