Abstract
Background: Late referral of Chronic Kidney Disease (CKD) patients requiring emergency hemodialysis (HD) for survival poses a serious threat to global health particularly in sub-Saharan Africa (SSA). Objective: Describe the epidemiological and clinical profiles of CKD patients starting HD in emergency. Methodology: This was a retrospective cross-sectional study. Files of patient files of CKD patients who underwent dialysis from January 1st, 2016 to December 31st, 2020 were reviewed at the HD centres of the two main hospitals of the Cameroon city capital, Yaoundé. We included all emergency HD for End Stage Renal Disease (ESRD). Socio-demographic and clinical data including past medical history, signs and symptoms at presentation and indications for emergency HD were recorded. Emergency HD was defined as a dialysis session performed in ESRD with a temporary vascular access. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 26 for Windows. Results: Out of 700 recorded CKD patients who started HD, 570 underwent an emergency HD, thus a prevalence of 81.43%. We included 311 patients, 63.7% were males. The mean age was 47.05 ± 15.60 years ranging from 8 to 83 years with a modal age group of 40 - 59 years. The most prevalent co morbidities were hypertension (66.2%), diabetes mellitus (28.6%) and HIV infection (10%). The commonest presenting symptoms were asthenia (68.2%), lower limbs swelling (52.1%) and anorexia (41.8%) and the main clinical signs were high blood pressure (74.92%), and pallor (60.5%) and altered general state (55%). The indications for emergency HD were dominated by uremic encephalopathy (33.4%) and pulmonary oedema (25.7%). Conclusion: More than eight out of ten CKD patients start emergency HD. Patients are mostly middle-aged adults with a male predominance. Hypertension and diabetes mellitus remain the most common co morbidities and uremic encephalopathy is by far the first indication for emergency HD.
Highlights
According to Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference in 2020, Chronic kidney disease (CKD) is defined as a GFR < 60 ml/min per 1.73 m2 or markers of kidney damage present for >3 months [1]
Late referral of Chronic Kidney Disease (CKD) patients requiring emergency hemodialysis (HD) for survival poses a serious threat to global health in sub-Saharan Africa (SSA)
In Cameroon, a single centre study revealed that 82.8% of CKD patients were referred late to the nephrologists with a consequent high rate of hospitalizations and emergency HD on first nephrology visit [10]
Summary
According to Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference in 2020, Chronic kidney disease (CKD) is defined as a GFR < 60 ml/min per 1.73 m2 or markers of kidney damage present for >3 months [1] It is a major public health problem and was ranked as the 12th cause of mortality worldwide in 2015 [2]. CKD poses a serious threat to global health [8], in sub-Saharan Africa (SSA) with late presentation or referral of patients requiring emergency HD for survival [9]. Late referral of Chronic Kidney Disease (CKD) patients requiring emergency hemodialysis (HD) for survival poses a serious threat to global health in sub-Saharan Africa (SSA).
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