Search

Background: Diabetes is a major cardiovascular disease (CVD) risk factor. There has been a epidemiological shift and chronic CVD is increasing in Sub-Saharan Africa, however, the extent is unknown. Methods: Data were collected between March and April 2013 from 3 regions of the Northern Senegal (i.e., Saint-Louis, Matam etand Louga) using a cluster sampling method and the survey base of the national statistical and demographical agency, we included subjects aged between 18 and 80 years old. Participants underwent a face-to-face questionnaire to collect demographics and data on cardiovascular history/risk factors. Blood pressure and anthropometric measurements were measured in addition to blood tests including fasting plasma glucose. Diabetes was defined as fasting plasma glucose >= 1.26 g/L. Continuous data were reported as mean ± standard deviation (SD). Comparisons used the chi-squared test for categorical variables and Student’s t test for continuous variables. Multivariable adjusted logistic regression was used to identify factors associated with diabetes. Covariates with significant association (P Results: Among the 2440 subjects in this study (mean age: 44 years old, SD: 15.99), 692 (28%) were male. Nearly half of the sample never attended school (48%, 95%CI: 46-50%). Body mass index (BMI) higher than 25 was present in 43% of the sample (95%CI: 29-35%), with a significant increase in women (51% vs 22%, p Conclusion: This community-based study revealed a low prevalence of diabetes. However, the prevalence of additional CVD risk factors in this population was high. Preventive measures should be implemented to avoid increasing rates of diabetes in Sub-Saharan Africa.

Introduction: It is recommended that patients should start chronic haemodialysis using an arteriovenous fistula (AVF). We aimed to determine the proportion of Senegalese patients who used an AVF at the start of haemodialysis and examined the factors associated with its use.

Nephrology was a relatively poorly known specialty in sub-Saharan Africa until the early 1980s, because of low awareness and lack of access to diagnosis and renal replacement therapies. Nephrology has seen progress on the continent despite an unfavourable economic and geopolitical environment. With a prevalence of fewer than five nephrologists per million inhabitants, the training of nephrologists, now carried out on the continent, allowed to have more than 200 specialists trained in the last decade in French-speaking sub-Saharan Africa. Clinical and basic research is developing with quality work published from the continent in major international journals. The population receiving haemodialysis remains small, between 0 and 200 per million inhabitants. Kidney transplantation, with a prevalence between 0 and 5 per million inhabitants, is only well structured in South Africa. In this context of scarce resources, a strategy based on the prevention of non-communicable diseases in general, and chronic kidney disease in particular, should be prioritised.

Hibiscus sabdariffa L. (local names: bissap, karkade) and Combretum micranthum (kinkeliba) are widely known in traditional medicines and popular beliefs for their antihypertensive effect. This study assessed the clinical effectiveness of these two plants in the galenic forms of tablet and brew (decoction) in noncomplicated hypertensive patients. In total, 219 hypertensive patients with systolic blood pressure (SBP) between 140 and 180 mmHg and/or diastolic blood pressure (DBP) between 90 and 110 mmHg, without cardiovascular or renal complications, were involved in a multicentric randomized clinical trial in Senegal comparing five treatment regimens: bissap tablets (2 × 375 mg/day), bissap brew (10 g of calyx/day), kinkeliba tablets (2 × 200 mg/day), kinkeliba brew (10 g of leaves/day), and captopril (2 × 50 mg/day) as control. During the 6 months’ follow-up, a significant and equivalent decrease of SBP was observed with the herbal drug approach (−19.5 ± 16.1 mmHg, p

L’autosuffisance en riz poursuivie par l’État du Sénégal depuis l’Indépendance a motivé des investissements colossaux dans le Delta du fleuve Sénégal, au nord du pays. Cet article évalue la contribution du Projet de promotion du partenariat rizicole dans le Delta (3PRD) aux dynamiques organisationnelles et techniques. L’importance de ce projet repose sur le partenariat public-privé, un paradigme récent dans le monde du développement de l’agriculture irriguée. Notre démarche est basée sur un travail de synthèse bibliographique, des visites de terrain, des entretiens avec les responsables du projet et des enquêtes auprès des agriculteurs. Les résultats suggèrent deux progrès majeurs réalisés par le 3PRD : l’autonomisation des producteurs privés dans un grand aménagement collectif impliquant la participation de la société de développement SAED et l’introduction d’un nouveau matériel pour l’irrigation, l’électropompe. Ils montrent aussi que des efforts restent à réaliser en matière d’intensité culturale et de rendement agricole pour permettre aux producteurs de mieux rentabiliser les investissements qu’ils ont réalisés dans leurs périmètres.

Background Hemodialysis patients are among high-risk groups for COVID-19. Africa is the continent with the lowest number of cases in the general population but we have little information about the disease burden in dialysis patients. Objectives This study aimed to describe the seroprevalence of SARS-CoV-2 antibodies in the hemodialysis population of Senegal. Patients and methods We conducted a multicenter cross-sectional survey, between June and September 2020 involving 10 public dialysis units randomly selected in eight regions of Senegal. After seeking their consent, we included 303 patients aged ≥ 18 years and hemodialysis for ≥ 3 months. Clinical symptoms and biological parameters were collected from medical records. Patients’ blood samples were tested with Abbott SARS-CoV-2 Ig G assay using an Architect system. Statistical tests were performed with STATA 12.0. Results Seroprevalence of SARS-CoV-2 antibodies was 21.1% (95% CI = 16.7–26.1%). We noticed a wide variability in SARS-CoV-2 seroprevalence between regions ranging from 5.6 to 51.7%. Among the 38 patients who underwent nasal swab testing, only six had a PCR-confirmed infection and all of them did seroconvert. Suggestive clinical symptoms were reported by 28.1% of seropositive patients and the majority of them presented asymptomatic disease. After multivariate analysis, a previous contact with a confirmed case and living in a high population density region were associated with the presence of SARS-CoV-2 antibodies. Conclusion This study presents to our knowledge the first seroprevalence data in African hemodialysis patients. Compared to data from other continents, we found a higher proportion of patients with SARS-CoV-2 antibodies but a lower lethality rate.

Introduction Recipients of kidney transplants are a very heterogeneous population and the risk of posttransplantation complications markedly varies according to the recipient’s status. Scoring systems that predict survival outcome after kidney transplantation can help physicians improve risk stratification among recipients and make the best therapeutic decisions. This study aimed to assess the 1-year risk of major adverse events in potential recipients of kidney transplant at Saint-Louis University Hospital. Material and methods We performed a cross-sectional study including 65 patients with end-stage renal disease who were treated in the hemodialysis unit at Saint-Louis University Hospital. Scoring was based on a simple clinical tool with 4 items (age, cardiopulmonary factors, functional status, and metabolic parameters) reported to predict risk of severe adverse events during the first posttransplant year. Results The mean age of patients in years ± SD was 46.9 ± 23.5 and 53% were male. Median dialysis duration was 29.9 months and the main causes of kidney disease were hypertension and diabetes. A history of coronary artery disease was present in 22.3% of patients, and 33.5% had a high cardiovascular risk. According to the clinical score, 63.8% of potential recipients of kidney transplant presented a high risk of adverse events and 12.5% had a low risk of developing major complications during their first year posttransplantation. Conclusions This study shows that based on a simple pretransplant clinical assessment, two-thirds of our patients are at high risk for major adverse events during their first posttransplantation year. Such information could be invaluable during the counseling of donor and recipient couples.

International audience; Very few studies have analyzed the influence of the environment, rural or urban, on the notion of good life and subjective well-being in sub-Saharan Africa and none, to our knowledge, has combined qualitative and quantitative methodologies for this purpose. The objectives of this interdisciplinary study were: a) to understand the emic representations of the good life in rural and urban Senegal and; b) to compare the levels and determinants of satisfaction with life between these two populations. This study was carried out in Dakar and in a very isolated rural area in the North East of Senegal: the sylvo-pastoral zone of Ferlo. A total of six focus groups were conducted for the qualitative phase, while the quantitative phase was conducted on representative samples of the populations living in Dakar (N = 1000) and Té ssé ké ré (N = 500). Our results indicate that, against all expectations, life satisfaction is better in the Senegalese Ferlo than in the capital, Dakar. This difference may be the joint result of less meaningful social comparisons and a relationship with nature as a source of stress restoration in rural areas. However, the lifeworld of the rural Fulani of the Ferlo is being undermined by global climatic disturbances, which imposes rapid adaptations of pastoralism; otherwise this activity, that is not only subsistence but also identity-based, may disappear.

Cet article tente de caracteriser les menages agricoles pauvres dans le Delta du fleuve Senegal apres la crise alimentaire de 2008, durant laquelle les politiques publiques ont realise des amenagements hydroagricoles pour lutter contre la pauvrete et l’insecurite alimentaire. Il s’appuie sur des enquetes de terrain aupres des producteurs. Les resultats montrent une forte inegalite entre les cultivateurs en termes de capital foncier et de surfaces cultivees. Aussi les menages les plus pauvres sont-ils ceux qui n’emblavent pas assez de superficies, qui ne cultivent qu’en contre-saison chaude et, par consequent, ne gagnent pas assez de revenus agricoles pour ameliorer leur condition de vie. This paper attempts to characterise poor farming households in the Senegal River Delta after the 2008 food crisis, during which public policies implemented hydro-agricultural developments to combat poverty and food insecurity. It is based on field surveys of producers. The results show a strong inequality between farmers in terms of land capital and cultivated areas. As a result, the poorest households are those that do not cultivate enough land, only cultivate in the off-season and therefore do not earn enough agricultural income to improve their living conditions.

Hibiscus sabdariffa L. (local names: bissap, karkade) and Combretum micranthum (kinkeliba) are widely known in traditional medicines and popular beliefs for their antihypertensive effect. This study assessed the clinical effectiveness of these two plants in the galenic forms of tablet and brew (decoction) in noncomplicated hypertensive patients. In total, 219 hypertensive patients with systolic blood pressure (SBP) between 140 and 180 mmHg and/or diastolic blood pressure (DBP) between 90 and 110 mmHg, without cardiovascular or renal complications, were involved in a multicentric randomized clinical trial in Senegal comparing five treatment regimens: bissap tablets (2 × 375 mg/day), bissap brew (10 g of calyx/day), kinkeliba tablets (2 × 200 mg/day), kinkeliba brew (10 g of leaves/day), and captopril (2 × 50 mg/day) as control. During the 6 months' follow-up, a significant and equivalent decrease of SBP was observed with the herbal drug approach (-19.5 ± 16.1 mmHg, p 0.001) and control group (-19.7 ± 16.7, p 0.001). Regarding the galenic forms, the brews tended to be slightly more effective than tablets (reduction of SBP: -20.7 ± 15.1 mmHg vs -18.7 ± 16.7). The rates of clinically significant effectiveness (decrease in SBP ≥ 10 mmHg) were 75%, 67%, and 65% with bissap, kinkeliba, and captopril, respectively. After 6 months, target blood pressure of140/90 mmHg was attained by 49% of patients with bissap, 51% with kinkeliba and 40% with captopril. Bissap and kinkeliba appeared, at doses utilized, to be as effective as captopril over the 6 months' follow-up. In subsequent studies, brews might be started with a lower dosage.

Nephrology was a relatively poorly known specialty in sub-Saharan Africa until the early 1980s, because of low awareness and lack of access to diagnosis and renal replacement therapies. Nephrology has seen progress on the continent despite an unfavourable economic and geopolitical environment. With a prevalence of fewer than five nephrologists per million inhabitants, the training of nephrologists, now carried out on the continent, allowed to have more than 200 specialists trained in the last decade in French-speaking sub-Saharan Africa. Clinical and basic research is developing with quality work published from the continent in major international journals. The population receiving haemodialysis remains small, between 0 and 200 per million inhabitants. Kidney transplantation, with a prevalence between 0 and 5 per million inhabitants, is only well structured in South Africa. In this context of scarce resources, a strategy based on the prevention of non-communicable diseases in general, and chronic kidney disease in particular, should be prioritised.

Après l’édification des barrages sur le fleuve Sénégal, l’agriculture irriguée devait progressivement remplacer l’agriculture de décrue dans la moyenne vallée. Néanmoins, lorsque la crue est d’ampleur suffisante, on observe encore des cultures de décrue dans le lit majeur. Cette étude, réalisée entre juin 2016 et décembre 2019 dans la cuvette de Podor (Sénégal), vise à évaluer la surface inondée et celle cultivée en décrue, à caractériser les producteurs et à estimer les productions. Sur quatre crues observées, trois ont été suffisantes pour inonder plus de 1000 ha et exploiter plus de 400 ha, avec principalement du sorgho associé au niébé. Les crues actuelles sont moins fortes qu’avant 1976, mais l’exondation de la zone exploitable est plus précoce et la période propice aux semis est relativement plus longue. La cuvette est exploitée essentiellement par des habitants de la ville de Podor, agriculteurs ou non, irrigants ou non. La production en 2018 a été estimée à 121 tonnes de grains de sorgho et niébé, et 117 tonnes de fourrage pour 470 ha implantés. C’est peu et aléatoire comparé aux cultures irriguées, mais sans investissement, et les résidus de culture sont d’excellents fourrages. L’agriculture de décrue peut donc être une activité complémentaire rentable pour la population locale. Elle pourrait aussi être rentable à l’intérieur des périmètres irrigués de la moyenne vallée, qui sont inondables et ne sont donc exploités, au mieux, qu’une fois par an seulement. Déjà contrôlé à 50 % depuis 1987, le débit du fleuve pourrait être régulé à 70 % par des barrages réservoirs dans un proche avenir. Le soutien de crue deviendra alors indispensable, malgré son impact négatif sur la production électrique, si l’on veut préserver des cultures de décrue ou certains services écosystémiques nés de l’inondation dans la vallée.

Introduction: Diabetes is a leading cause of chronic kidney disease in the world. During the next decade, its burden is expected to increase in Africa with potential complications such as chronic kidney disease. However, epidemiology and risk factors of diabetic kidney disease are poorly described at population level. This study aimed to determine prevalence of diabetic kidney disease (DKD) in adult diabetics living in Saint-Louis, northern Senegal. Methods: A cross-sectional study including diabetic patients followed-up aged ≥18 years during a five-year period (2013-2018) in Saint-Louis. Clinical and biological parameters were collected during annual community-based mass screening. Diabetes was defined as fasting blood glucose ≥ 1.26 g/L confirmed by a second lab dosage. DKD was defined as persistence of albuminuria ≥ 30 mg/24h and/or estimated glomerular filtration rate (eGFR) 2. Data were analyzed with Stata 12.0. Results: We included a total of 1310 diabetic patients among whom 3.7% (95% CI = 1.4% - 9.8%) presented DKD. Their mean age was 46.2 ± 11.8 years and sex-ratio was 0.7. Micro-albuminuria and macro-albuminuria were present respectively in 59.2% and 18.4% of patients with DKD and half of them had a normal eGFR. Before the survey 89.8% of patients with DKD were not aware of their renal disease and only four of them had seen a nephrologist. After multivariate analysis, age (OR = 1.5; 95% CI = 1.1 - 3.4), duration of diabetes (OR = 1.2; 95% CI = 1.6 - 4.4) and hypertension (OR = 2.5; 95% CI = 1.4 - 4.6) were associated with the presence of DKD in diabetic patients while no significant association was not found with gender, blood glucose level, smoking and familial history. Conclusion: DKD is a frequent complication in diabetic adult population living in Saint-Louis. Early detection and management should be promoted in order to prevent progression to end-stage renal disease.

Africa trails the rest of the world in COVID-19 cases and deaths. However, as the pandemic spreads through the continent, we expect increases in community infection in the months ahead. Patients with kidney infection, especially those with end-stage kidney disease and those with kidney transplants, are at high risk for acquiring the disease and dying from it. While there is limited evidence for the benefit of interventions, we have the advantage of learning from the experiences of those in China, Europe and the Americas. This document sets forth guidance for dealing with our patients who have acute and chronic kidney disease, including those on renal replacement therapy and the staff involved in their care. Emphasis is placed on preparedness and prevention strategies. As evidence and experience accumulate, it is likely that updated guidance will be needed. L’Afrique suit le reste du monde en termes de nombre de cas et de décès dus à COVID-19. Cependant, alors que la pandémie se propage à travers le continent, nous prévoyons une augmentation de l’infection communautaire dans les mois à venir. Les patients atteints d’une maladie rénale, en particulier ceux atteints d’une maladie rénale chronique en phase terminale et ceux ayant subi une transplantation rénale, courent un risque élevé de contracter la maladie et d’en mourir. Bien que les preuves d’interventions soient limitées, nous avons l’avantage de tirer des enseignements des expériences de ceux qui se trouvent en Chine, en Europe et dans les Amériques. Ce document présente des conseils pour traiter nos patients atteints d’insuffisance rénale aiguë et chronique, y compris ceux sous thérapie de suppléance rénale et le personnel impliqué dans leurs soins. L’accent est mis sur les stratégies de préparation et de prévention. Au fur et à mesure que les preuves et l’expérience s’accumulent, il est probable que des directives actualisées seront nécessaires.

Resume Objectif Decrire les etiologies, la presentation clinique et la prise en charge therapeutique du glaucome neovasculaire (GNV) chez les patients senegalais. Patients et methodes Nous avons realise une etude retrospective sur les dossiers des patients suivis pour GNV entre 1993 et 2016. Nous avons inclus les yeux presentant une rubeose irienne avec ou sans hypertonie oculaire. Pour chaque patient, nous avons releve l’âge, le sexe, les antecedents medicaux et ophtalmologiques, les donnees de l’examen ophtalmologique, les modalites therapeutiques reparties en hospitalisation, gestes therapeutiques et nombre d’hypotonisants prescrits. Nous avons utilise le logiciel epi-info 7 pour l’analyse des donnees. Resultats Quarante-huit yeux de 44 patients etaient atteints. L’âge moyen etait de 59,7 ans et le sexe ratio de 2,1. Les etiologies etaient le diabete de type II chez 31,8 % des patients et une occlusion de la veine centrale de la retine chez 16,6 % des yeux. La cecite touchait tous les yeux. La douleur oculaire etait presente chez 75 % des yeux, un cercle perikeratique chez 29,1 % des yeux, une mydriase areflexique chez 31,25 % des yeux. La pression intraoculaire moyenne etait 49,7 mmHg. Un œdeme corneen etait observe a 54,1 % des yeux. L’examen du fond d’œil montrait 14,5 % de retinopathie proliferante. Le traitement avait necessite une hospitalisation chez 43,75 % des patients. Les gestes therapeutiques realises etaient la cyclocryoapplication pour 31,25 % des yeux, l’injection retrobulbaire xylo-alcool pour 14,5 % des yeux et la photocoagulation panretinienne (PPR) au laser a 12,5 % des yeux. Les hypotonisants etaient utilises en bitherapie pour 29 % des yeux, en tritherapie et quadritherapie pour 25 % des yeux chacun. Discussion Les etiologies sont comparables aux donnees de la litterature. Le diagnostic etait tardif et les moyens therapeutiques limites par des conditions economiques defavorables. Conclusion Le GNV du patient senegalais est une affection de l’homme de la soixantaine. Il est responsable de cecite irreversible douloureuse au traitement difficile d’ou l’interet de sa prevention par une surveillance rigoureuse et un traitement energique de toute ischemie retinienne.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common worldwide enzymopathy with approximately 400 million individuals affected. This inherited disease is sex-linked recessive inheritance. The high prevalence of certain variants of G6PD in different populations and ethnic groups increases the likelihood of finding associations with other pathologies. Sickle cell disease and thalassemia are the most common pathologies associated with G6PD deficiency. The aim of this study was firstly to study the prevalence of glucose-6-phosphate dehydrogenase deficiency (A-376/202) by molecular analysis in homozygous sickle cell patients, and secondly to study the influence of this association on the clinical severity of the disease. In a cross-sectional study, 100 patients aged 15 years with homozygous sickle cell disease in the stationary phase regularly monitored in a National Center for Blood Transfusion were included over a six-month period stretching from September 2015 to February 2016. An EDTA sampling tube was taken from each patient for the study of hematological parameters and a molecular study for the detection of mutations 376 and 202. Clinical, epidemiological and biological variables were collected using a questionnaire. Data was analyzed using Epi-info 7.2. The results of the study showed that the variant A- characterized by a double mutation (376/202) was found with a frequency of 13% (13/100) with a clear male predominance (p E‚ 0.006). Variant A- was statistically significantly associated with cholelithiasis (pE‚0.031). This study is of therapeutic interest since the recognition of G6PD-deficient sickle cell disease would make it possible to take adequate preventive measures with respect to the taking of oxidizing drugs. Key words: Glucose-6-phosphate dehydrogenase (G6PD) deficiency, sickle cell disease, stationary phase, Senegal.

Context Acetyl-l-carnitine (ALC), a mitochondrial carrier involved in lipid oxidation and glucose metabolism, decreased systolic blood pressure (SBP), and ameliorated insulin sensitivity in hypertensive nondiabetic subjects at high cardiovascular risk. Objective To assess the effects of ALC on SBP and glycemic and lipid control in patients with hypertension, type 2 diabetes mellitus (T2D), and dyslipidemia on background statin therapy. Design After 4-week run-in period and stratification according to previous statin therapy, patients were randomized to 6-month, double-blind treatment with ALC or placebo added-on simvastatin. Setting Five diabetology units and one clinical research center in Italy. Patients Two hundred twenty-nine patients with hypertension and dyslipidemic T2D >40 years with stable background antihypertensive, hypoglycemic, and statin therapy and serum creatinine, In a prospective randomized controlled trial in 229 patients with hypertension and T2D, 6-month oral acetyl-L-carnitine (1000 mg twice daily) or placebo treatment had similar effects on blood pressure, metabolic control, lipids, and GFR.

This epidemiologic assessment of population-based cohorts investigates the change in treatment for chronic kidney disease associated with population-based screening compared with measuring blood pressure and assessing glycemia., Key Points Question How frequently is population-based screening for chronic kidney disease (CKD) associated with a change in recommended treatment compared with a strategy of measuring blood pressure and assessing glycemia? Findings This epidemiologic assessment of 126 242 adults screened for CKD in population-based cohorts from China, India, Mexico, Senegal, and the United States found that most treatment gaps identified by population-based screening for CKD were apparent by measuring blood pressure or glycemic control. Case finding, defined by testing for CKD only in adults with hypertension or diabetes, was associated with a lower frequency of testing and a greater proportion of individuals with identified treatment gaps compared with screening. Meaning These findings suggest that case finding was more efficient than population-based screening and detected most patients with CKD requiring treatment changes., Importance Population-based screening for chronic kidney disease (CKD) is sometimes recommended based on the assumption that detecting CKD is associated with beneficial changes in treatment. However, the treatment of CKD is often similar to the treatment of hypertension or diabetes, which commonly coexist with CKD. Objective To determine the frequency with which population-based screening for CKD is associated with a change in recommended treatment compared with a strategy of measuring blood pressure and assessing glycemia. Design, Setting, and Participants This cohort study was conducted using data obtained from studies that evaluated CKD in population-based samples from China (2007-2010), India (2010-2014), Mexico (2007-2008), Senegal (2012), and the United States (2009-2014), including a total of 126 242 adults screened for CKD. Data were analyzed from January 2020 to March 2021. Main Outcomes and Measures The primary definition of CKD was estimated glomerular filtration rate less than 60 mL/min/1.73 m2. For individuals with CKD, the need for a treatment change was defined as not taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker or having blood pressure levels of 140/90 mm Hg or greater. For individuals with CKD who also had diabetes, the need for a treatment change was also defined as having hemoglobin A1c levels of 8% or greater or fasting glucose levels of 178.4 mg/dL (9.9 mmol/L) or greater. Case finding was defined as testing for CKD only in adults with hypertension or diabetes. Results Among 126 242 adults screened for CKD, there were 47 204 patients in the China cohort, 9817 patients in the India cohort, 51 137 patients in the Mexico cohort, 2441 patients in the Senegal cohort, and 15 643 patients in the US cohort. The mean age of participants was 49.6 years (95% CI, 49.5-49.7 years) in the China cohort, 42.9 years (95% CI, 42.6-43.2 years) in the India cohort, 51.6 years (95% CI, 51.5-51.7 years) in the Mexico cohort, 48.2 years (95% CI, 47.5-48.9 years) in the Senegal cohort, and 47.3 years (95% CI, 46.6-48.0 years) in the US cohort. The proportion of women was 57.3% (95% CI, 56.9%-57.7%) in the China cohort, 53.4% (95% CI, 52.4%-54.4%) in the India cohort, 68.8% (95% CI, 68.4%-69.2%) in the Mexico cohort, 56.0% (95% CI, 54.0%-58.0%) in the Senegal cohort, and 51.9% (51.0%-52.7%) in the US cohort. The prevalence of CKD was 2.5% (95% CI, 2.4%-2.7%) in the China cohort, 2.3% (95% CI, 2.0%-2.6%) in the India cohort, 10.6% (95% CI, 10.3%-10.9%) in the Mexico cohort, 13.1% (95% CI, 11.7%-14.4%) in the Senegal cohort, and 6.8% (95% CI, 6.2%-7.5%) in the US cohort. Screening for CKD was associated with the identification of additional adults whose treatment would change (beyond those identified by measuring blood pressure and glycemia) per 1000 adults: China: 8 adults (95% CI, 8-9 adults); India: 5 adults (95% CI, 4-7 adults); Mexico: 26 adults (95% CI, 24-27 adults); Senegal: 59 adults (95% CI, 50-69 adults); and the US: 19 adults (95% CI, 16-23 adults). Case finding was associated with the identification of 46.2% (95% CI, 45.1%-47.4%) to 86.4% (95% CI, 85.4%-87.3%) of individuals with CKD depending on the country, an increase in the proportion of individuals requiring a treatment change by as much 89.6% (95% CI, 80.4%-99.3%) in the US, and a decrease in the proportion of individuals needing GFR measurements by as much as 57.8% (95% CI, 56.3%-59.3%) in the US. Conclusions and Relevance This study found that most additional individuals with CKD identified by population-based screening programs did not need a change in treatment compared with a strategy of measuring blood pressure and assessing glycemia and that case finding was more efficient than screening for early detection of CKD.

La notion de droits fonciers recouvre des réalités bien différentes selon l'interlocuteur et le contexte, en particulier dans les situations au Sud marquées par une appréhension du foncier bien différente des conceptions occidentales. Cet article montre qu'il ne peut y avoir de traduction objective de ces droits et que, selon la facette (anthropologique, économique et environnementale) que l'on privilégie, la nature des droits qui seront reconnus diffèrera. La démonstration s'appuie sur les mécanismes de formalisation de droits mis en oeuvre dans la partie sénégalaise de la vallée du Sénégal durant les deux dernières décennies. Elle y argumente que l'option pour la reconnaissance des formes locales de régulation (cf. la facette anthropologique) plutôt que des droits conduit à envisager de nouvelles formes de gouvernance des ressources naturelles qui ne soit pas basée sur une relation personnalisée d'appropriation, mais plutôt sur une responsabilisation accrue de la société sur la préservation à long terme de son environnement.

Resume Introduction Le but de ce travail est d’identifier les principales armes en causes des traumatismes oculaires lors des campagnes de l’armee senegalaise au sud du pays, ainsi que le pronostic de ces traumatismes. Patients et methodes Cette etude est retrospective et concerne les militaires blesses a l’œil par armes de guerre dans l’exercice de leur mission au sein des forces armees senegalaises de 1991 en 2005. Il s’agit essentiellement de militaires touches au sud du pays lors d’accrochages avec les rebelles ou en Guinee-Bissau lors de l’operation Gabou en 1998. Et qui ont ete evacues dans le service d’ophtalmologie de l’hopital principal de Dakar, qui est un niveau 3. Resultats Trente-sept militaires tous du sexe masculin, avec un âge moyen de 30,5 ans. Quarante-six yeux dont 9 atteintes bilaterales. L’agent du traumatisme est un eclat d’obus RPG7 dans 62 % des cas, explosion de mines dans 13,5 %, grenade offensive 10,8 %, balles de fusil d’assaut 5,7 % et flamme lance-roquette anti-char (LRAC) represente 8 %. Nous avons note une phtyse du globe pour 14 yeux (30,43 %) et pour 15 yeux (32,60 %) une perte fonctionnelle du globe atteint. L’inaptitude au combat a ete decidee chez 29 soldats blesses (78,37 % des cas), la mise en emploi sedentaire dans 27 cas (72,97 %) et 10 cas (27,03 %) de soldats reformes. Discussion Dans le conflit au sud du Senegal, l’eclat d’obus de RPG7 cause 62 % des blessures oculaires. Cet obus RPG7 appele « arme des rebelles » est frequemment utilise dans les conflits en Afrique. Le pronostic des traumatismes avec ces types d’armes est severe. Conclusions Les lunettes de combat systematiquement integrees dans l’equipement du combattant senegalais, seraient d’un apport inestimable sur la prevention des traumatismes oculaires.

Obstructive sleep apnea syndrome (OSAS) is a common condition in patients undergoing chronic dialysis and is associated with increased cardiovascular morbidity and mortality. This study aimed to determine the prevalence and risk factors of OSAS in Senegalese dialysis patients. In a cross-sectional study including 128 patients (75 men and 53 women) dialyzed since ≥6 months in four dialysis units. Data were collected during the dialysis session in the units. OSAS was assessed with the Berlin Questionnaire. Factors associated with OSAS risk were identified by multivariate logistic regression. The mean age of patients was 46.8 ± 16.9 ¥16–85 years). OSAS was found in 53 patients (overall prevalence of 41.4%) with predominance among individuals aged ≥50 years (52.6%). Hypertension and diabetes were more frequent in patients with OSAS, while the prevalence of obesity and sedentary was not different. The majority of patients were not aware of their disease before the survey, and none was treated. After multivariate regression analysis, age >50 years [odds ratio (OR) = 1.09, P = 0.02], neck circumference >45 cm (OR= 1.25, P= 0.03), and daytime hypersomnia (OR = 1.18, P= 0.02) were significantly associated with OSAS. This study showed that OSAS is frequent among Senegalese dialysis patients but is usually under-diagnosed. Older age, excessive daytime sleepiness, and neck circumference are the main associated factors.

Introduction: Sleep disorders (SD) are common dialysis patients and can impact their quality of life. In previous studies, black ethnicity was associated with higher incidence of SD but a few data are available in African patients. This study aimed to describe prevalence and risk factors of SD among Senegalese dialysis patients. Methods: We performed a cross-sectional study between February 15th and April 30th 2012 including 127 patients (75 males and 52 females) aged 46.8 ± 16.9 (16 - 85 years) and dialysed since >6 months in three dialysis centres. For each patient, we assessed insomnia according to international definition, obstructive sleep apnea syndrome (OSAS) with the Berlin questionnaire, restless leg syndrome (RLS) using abridged version of Cambridge-Hopkins RLS questionnaire, and excessive daytime sleepiness (EDS) with Epworth sleepiness scale. Logistic multivariate regression was used to identify factors associated with different SD. Results: Overall prevalence of SD was 88% comprising: insomnia (64.3%), OSAS (49.1%), RLS (24.1%) and EDS (20.5%). Forty-two patients presented at least two disorders. No difference was noticed in prevalence of SD between genders (p = 0.14). Level of blood pressure were not different across patients with and without SD. Insomnia correlated with anemia, inflammation and EDS. OSAS was associated with age ≥50 years, EDS and neck circumference ≥25 cm. RLS correlated with anemia and EDS. Other parameters such as gender, dialysis vintage, KT/V, obesity, diabetes status and hypoalbuminemia were not associated with the different SD. The majority of patients had not been diagnosed before the survey and none of them was under treatment. Conclusions: Our findings are compatible with high prevalence of sleep disorders reported in other populations. Insomnia and OSAS are the most frequent SD but some patients combined many disorders. Nephrologists should be more aware of these SD in order to detect them early and provide efficient treatment.

Introduction: Idiopathic nephrotic syndrome represents 25% to 30% of glomerulonephritis in adults. These glomerulonephritides are responsible of about the half of chronic kidney failure examined as well in United States as in Europe or Africa. The aim of this study was to determine the anatomoclinic, therapeutic and progression patterns of idiopathic nephritic syndrome in Dakar. Patients and Methods: It is a retrospective ten-year study in the nephrology department of Aristide Le Dantec Hospital. Patients with idiopathic nephrotic syndrome were included. We analyzed anatomoclinic, therapeutic and progression data of idiopathic nephrotic syndrome. Results: On 202 patients with nephrotic syndrome, 156 (77%) were primitive. The mean age was 29.7 ± 12 years with a sex ratio of 2.4. Edema was found in 98 patients (62.8%) and hypertension in 63 patients (40%). The mean proteinuria was 6.8 ± 4.8 g/24h. Histologic lesions found at renal biopsy were focal segmental glomerulosclerosis in 71 patients (45.5%), minimal change disease in 68 patients (43.5%) and membranous nephropathy in 8 patients (5%). 134 patients (85.8%) received steroids alone, 12 patients (7.6%) received cyclophosphamide and 4 patients (2.5%) azathioprine in association with steroids. 44 patients (28.2%) reached remission. The factors of poor prognosis were: age, above 40 years, proteinuria above 10 g/24h, existence of renal failure at admission, absence of use of steroids therapy. Conclusion: This study shows that idiopathic nephrotic syndrome is frequent in our country with a prevalence of 77%. The most common lesion found at the renal biopsy is the focal segmental glomerulosclerosis. Remission is found only in 28% which is very low. 33% of patients progress towards chronic kidney disease due to the lack of early diagnosis and the use of traditional medicine.

Resume Introduction Le but de notre etude etait d’evaluer a court et moyen terme, les resultats de la pression intraoculaire apres trabeculoplastie au laser selectif du melanoderme atteint de glaucome chronique a angle ouvert ou d’hypertonie oculaire isolee. Materiel et methode Nous avons effectue une etude retrospective apres un suivi moyen de 12,5 mois chez des patients melanodermes ayant beneficie d’un SLT. Les criteres d’inclusion etaient les suivants : un angle iridocorneen ouvert superieur ou egal a 3 selon Schaeffer, la presence de donnees disponibles et consignees sur la pigmentation trabeculaire, les donnees sur la realisation du SLT et la mesure du tonus oculaire au tonometre a aplanation de Goldmann. Etait retenu comme resultat positif, une PIO post-laser inferieure a 21 mmHg apres 1 mois de suivi. La principale motivation a ete la reduction du nombre de collyres utilises. Etait effectuee d’abord une premiere seance sur les 180° inferieurs (3h–9 h), completee eventuellement par une deuxieme seance a 15 jours ou a 1mois si une baisse de pression etait notee apres la premiere seance. Les resultats pressionnels etaient evalues ; avant SLT, immediatement apres la seance de SLT et a distance. L’analyse statistique a ete effectuee grâce au logiciel EPI.info 7. Resultats Nous avons collige 69 yeux traites par SLT de 40 patients. La PIO moyenne avant SLT etait de 18,3 mmHg ± 4. Nos resultats notaient 90 % de repondeurs (10 % d’echec) avec une baisse pressionnelle moyenne de 2,3 ± 1mmhg soit 13 % a partir de la deuxieme semaine. La baisse de pression moyenne passait a 4,78 ± 1mmhg dans le groupe de patients de notre serie (30 %) traites sur 360° soit 27 %, dans les memes delais. Le SLT a permis d’arreter une prostaglandine dans 60 % (42 cas). Les yeux sous tritherapie sont passes de 23 avant SLT a 5 apres SLT (soit 26 % de recul), les yeux sous bitherapie de 32 a 16 (recul de 24 %). Dans les tests d’association au resultat, seule la pigmentation de l’angle et le stade campimetrique, presentaient une probabilite statistiquement significative. Discussion Dans notre experience, le SLT est une bonne indication chez le melanoderme, pour potentialiser un traitement peu efficace, reduire le nombre de collyres afin de limiter les effets collateraux. Mais aussi eviter, ou retarder une monotherapie sur yeux naifs et hypertones. Conclusion Le SLT a permis a court et moyen terme une baisse pressionnelle chez le melanoderme dans 90 % des cas, et au retrait d’une prostaglandine chez 60 % de nos patients. Par ailleurs, l’angle iridocorneen du melanoderme semble moins pigmente qu’on ne le pense et qu’un protocole qui traiterait systematiquement les 360° semble donner de meilleurs resultats.

Resume Introduction Dans ce travail, les auteurs ont pour but d’etudier certains aspects cliniques et epidemiologiques des cancers primitifs oculo-orbitaires en Afrique au sud du Sahara. Patients et methodes Il s’agit d’une etude retrospective sur une periode de 21 ans, allant de 1984 a 2004, portant sur tous les cas de cancers oculaires histologiquement prouves, apres chirurgie du globe et/ou de l’orbite. Pour chaque patient, nous avons etudie les parametres suivants : âge, sexe, le ou les motifs de consultation, l’œil atteint, le resultat histologique de la piece operatoire. Ces donnees ont ete collectees grâce a l’analyse du registre operatoire du service, du dossier du malade et du registre des tumeurs du laboratoire anatomopathologique d’un hopital de reference en Afrique sub-saharienne. Resultats Nous avions collige 111 patients tous melanodermes, dont 15 cas (13,5 %) d’atteinte bilaterale, soit 126 yeux. Le sex-ratio etait de 1,17. Les circonstances de decouverte montraient une predominance de la leucocorie (30,2 %) suivie de l’exorbitisme (21,7 %) et en troisieme position, la masse bourgeonnante conjonctivale (10,8 %). Le retinoblastome a ete plus frequemment retrouve avec 66,6 % des tumeurs oculo-orbitaires et 95,45 % des tumeurs du globe ; suivi du carcinome epidermoide avec 15,08 % des cas. Le melanome malin arrivait en troisieme position (4,76 %) avec 83 % de localisation uveale anterieure et 7 % de siege choroidien. Le carcinome basocellulaire et le rhabdomyosarcome suivaient en quatrieme position. Le carcinome basocellulaire constituait la moitie (50 %) des tumeurs palpebrales. Le rhabdomyosarcome etait la premiere tumeur orbitaire de notre serie (57 %). Suivaient les lymphomes a localisation conjonctivale (2,38 %), les leucemies aigues a localisation orbitaire (1,59 %). Ensuite des tumeurs rares, un dermatofibrosarcome palpebral (0,79 %), un angiosarcome orbitaire (0,79 %), un glioblastome du globe (0,79 %) et une tumeur fibreuse solitaire maligne de l’orbite (0,79 %). Conclusion Les cancers primitifs oculo-orbitaires du melanoderme restent des tumeurs du sujet jeune, equitablement reparties aux deux sexes. Le retinoblastome en est la forme la plus frequente, devant le carcinome epidermoide. Le globe est site de predilection de ces cancers.

Renal cortical necrosis (RCN) is anecdotal in malaria. To our knowledge, RCN secondary to Plasmodium malariae has not yet been published. We report a case of severe malaria complicated by RCN. A 29 year old Senegalese patient was transferred to our department for anuria in a context of severe malaria. The diagnosis was RCN secondary to a severe Plasmodium malariae malaria. Physical examination showed anuria, anaemic syndrome, haemorrhagic syndrome and a generally impaired condition. There was a normocytic normochromic anaemia aplastic, thrombocytopenia leukocytosis of 11.580/mm3, serum creatinine of 12.45 mg/dl and blood urea of 252 mg/dl. The Plasmodium malariae had been shown to thick blood film with high parasite density. The molecular study was able to confirm the infestation of this parasite. Treatment consisted of four haemodialysis sessions and antimalarial molecules. Initial evolution was favourable with a recovery through diuresis and a partial improvement in renal function. Given the persistence of impaired renal function, a renal biopsy was performed. This confirmed the RCN. At last consultation, he had no symptoms and his last glomerular filtration rate (GFR) was 30 mL/min/1.73 m2.

La drepanocytose est caracterisee par une grande variabilite d’expression clinique et biologique qui depend de plusieurs facteurs. L’objectif de ce travail etait d’etudier les perturbations biologiques des patients drepanocytaires homozygotes en phase stationnaire. Il s’agit d’une etude prospective transversale ayant inclus 100 drepanocytaires homozygotes en phase stationnaire d’âge superieur a 15 ans. Chaque patient a beneficie de deux tubes de prelevements pour l’etude des parametres hematologiques et pour les dosages biochimiques. Un questionnaire a ete utilise pour recueillir les variables epidemiologiques, cliniques et biologiques. Ces donnees ont ete saisies et analysees par le logiciel Epi-info 7.2. Une valeur p ≤ 0,05 a ete consideree comme significative. L’âge moyen des patients etait de (28 ± 8,94) ans, les extremes (15-57 ans) et le sex-ratio (H/F) de 0,75. Le taux d’hemoglobine de base etait en moyenne de (8,2 ± 1,4g/dl), les globules blancs de (12352 ± 6.906/ mm3), les plaquettes (439.920 ± 139.000/mm3), la TCMH (31,18pg ± 4,12 pg). Le taux d’hemoglobine S etait en moyenne de (87,79 ± 8,19 %) et l’hemoglobine F (HbF) (9,5 ± 8,3%). Le taux HbF etait associee de facon significative avec le syndrome thoracique aigu et la lithiase biliaire (r=0,56 ; p=0,003). Cette etude a montre que les perturbations biologiques sont frequentes chez les dans la drepanocytaires homozygotes. Leur connaissance servira de base de comparaison lors des crises et pour evaluer l’efficacite du traitement.© 2017 International Formulae Group. All rights reserved.Mots cles: Drepanocytose SS, phase stationnaire, perturbations biochimiques, hematologiquesEnglish Title: Biochemical and hematological profile of homozygous sickle cell patients in stationary phase at the Blood Transfusion National Center of DakarEnglish AbstractSickle cell disease is frequently associated with a high clinical and biological variability. This study aimed to describe biological abnormalities in Senegalese patients with homozygous sickle cell disease. In a cross-sectional study, we included 100 patients aged 15 years with homozygous sickle cell disease. Hematological and biochemical parameters were assessed for each patient. Clinical, epidemiological and biological variables were collected using a questionnaire. Data were analyzed using Epi-info 7.2. The mean age of patients was (28 ± 8.94) years and sex ratio (H/F) was 0, 75. The basal hemoglobin level was (8.2 ± 1.48 g / dl), white blood cells (12352 ± 6.906/ mm3), platelets (439.920 ± 139.000/ mm3), TCMH (31, 18 ± 4.12 pg). The mean Hemoglobin S was (87.79 ± 8.19%) and hemoglobin F (HbF) (9.5 ± 8.3%). HbF was associated with acute chest syndrome and biliary lithiasis (r=0, 56; p=0,003). This study showed that biological abnormalities in homozygous sickle cell patients in the stationary phase are frequent. The base line characteristics will help for comparison during next crises and for assess effectiveness of treatment.© 2017 International Formulae Group. All rights reserved.Keywords: Sickle cell disease, stationary phase, biochemical disturbances, hematological

Medicinal plants are widely used as a first-line therapy for hypertension, often without comparative clinical data. A prospective, randomized controlled trial was conducted to assess efficacy of Combretum micranthum (kinkeliba) and Hibiscus sabdariffa (bissap), in the galenic form of capsules of plant powder, on blood pressure in adult patients with non-complicated hypertension ( > 140/90 mm Hg). One hundred and twenty five patients were randomly allocated into group 1 (kinkeliba leaves 190 mg × 2/day), or group 2 (bissap calyx 320 mg × 2/day), or group 3 (ramipril 5 mg /day) during four consecutive weeks. Blood and urinary samples were collected on day 0 and 28 while patients' blood pressure was measured weekly. In all three groups SBP and DBP decreased over 3 weeks of treatment (P

Resume Objectifs Mesurer l’epaisseur corneenne centrale (ECC) du melanoderme senegalais atteint de glaucome primitif a angle ouvert (GPAO) et determiner son influence sur les atteintes fonctionnelles, pressionnelles, optiques et perimetriques. Patients et methodes Nous avons realise une etude retrospective sur les dossiers de patients suivis pour GPAO entre mai et juillet 2012. Nous avons releve l’ECC mesuree par pachymetrie ultrasonique et les donnees du premier examen clinique que sont l’acuite visuelle corrigee (AVC), la pression intraoculaire (PIO) mesuree au tonometre de Goldmann, le rapport du cup-disc vertical (C/D), les resultats du champ visuel automatique selon la classification de Hodapp. Resultats Notre echantillon comptait 117 patients soit 234 yeux. L’âge moyen etait de 56,53 ± 11,29 ans. L’ECC moyenne etait de 525,40 ± 39,63 μm pour tous les yeux, droits et gauches ( p = 0,734). L’ECC moyenne etait de 521,20 ± 36,20 μm chez les femmes et de 526,91 ± 40,79 μm chez les hommes ( p = 0,332). La cornee etait plus fine apres l’âge de 50 ans ( p = 0,0047) et chez les yeux ayant une AVC p = 0,01) ou un C/D ≥ 8/10 ( p = 0,043). L’ECC n’influencait pas la frequence des hypertonies ( p = 0,16) et des deficits avances du champ visuel ( p = 0,33). Conclusion L’ECC du glaucomateux senegalais est independante du cote et du sexe mais diminue avec l’âge. Une cornee fine favorise la malvoyance et l’agrandissement de l’excavation papillaire d’ou l’interet d’une mesure systematique de l’ECC.

Chronic kidney disease is an emerging public health issue in Africa. At end-stage renal disease (ESRD), patients need hemodialysis (HD), which may expose them to blood transmitted infections, such as the hepatitis C virus (HCV). Sub-Saharan Africa has the highest HCV prevalence in the world, but data on HD patients is scarce and shows an exceptionally high rate in Senegal. To assess the efficacy of preventive measures in reducing HCV infection among dialysis patients, we retrospectively conducted a cross-sectional study in three Senegalese HD centers, including all HD patients who performed HCV serology between 1 st and 31 st August 2011. The demographical, clinical, and biological data were collected for each patient. We included 106 patients with a mean age of 43.4 ± 15.8 years (range from 18 to 80 years), with 52.8% males. HD vintage was 60.5 ± 15 months (range from six to 206 months). The main causes of kidney disease included nephrosclerosis (36%) and diabetes (24%). The prevalence of HCV was 5.6%, with one patient co-infected with the hepatitis B virus. After adjusting for age and sex, HD vintage was the only risk factor for HCV infection, while nutritional status and the number of blood transfusions did not significantly correlate with HCV infection. We conclude that during the past decade, the prevalence of HCV infection in HD patients living in Senegal has declined considerably, mainly because of improved transfusion measures and better clinical practice in the HD centers. Such efforts should be maintained and reinforced to reduce the seroprevalence of HCV infection.

Resume Introduction Les mycetomes sont des processus pathologiques au cours desquels des agents etiologiques fongiques ou actinomycosiques d’origine exogene produisent des grains. Ces agents etiologiques resident dans les sols et vegetaux des zones endemiques. Ils sont introduits lors de traumatismes et la principale localisation est podale. La localisation orbitaire est exceptionnelle. Observation Nous rapportons le cas d’un eleve de 17 ans recu pour une exophtalmie gauche evoluant depuis deux ans, apres un traumatisme penetrant, par une fourche en milieu rural. L’examen montre une tumefaction orbitaire heterogene polyfistulisee produisant du pus et des grains noirs et fait evoquer le diagnostic de mycetome fongique devant la couleur des grains. L’IRM montre le processus effondrant la lame papyracee de l’ethmoide et le plancher de l’orbite. L’examen anatomopathologique confirme la nature fongique de l’affection meme si la culture sur milieu de Sabouraud n’est pas contributive. L’evolution est favorable apres exenteration et evidemment du sinus maxillaire ipsilateral et des fosses nasales, associes a un traitement a base de ketoconazole pendant quatre mois. On constate une absence de recidive 14 mois apres la chirurgie. Discussion Les mycetomes sevissent a l’etat endemique au Nord de l’Afrique de l’Ouest. Leur localisation, frequente au niveau du pied est exceptionnelle au niveau de l’orbite. La couleur des grains donne une orientation etiologique. Les mycetomes a grains noirs sont toujours fongiques et leur traitement est chirurgical, chirurgie quasi carcinologique, la persistance d’un seul grain conduisant a une recidive certaine. Conclusion La localisation orbitaire d’un mycetome est exceptionnelle. Dans ce cas clinique, la notion de porte d’entree, l’aspect clinique et la couleur des grains ont oriente le diagnostic. L’examen histologique de la piece operatoire l’a confirme.

Autosomal polycystic kidney disease (ADPKD) is a genetic disorder with two causal PKD-1 and PKD-2. Genetic studies have demonstrated an important allelic variability between patients but few data are known about genetic variants in African populations. We report a new mutation found in a 41-year old women with mild chronic kidney disease secondary to ADPKD. Molecular genetic testing found a deletion of 2 nucleotides A and C at positions 7290 and 7291 followed by insertion of a 5-base pair (CTGCA) located in exon 18 of the PKD1 gene. This newly identified frame shifting was compared to the PKD gene database but no similar mutation was yet reported. Other screened family members did not present any mutation.

Chronic kidney disease (CKD) is frequently described in elders. This study describes the epidemiological patterns of patients ≥60 years old admitted in our department during one year. The prevalence of CKD was 10.8% (60/552). The mean age of the patients was 70.5 years (60-84 years) and the sex ratio (male:female) was 1.08. The mean serum creatinine level was 7.10 mg/dL (1.31-25.0 mg/dL) and more than two-third of the patients presented CKD stage 4-5. Causes of CKD were dominated by hypertension (30%) and diabetes (25%). Prevalence of inpatients aged 60-69 years old was higher than in those ≥80 years old but lower than that in patients aged 70-79 years. At admission, 83.3% of the patients were hypertensive, 75% were anemic and 13% presented proteinuria. The main co-morbidities associated with CKD were neoplasms (17% of cases), chronic heart disease (15% of cases) and pneumonia (15% of cases). Furosemide was prescribed in 55% of the patients, calcium channel blockers in 23% of the patients and ACE inhibitors in 20% of the patients. Renal replacement therapy was not performed for any patient. Evolution was favorable in the majority of patients (77%), but 23% died mainly because of uremia and infections.