SAT-038 HEMODIALYSIS IN BURUNDI: DATA AND CHALLENGES

Abstract

The incidence of end-stage renal disease (ESRD) is increasing worldwide at an annual growth rate of 8%. In Sub-Saharan Africa, economic and manpower factors dictate a conservative approach to therapy in most instances. The majority of those with ESRD perish because of the lack of funds, as very few can afford regular maintenance dialysis and renal transplantation is often not available. Hemodialysis remains the most common modality of management, with a very few units offering peritoneal dialysis. Chronic hemodialysis became available in Burundi in July 2014 commenced in a private unit. The country has now 6 dialysis units situated in one city, Bujumbura. Four units are in public hospitals and two in private clinics. This is a retrospective study.The data were extracted from the African Renal Registry on Burundi. All chronic hemodialysis patients from 2014 to 2017 were included. Their characteristics were analyzed with the aim of to determine the etiology, status and challenges of dialysis in Burundi. From 2014 to 2017, 65 patients have been treated by chronic hemodialysis in Burundi. There were 56 men (86.1%). The mean age was 52.16 years. Forty-eight patients (73.8%) were followed in a private unit and 28 (26.2%) in public units. The prevalence for 2017 of patients on renal replacement treatment (RRT) was 1.6 per million population. The etiology of end stage renal disease was diabetes mellitus (32.3%), hypertension (30.7%), glomerulonephritis (10.8%), cystic kidney disease (1.5%) and unknown (21.7%). The seropositive rate for hepatitis B virus was 4.6%, for hepatitis C virus 18.5% and for HIV 9.2%. The initial modality treatment was hemodialysis (98.5%) and peritoneal dialysis (1.5%). The frequency distribution of initial vascular access types was 40.6% for femoral, 59.4% for internal jugular catheter and 0% for arteriovenous fistula. The RRT vintage was 1.5 years, and majority 60% were undergoing dialysis twice, 27.7% thrice dialysis and 12.3 % only single dialysis session per week. The main complications were catheter infection (60%) and acute pulmonary edema (19%). The mortality rate was 77.7%, and 7 patients abandoned dialysis due to financial matter. The prevalence and outcomes associated with dialysis in Burundi are influenced by the following: absence of governement funding for dialysis, gross shortage of nephrologists, dialysis nurses, and technicians, lack of educational initiatives to promote dialysis, no establish health insurance to support dialysis definitely. To run dialysis in Burundi is a challenge. Our recommendations based on these observation include optimizing dialysis treatment initiatives and integrating them with other health strategies, as well as training of local health care providers, re-use of dialyzers to cut costs, implementation of a National Kidney Foundation to fund dialysis and a National Health Policy to prevent hypertension and diabetes.