Dialysis is a replacement therapy for patients with End-Stage Renal Disease (ESRD). Patients on dialysis are at high risk of acquiring hepatitis C virus (HCV), which has become a leading cause of ...morbidity and mortality in this population. There is a wide range of prevalence of HCV in dialysis populations around the world. It is still unknown how prevalent HCV infection is among worldwide dialysis patients (including those undergoing hemodialysis and peritoneal dialysis). A review was conducted to estimate the global epidemiology of hepatitis C in dialysis patients. We searched PubMed, Excerpta Medica Database (Embase), Global Index Medicus and Web of Science until October 2022. A manual search of references from relevant articles was also conducted. Heterogeneity was evaluated by the χ2 test on Cochrane's Q statistic, and the sources of heterogeneity were investigated using subgroup analysis. In order to assess publication bias, funnel plots and Egger tests were conducted, and pooled HCV prevalence estimates were generated using a DerSimonian and Laird meta-analysis model. The study is registered with PROSPERO under CRD42022237789. We included 634 papers involving 392160 participants. The overall HCV case fatality rate was 38.7% (95% CI = 28.9-49). The global prevalence of HCV infection in dialysis population group were 24.3% 95% CI = 22.6-25.9. As indicated by UNSD region, country, dialysis type, and HCV diagnostic targeted; Eastern Europe had the highest prevalence of 48.6% 95% CI = 35.2-62, Indonesia had 63.6% 95% CI = 42.9-82, hemodialysis patients had 25.5% 95% CI = 23.8-27.3, and anti-HCV were detected in 24.5% 95% CI = 22.8-26.2. Dialysis patients, particularly those on hemodialysis, have a high prevalence and case fatality rate of HCV infection. Hemodialysis units need to implement strict infection control measures.
Background
Chronic kidney disease (CKD) is a major health problem with growing prevalence in sub-Saharan Africa.
Aim
Assess the prevalence and determinants of CKD in Garoua and Figuil cities of the ...North region of Cameroon.
Methods
A cross-sectional survey was conducted from January to June 2018 in the two cities, using a multi-level cluster sampling. All adults with low estimated glomerular filtration rate (eGFR) (< 60 ml/min/1.73 m
2
) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albuminuria (≥ 30 mg/g) were reviewed three months later. Logistic regression models (accounting for the sampling strategy) were used to investigate the predictors of the outcomes.
Results
A total of 433 participants were included, with a mean age (95%CI) of 45.0 (43.4–46.6) years, 212 (48.7%) men, 294 (67.9%) from Garoua and 218 (45.6%) with no formal education. Risk factors for chronic nephropathy were highly prevalent including longstanding use of street medications (52.8%), herbal medicines (50.2%) and non-steroidal anti-inflammatory drugs (50%), alcohol consumption (34.4%), hypertension (33.9%), overweight/obesity (33.6%), hyperuricemia (16.8%), smoking (11.3%) and hyperglycemia (6.5%). The prevalence of CKD was 11.7% overall, 10.7% in Garoua and 13% in Figuil participants. Equivalents figures for CKD G3-5 and albuminuria were 2.8%, 2.0% and 4.5%; and 9.1%, 9.3% and 8.5%, respectively. History of diabetes, increase systolic blood pressure, hyperglycemia and hyperuricemia were predictors of CKD.
Conclusion
The prevalence of CKD is as high in these northern cities as previously reported in southern cities of Cameroon, driven mostly by known modifiable risk factors of chronic nephropathy.
Despite progress in haemodialysis and conventional medicine approaches, many patients still struggle to maintain an acceptable quality of life and turn to complementary and alternative medicine (CAM) ...to address their unmet needs.
This study aims to determine the prevalence, types, indications, and factors associated with CAM use by patients on maintenance haemodialysis (MHD) in Cameroon.
This was a multicentric cross-sectional study involving MHD patients in Cameroon from February 2019 to May 2019. We included all consenting participants on MHD for at least 3 months and excluded participants with cognitive and behavioral problems. Face-to-face interviews were conducted.
A total of 224 participants (145 males) with a mean age of 56.5 ± 14.2 years and a median haemodialysis vintage of 34.5 IQR: 17.3-64.4 months were recruited. In all, 89.7% (n = 201) reported having used CAM before, while 71.6% (n = 144) were still using it. Biologically based therapies were the most popular (94%, n = 189), with herbal medicine (81.5%, n = 154) and Calabar chalk (52.4%, n = 99) being the most common. Physical well-being (57.2%), nausea (52%), and insomnia (42.7%) were the main indications for CAM use. Most respondents did not disclose their CAM use to their physicians (61.2%). Long haemodialysis vintage was associated with CAM use (AOR: 7.9; CI = 2.8-22.3; p < 0.001).
The use of CAM is common among Cameroon's haemodialysis population, with herbal medicines and Calabar chalk being the most frequent. The high symptom burden makes CAM attractive to them. Healthcare teams should be aware of these practices, initiate an open discussion, and appropriately advise patients about dangers, risks, and safety associated with their use.
The institutional review board of the University of Bamenda. Reference: 2019/0038H/UBa/IRB UPM/TNCPI/RMC/1.4.18.2.
Mineral bone diseases in dialysis patients is a common but disturbing phenomenon. The involvement of the mandibular bone has been noted but few studies have investigated this in the sub Saharan ...region.
To describe the clinical and scanographic mandibular abnormalities in patients with secondary hyperparathyroidism on maintenance haemodialysis.
We conducted a cross sectional study where we included patients who had been on maintenance haemodialysis for at least 4 months with biochemical evidence of secondary hyperparathyroidism. We collected relevant medical and oral history. Thereafter, we evaluated oral functional status and performed CT scans of the mandible. Mandibular abnormalities, mental and gonial indices were noted. Data analysis was done with IBM SPSS 26.0 software. Statistical significance was set at a p value < 0.05.
A total of 38 patients were enrolled with a mean ± SD age of 44 ± 12.9 years. The median PTH level and dialysis vintage were 807.6605.0, 1166.0pg/ml and 51.0 51.3–92.8months respectively. Twenty-nine (76.3%) participants had oral functional abnormalities with xerostomia (96.6%) and pain during mastication (62.1%) being the most frequent. Mental index was reduced in 96.7% of participants. Scanographic mandibular abnormalities were present in 94.7% of the participants with osteoporosis (100%) and alterations of the bone trabeculae (22.2%), the most prevalent. There was a negative correlation between the left (r = −0.405, p = 0.012) and right (r = −0.358, p = 0.027) gonion indices, the left (r = −0.358, p = 0.027), and right (r = −0.397, p = 0.014) mental indices and the PTH Level. PTH levels were significantly higher in mandibular cortical index Class C patients (p = 0.001).
Mandibular involvement in mineral bone disease and oral function abnormalities were frequent.
Chronic hemodialysis is associated with reduced fertility. Hence, pregnancy remains rare, challenging, and deleterious when unplanned, especially in low-resource countries. Contraception and births ...are very important in these settings. Though the main modes of contraception have been proposed in the chronic kidney disease (CKD) population, contraception still remains challenging in patients on maintenance hemodialysis. Most doctors, however, overlook contraception because of the low fertility, high rate of amenorrhea, and low libido. Furthermore, patients are less receptive to contraceptive counseling either because of a high desire to give birth or due to amenorrhea and low libido. Management of unplanned pregnancies is therefore very challenging and a multidisciplinary approach is the rule; however, it does not guarantee a good prognosis for both the mother and child. Very few cases of multiple pregnancies without induction of ovulation have been reported in patients with severe renal failure, especially those on maintenance dialysis. A 32-year-old multiparous woman with end-stage kidney failure (ESKF) and a residual diuresis of 700 mL per day who had been on inadequate maintenance hemodialysis for 36 months, presented with abdominal distension, which was confirmed on abdominal ultrasound to be a twin pregnancy at 22 weeks of gestation. Thereafter, we intensified hemodialysis (3 sessions/week), managed hypertension and anemia. The obstetrical course was uneventful until the 25th week of gestation when she developed grade 3 (WHO) hypertension and peripheral fluid overload. At the 29th week, she had a spontaneous vaginal preterm delivery of 2 babies weighing 1,350 g and 1,000 g, with an Apgar score of 8 and 7, respectively. Babies, however, died on day 1 and day 5 postpartum, respectively, from respiratory distress and early neonatal infection. The evolution of the mother was uneventful as she continued with her hemodialysis sessions. Twin pregnancies are a rare and very high-risk condition in end-stage renal disease and require multidisciplinary management.
Hypercalcemia and aplastic anemia are two uncommon presentations of non-Hodgkin lymphoma that potentially worsen the disease prognosis. Although hypercalcemia has been reported in the B-cell subtypes ...and some T-cell subtypes of non-Hodgkin lymphoma, it has not been described in T-cell lymphoblastic lymphoma. The same applies to aplastic anemia, which is also not described in T-type lymphomas.
We report a case of a 52-year-old Cameroonian man with acute kidney injury who presented with confusion, abdominal pain, constipation, polyuria, polydipsia, calciphylaxis, enlarged lymph nodes, tachycardia, and a blood pressure of 170/88 mmHg. Laboratory investigations revealed hypercalcemia (total/ionized 199.5/101.75 mg/L), normal serum phosphorus (40.20 mg/L), and a low intact parathyroid hormone (9.70 pg/ml). Complete blood count revealed pancytopenia. Peripheral blood smear confirmed thrombocytopenia but showed neither blasts nor flower cells. Bone marrow aspirate revealed hypocellularity with no blasts or fibrosis. Lymph node biopsy was suggestive of T-cell precursor lymphoma. T-lymphoblastic lymphoma presenting with hypercalcemic crisis and aplastic anemia was diagnosed, and the patient received the cyclophosphamide-doxorubicin-vincristine-prednisone protocol of chemotherapy together with filgrastim and whole-blood transfusion for aplastic anemia. The short-term outcome was fatal, however.
Severe hypercalcemia and aplastic anemia are potential paraneoplastic syndromes of adult T-type lymphoblastic lymphoma, with fatal short-term outcome.
IntroductionAcquired Cystic Kidney Disease (ACKD) is a known complication in patients on maintenance hemodialysis, and it is associated with a high risk of malignant transformation. There is a ...paucity of data on ACKD in sub-Saharan Africa. Objectives: To determine the prevalence and factors associated with acquired cystic kidney disease in patients on maintenance hemodialysis.Methodspatients on maintenance hemodialysis were screened for ACKD. Patients with hereditary cystic kidney disease were excluded. Renal ultrasounds were performed by two radiologists. ACKD was defined as 3 or more bilateral renal cysts in a small or normal size kidney. Associated factors were determined using logistic regression. A p-value <0.05 was significant.Resultsa total of 158 participants were enrolled and 61.4% (97) were male. Their mean (SD) age was 45.8 (14.9) years. The median dialysis vintage was 33.5 10.7-63.2 months. The mean (SD) length of the kidneys was 85.1 (17.5) mm on the left and 81.2 (17.1) mm on the right. The prevalence of ACKD was 31.6% (n=50). Septated cysts (4), calcification of the wall of the cysts (2), irregular thick calcified wall (1), septated cysts with calcification (1) and hemorrhagic cyst (1) cysts were also observed. Dialysis vintage > 36 months (OR 7.1, 95% CI: 3.3 - 15.5) and male sex (OR 2.6, 95% CI: 1.2-5.6) were independently associated with ACKD.Conclusionthe prevalence of ACKD is high in a population of Cameroonians on maintenance. This result calls for the implementation of strategies to screen for the condition and its complications.
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