Spectrum of Neurological Disorders amongst Patients on Maintenance Haemodialysis in Douala, Cameroon: A Cross-Sectional Study

Halle Marie Patrice,Mapoure Njankouo Yacouba,Fouda Hermine,Ngamby Vincent Ebenezer,Kaze Folefack Francois,Tchouamou Tchouamou Eric Gildas,Tewafeu Denis,Gams Massi Daniel

doi:10.4236/ojneph.2022.121011

Abstract

Context: Neurologic disorders are common in patients on maintenance haemodialysis (MHD). Data in Sub-Saharan Africa are scarce. Aim: To determine the prevalence and associated factors of neurological disorders amongst patients on MHD in Cameroon. Settings and Design: This was a four-month cross-sectional study carried out at the Douala General Hospital (DGH) a tertiary referral hospital in Cameroon. Methods: The diagnosis of neuropathy was made using the Michigan Neuropathy Screening Instrument (MNSI), neuropathic pain with the DN4 score, Restless Legs Syndrome (RLS) with the International Restless Legs Syndrome Study Group questionnaire (IRLSSG) and cognitive disorders with the Mini-Mental State Examination test (MMS). Student T and Chi-square tests were used to compare qualitative and quantitative variables. The level of significance was set at p < 0.05. Results: A total of 157 patients were included with 65% being males. The mean age was 48.8 ± 13.7 years. The main comorbidities were hypertension (90.4%), diabetes (19.1%), hepatitis C (10.5%) and HIV infection (10.8%). The median dialysis vintage was 36 (1 - 178) months. The overall prevalence of neurological disorders was 85.4%. The leading type was sensory polyneuropathy (57.3%), cognitive dysfunction (52.9%), neuropathic pain (23%), and restless legs syndrome (17.8%). Male gender was statistically associated with neuropathic pain, while age ≥ 40 years and diabetes were associated with sensory neuropathy and RLS. Conclusions: The burden of neurological disorders is high among patients on MHD as up to 4/5 of them had neurological involvement dominated by sensory polyneuropathy and cognitive dysfunction.

Highlights

Chronic kidney disease (CKD) is a worldwide public health problem with an 8% to 10% prevalence in the adult population [1]
Context: Neurologic disorders are common in patients on maintenance haemodialysis (MHD)
CKD progress in five stages and at end-stage, renal replacement therapy (RRT) either dialysis or renal transplantation is necessary for survival [4]

Summary

Introduction

Chronic kidney disease (CKD) is a worldwide public health problem with an 8% to 10% prevalence in the adult population [1]. The outcome of patients on HD is characterized by a high morbidity and mortality rate [7] [8] [9] mainly due to comorbidities and HD complications [10]. These complications affect all body systems, especially the cardiovascular and nervous systems [11]. Neurological complications affect both the central nervous system such as stroke, cognitive dysfunction, and encephalopathy, and the peripheral nervous systems such as autonomic and peripheral neuropathies [12] [13]. These complications are mainly related to uremic toxins, dialysate type, water quality and HD follow-up [13].

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