SUN-108 CLINICAL SPECTRUM AND OUTCOME OF RENAL DISEASE AMONG MEDICAL ADMISSIONS IN A SEMI-URBAN AREA OF CAMEROON

Abstract

There is a growing burden of kidney disease worldwide with more adverse outcomes in low-income countries resulting from limited access to expensive therapies. There is a paucity of data on burden of kidney disease among medical admissions in a semi-urban area of Cameroon. We sought to describe the clinical pattern and outcome of renal diseases among medical admissions at the Bamenda Regional Hospital. We conducted a two-year hospital-based retrospective study on medical records of medical admissions at the Bamenda Regional hospital from January 1st 2017 to December 31st 2018. We included available files of admissions recorded in the registers of the medical wards. We excluded files with no diagnosis and outcome information. Relevant sociodemographic and clinical data was obtained. The primary admission diagnosis was classified according to the ICD 11. For renal disease, we noted the renal syndrome, the clinical characteristics, source of referral, and the in-hospital outcome. The institutional ethics review board of the Faculty of Health Sciences of the University of Bamenda approved the study. A total of 2079 medical records of the 2427 medical admissions were included in the study. The prevalence of renal disease was 13.2 % (n=274), ranking fourth after infections, cardiovascular disease and digestive disease. Hypertension, diabetes mellitus and HIV were the major comorbidities irrespective of clinical syndrome. Chronic kidney disease non-on haemodialysis (CKD-ND = 40.9%), acute kidney disease (AKI = 27.4%), complicated urine tract infection (cUTI = 14.6%), ESKD on maintenance haemodialysis (MHD = 12.8%), nephrotic syndrome (2.2%) and renal colic (2.2%) were the clinical renal entities observed. On CKD-ND group, 76.8% of participants were in KDIGO stage 5 and hypertensive emergencies (43.8%, n = 49) and severe uremic symptoms requiring dialysis initiation (23.2%, n = 26) were the major reasons for admission. On AKI group, 60 % (n= 45) were on stage 3, 34.7% (n=26) on stage 2 and 5.3 (n=4) on stage 1 of 2012 KDIGO classification. Nephrotoxins (49.1%), infections (26.4%) and obstructive uropathies (17.3%) were the principal cause of AKI. The most common reasons for admission of MHD patients were severe anaemia (48.6%, n=17), pulmonary oedema (25.7%, n=9) and catheter-related sepsis (22.9%, n=8). On nephrotic syndrome group, the reason for admission were invalidating anasarca (66.7%, n=4) and severe sepsis (33.3%, n=2). The mortality rate was 13.8% (n=38) driven by CKD-ND mostly on stage 5 (47.4%, n=18) and AKI (34.2%, n=13). Patients with renal disease had a longer hospital stay compared to non-renal disease [10 (IQR: 7-15) Vs 6 (IQR: 3-10), p<0.001]. The prevalence of renal disease was high. The clinical spectrum of renal diseases were diverse and dominated by chronic kidney disease and acute kidney injury, which were mostly present at late stages with driven high mortality.