Causes of end stage renal failure among haemodialysis patients in Khartoum State/Sudan

Chronic kidney disease of unknown aetiology in Africa: A review of the literature

During the last two decades, an epidemic of a severe form of chronic kidney disease (CKD) unrelated to traditional risk factors (diabetes and hypertension) has been recognized in low- to middle-income countries. CKD of unknown aetiology (CKDu) mainly affects young working-age adults, and has become as an important and devastating public health issue. CKDu is a multifactorial disease with associated genetic and environmental risk factors. This review summarizes the current epidemiological evidence on the burden of CKDu and its probable environmental risk factors contributing to CKD in Africa. PubMed/Medline and the African Journals Online databases were searched to identify relevant population-based studies published in the last two decades. In the general population, the burden of CKD attributable to CKDu varied from 19.4% to 79%. Epidemiologic studies have established that environmental factors, including genetics, infectious agents, rural residence, low socioeconomic status, malnutrition, agricultural practise and exposure to agrochemicals, heavy metals, use of traditional herbs, and contaminated water sources or food contribute to the burden of CKD in the region. There is a great need for epidemiological studies exploring the true burden of CKDu and unique geographical distribution, and the role of environmental factors in the development of CKD/CKDu.

The burden of end-stage renal disease in Khartoum, Sudan: cost of illness study

BACKGROUND AND PURPOSE

The incidence of end-stage renal disease (ESRD) in Sudan is increasing, affecting the economic status of patients, caregivers and society. This study aimed to measure ESRD's costs, including direct and morbidity indirect expenditures, and to investigate any associated factors and financial consequences.

MATERIALS AND METHODS

This cross-sectional study used a standardized questionnaire to collect data from 150 ESRD patients who had been receiving dialysis for at least one year before the time of data collection at 13 specialized renal centres in Khartoum state. Data about sociodemographic, clinical, and economic factors were gathered, and their relationship to the cost of ESRD was examined using both bivariate (Man Whitney test, Kruskal Wallis test and Spearman correlation) and multivariate analytical procedures (multivariate linear regression).

RESULTS

This study reported a median direct per capita ESRD cost of 38 600 SDG ($1 723.2 PPP) annually with an interquartile range of 69 319.3 SDG ($3 094.6 PPP). The median morbidity indirect cost was estimated to be 0.0 ± 3 352 SDG ($ 0.0 ± 149.6 PPP) per annum. In 28.8% of cases, the patients were their family's primary income earner and over 85% were covered by medical insurance. Our study found that none of the study variables were significantly associated with the total cost of ESRD.

CONCLUSION AND LIMITATIONS

Our findings point out considerable direct out-of-pocket expenses and productivity losses for patients and their households. However, these results should be carefully applied for comparison between the different countries due to differences in the cost of medical interventions and insurance coverage. Further longitudinal studies and studies on health finance and insurance policies are recommended.

Comorbid Conditions in Kidney Transplantation: Outcome Analysis at King Abdulaziz Medical City

BACKGROUND

Kidney transplantation is most commonly performed for end-stage renal disease (ESRD) and provides the best chance for a cure. The surgery is shown to be beneficial to a patient's quality of life after transplantation in multiple studies. But graft failure is a serious consequence that might happen. The term graft failure refers to the failure of a transplanted kidney to function properly. There are various reasons why this can happen, such as rejection, infection, or medication complications.

METHODS

 A retrospective cohort study of comorbid conditions in patients who underwent renal transplantation at King Abdulaziz Medical City (KAMC) between 2016 and 2022. Data were collected by chart review using the BestCare system. The data collected included patients' demographics, comorbidities, calculated Charlson Comorbidity Index (CCI), surgery-related data, laboratory data, and the outcome of transplantation. The categorical data were presented using percentages and frequencies, while the numerical data were presented as mean and standard deviation. The Chi-square test was used for inferential statistics to find the association between categorical variables.

RESULTS

A total of 669 patients were included in the current study. Of these, 422 (63.1%) were men, and the mean age was 44 years. The incidence of graft failure within one year at KAMC was found to be 1.2% (eight cases). Regarding the CCI and its association with graft failure within one year, 37 (5.5%) patients had a myocardial infarction (MI) and 17 (2.5%) had congestive heart failure; however, no patients with MI or congestive heart failure experienced graft failure, and no significant association was found between MI or congestive heart failure and graft failure (p-value = 1.000 for both). A total of 417 (62.3%) patients had no or diet-controlled diabetes, 122 (18.2%) had uncomplicated diabetes mellitus (DM), and 130 (19.4%) had end-organ damage. DM and graft failure were not significantly associated (p-value = 1.000). A total of 286 (42.8%) patients had ESRD of unknown etiology, 109 (16.3%) patients had ESRD caused by diabetic nephropathy, and 100 (14.9%) had ESRD resulting from hypertension, apart from other causes.

CONCLUSION

Most patients were found to have ESRD of unknown etiology and the most frequently reported known risk factor for ESRD and subsequent transplantation was found to be diabetic nephropathy, followed by hypertension.

Non-traditional risk factors of progression of chronic kidney disease in adult population: a scoping review

Chronic kidney disease (CKD) has become a public health concern over the last several years. Nowadays developed countries spend around 3% of their annual health-care budget on patients with CKD. According to the scientific community the most remarkable risk factors for CKD are diabetes and hypertension. Unknown CKD etiology has been reported as a global phenomenon including uncommon risk factors such as: dehydration, leptospirosis, heat stress, water quality, and others. This study aims to report non-traditional risk factors for ESRD based on a scoping review methodology. The scoping review methodology described by Arksey and O'Malley was used by performing an extensive review of the information. A total of 46 manuscripts were reviewed. The non-traditional ESRD risk factors are depicted based on six categories. Gender and ethnicity have been considered as risk factors for ESRD. Erythematous systemic lupus (ESL) is reported as an important risk factor for ESRD. Pesticide use has been an significant risk factor due to its effects on human and environmental health. Some compounds commonly used in homes against insects and plants are related to ESRD. Congenital and hereditary diseases in the urinary tract have been studied as a cause of ESRD in children and young adults. End-stage renal disease is a major concern for public health on a global level. As it can be seen, non-traditional risk factors are several and have different etiologies. It is necessary to put the issue on the table and add it to the public agenda in order to find multidisciplinary solutions.

Cataract among Patients with Renal Transplantation in a Tertiary Care Centre: A Descriptive Cross-sectional Study

INTRODUCTION

Intensive immunosuppressant therapy after renal transplantation has found to cause systemic and ocular side effects among them is cataracts. Studies on a similar topic have still remained explored in our setting. The aim of the study was to find out the prevalence of cataract among patients with renal transplantation in a tertiary care centre.

METHODS

This descriptive cross-sectional study was conducted among patients of renal transplantation at tertiary care centres from 1 May 2021 to 31 October 2021. The data was collected after the ethical approval from Institutional Review Committee [Reference number: 397(6-11) e2077/078]. Study proforma recorded the number of patients with cataracts, duration of steroid use, mean age and other comorbidities. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated.

RESULTS

Out of 31 renal transplant patients, 10 (32.26%) (15.80-48.72, 95% Confidence Interval) had cataract.

CONCLUSIONS

The prevalence of cataract among renal transplantation patients was found to be lower than similar studies done in similar settings.

KEYWORDS

cataract; prevalence; renal transplantation; steroid.

Options for approaches to nephrectomy in patients with end-stage chronic kidney disease caused by autosomal dominant polycystic kidney disease: A review

Autosomal-dominant polycystic kidney disease is a common kidney disease that affects all racial groups around the world, occupies one of the leading places in the structure of urological diseases and forms a significant contribution to the structure of all causes leading to the end stage of chronic renal failure, disabling patients in this group and hence leading to the inevitability of renal replacement therapy. A highly effective clinical method for replacing lost kidney function is kidney transplantation. Based on the fact that the number of patients with this pathology is increasing, it is necessary to search for and introduce clear criteria for the best care, taking into account the high likelihood of developing infectious complications, hematuria, the absence or presence of diuresis, arterial hypertension in this category of patients. The article reflects the various methods of nephrectomy in patients suffering from autosomal dominant polycystic kidney disease, as well as how approaches to nephrectomy have evolved. The results of complications, as well as patient and graft survival in domestic and foreign studies, in which bilateral or ipsilateral nephrectomy was used using open or laparoscopic access before, during or after kidney transplantation, are demonstrated. Preference is rightfully given to minimally invasive methods of surgical treatment. Taking into account the already reduced resources of the organism of these patients, the volume and method of surgical treatment should be carefully chosen, taking into account safety, efficacy and risk minimization.

Prevalence and risk factors of Hantavirus infection in patients undergoing hemodialysis in Khartoum, Sudan, in 2019: a cross-sectional study

BACKGROUND

Hantaviruses are enveloped negative sense RNA viruses that cause hemorrhagic fever with renal syndrome. This study aimed to identify the prevalence of Hantavirus IgG antibodies and possible risk factors for Hantaviruses infections among end-stage renal disease (ESRD) patients attending the Dr Salma dialysis center in Sudan.

METHODOLOGY

This was a cross-sectional study in which 91 ESRD patients and 30 healthy plasma samples were screened for Hantavirus IgG antibodies using ELISA. A questionnaire containing sociodemographics, history of rat exposure and clinical data information was filled in by each ESRD patient.

RESULTS

In this study, 9 out of 91 ESRD patients (9.9%) tested positive for Hantaviruses antibodies (IgG) while none of the 30 healthy plasma samples showed seropositivity. There was no statistically significant association between age, gender, educational level and rat exposure and Hantavirus infection in ESRD patients (p>0.05).

CONCLUSION

This study is the first to be conducted in Sudan regarding Hantaviruses and ESRD. The prevalence of Hantavirus antibodies among ESRD patients is high compared with findings reported in the literature from studies conducted on the same group of patients. It points to an interesting question as to whether Hantaviruses have an association with ESRD but further studies are needed before drawing any conclusions.

Out-of-pocket payments by end-stage kidney disease patients on regular hemodialysis: Cost of illness analysis, experience from Sudan

INTRODUCTION

In Sudan, the number of end-stage kidney disease (ESKD) patients receiving hemodialysis (HD) is growing. Patients and their families incur a high out-of-pocket expenditure (OOPE), given that HD treatment is expensive. There are limited data about OOP spending on HD in the country. This study aims to explore patients' OOP expense on direct medical and nonmedical goods and services and to which extent they can be predicted from sociodemographic characteristics, health insurance status, comorbidity, and accommodation change.

METHODS

This is descriptive a cross-sectional study conducted in Ibn Sina Hospital. One hundred and thirty patients undergo regular HD were randomly selected.

FINDINGS

Among the study participants (130), the median of the overall total OOP (direct medical and direct nonmedical) spending per patients per year was found to be US$ 3859.1 (interquartile range [IQR]: 2298.1-6261.1). As for the medians OOP expenditure on direct medical and nonmedical costs, they were found to be US$ 2327.6 (IQR: 1421.5-3804.8) and US$ 1096 (IQR: 715.2-2345.2), respectively. The direct medical expenditure (355,586 US$) accounted for 60% of the overall total expenses.

DISCUSSION

Medications and investigations were the primary drivers of direct medical spending. Higher OOPE rates were found among those with one or more of these factors; uninsured patients, patient with comorbidity, female gender, and over 40 years aged. The multivariate analysis showed that the significant predictors of direct medical expenditure were health insurance and comorbid conditions, where as the predictors for direct nonmedical expenditure were accommodation change and gender. This study results in a better understanding of OOP spending on direct medical and nonmedical services and its associated predictors among HD patients within the context of Sudan. Further research is needed in this area.

The prevalence and associated factors of metabolic syndrome among patients with end-stage renal failure undergoing hemodialysis in Indonesia

BACKGROUND AND AIMS

Various components of Metabolic Syndrome (MetS) have been studied in general population, but few among patients undergoing hemodialysis (HD). This study aims to assess the metabolic profiles and to estimate the prevalence of MetS among patients with End-Stage Renal Failure (ESRF) undergoing HD.

METHODS

Patients undergoing HD during October 2016-August 2017 in three General Hospitals in Aceh - Indonesia were included in the study. MetS was defined according to the modified NCEP-ATP III criteria for South Asians.

RESULTS

The overall prevalence of MetS was 50.2%. Male patients have higher MetS prevalence (58.3%) than female (41.7%). MetS was only associated with gender and history of diabetes, and not with other demographic variables. Alteration central obesity was the most common metabolic abnormality among the patients (57.2%), followed by hypertension (30.7%), diabetes (30%), raised triglycerides (27.4%) and reduced HDL (23.7%). Pre-metabolic syndrome was found in 48.3%, leaving only 1.4% of patients free from metabolic abnormality.

CONCLUSIONS

Half of the patients undergoing HD in Indonesia suffered from MetS and almost half had pre-metabolic syndrome. High rate of metabolic abnormalities in patients with ESRF requires intensive examination and collaboration between nephrologists and endocrinologists to prevent the deterioration of patients' condition during HD.

Tunnelled haemodialysis catheters in central Free State: Epidemiology and complications

BACKGROUND

End-stage renal disease (ESRD) is a disease with profound impact on the patient, health system and economy. Tunnelled haemodialysis catheters (TDC) are amongst the most common dialysis methods. It has been established internationally that certain demographic descriptors and aetiologies carry an increased risk of complications. There is a dearth of epidemiological profiling of ESRD patients with TDC in South Africa.

OBJECTIVE

To establish the epidemiological profile of patients who received TDC and to establish the complication rate, with the goal of demonstrating associations between the epidemiological profiles and complications.

METHOD

This was a retrospective study of all patients who received TDC in an Academic Hospital Interventional Radiological Suite over a period of 60 months between 01 March 2011 and 29 February 2016.

RESULTS

A total of 179 patients received 231 catheters. The majority of patients were male (58.7%) and 35.8% of the patients resided in Mangaung. The leading aetiologies of ESRD included hypertensive nephropathy (43.6%), primary glomerular disease (17.3%) and HIV-associated nephropathy (6.1%). Procedural complications occurred in 7/224 (3.1%) insertions, whilst 37/185 (20.0%) developed catheter-related infection and 54/185 (29.2%) developed dysfunctional catheters. There were no deaths linked to catheter-related complications.

CONCLUSION

Our patients' demographic profile, ESRD aetiology, complication rate for procedural complications and catheter-related infections are roughly on par with international studies; however, the catheter dysfunction rate is higher than in the aforementioned studies. This possibly reflects the difficulty of accessing specialist care for our patients, the majority of whom reside outside the Mangaung district. Further studies with larger sample sizes are required to demonstrate statistically relevant associations.

Hypertension in a resource-limited setting: Poor Outcomes on Short-term Follow-up in an Urban Hospital in Maputo, Mozambique

Mozambique has low levels of detection, treatment, and control of hypertension. However, data on target organ damage and clinical outcomes are lacking. The authors aimed at characterizing the clinical profile, pattern of target organ damage, and short-term outcomes of patients referred to a first referral urban hospital in a low-income setting in Africa. We conducted a prospective descriptive cohort study from February 2016 to May 2017 in Maputo, Mozambique. Adult patients with systolic and diastolic blood pressure ≥180 mm Hg and/or ≥110 mm Hg, respectively, or any systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg in the presence of target organ damage (with or without antihypertensive treatment) were submitted to detailed physical examination, funduscopy, laboratory profile, electrocardiography, and echocardiography. Six months after the occurrence of complications (stroke, heart failure, and renal failure), hospital admission and death were assessed. Overall, 116 hypertensive patients were recruited (mean age 57.5 ± 12.8 years old; 111[95.7%] black; 81[70%] female) of which 79 had severe hypertension. The baseline mean values recorded for systolic and diastolic blood pressure were 192.3 ± 23.6 and 104.2 ± 15.2 mm Hg, respectively. Most patients (93; 80.2%) were on antihypertensive treatment. Patients' risk profile revealed dyslipidemia, obesity, and diabetes in 59(54.1%), 48(42.5%), and 23(19.8%), respectively. Target organ damage was found in 111 patients. The commonest being left atrial enlargement 91(84.5%), left ventricular hypertrophy 57(50.4%), hypertensive retinopathy 30(26.3%), and chronic kidney disease 27(23.3%). Major events during 6-month follow-up were hospitalizations in 10.3% and death in 8.6% of the patients. Worsening of target organ damage occurred in 10 patients: four stroke, two heart failure, and four renal damage. Patients with severe hypertension and target organ damage were young with high-risk profile, low hypertension control, and high occurrence of complications during short-term follow-up. Efforts to improve high blood pressure control are needed to reduce premature mortality in this highly endemic poor setting.

Prevalence of Microvascular Complications in Type 2 Diabetics Attending a Primary Healthcare Centre in Sudan

<b><i>Background:</i></b> Diabetes mellitus (DM) has become a global public health challenge. The increasing urbanisation and the significant lifestyle changes have resulted in an unprecedented rise in the rates of type 2 DM and, consequently, its microvascular complications which are the major outcome of the disease. It is the low- and middle-income countries where 80% of the diabetic patients live that face the greatest burden of the disease. <b><i>Study Objectives:</i></b> Our primary objective was to estimate the frequency of microvascular complications among patients diagnosed with type 2 DM. Our secondary objective was to investigate the relationship between the microvascular outcomes and the different characteristics and potential variables among patients with type 2 DM. <b><i>Methodology:</i></b> An observational descriptive clinic-based cross-sectional survey was conducted to calculate the prevalence of microvascular complications of type 2 DM and the associated risk factors in a lower middle-income country, Sudan. The study was carried out at Shambat Primary Healthcare Clinic during the period between May and June 2018. All patients aged 20 years and above visiting the clinic were included. Patients excluded from selection were those on steroid therapy and those having bilateral eye cataract. A total of 209 patients constituted the sample and were selected through systemic random sampling. Statistical analysis was carried out using SPSS software version 21. For the continuous variables, the mean was used as a measure of central tendency and the standard deviation as a measure of dispersion. The associations between the microvascular complications and the other variables were analysed using the χ² test. The <i>p</i> value was used as a test for statistical significance. <b><i>Results:</i></b> The response rate to the survey was 72.6%. The age of the enrolled subjects ranged from 24 to 88 years. Males constituted 61.7% of the study sample and females 38.3%. The mean body mass index (BMI) was 26.92 ± 2.06. Out of 209 patients known to have type 2 DM, 96 (45.9%) developed any of the microvascular complications. Nephropathy was the most frequent with a prevalence of 38.8%, followed by retinopathy and neuropathy with a frequency of 23.9 and 22.5%, respectively. The presence of other co-morbidities, namely hypertension, ischaemic heart disease, chronic kidney disease and dyslipidaemia, was a predictor for the occurrence of the small-vessel conditions. <b><i>Conclusions:</i></b> This study is probably the first of its kind to shed light on the magnitude of the microvascular complications of DM in Sudan. The yielded results reveal a significant burden caused by microvascular complications in the country. The concurrent presence of other chronic medical disorders, namely hypertension, ischaemic heart disease, chronic kidney disease and dyslipidaemia, amplifies the risk for the development of microvascular sequelae. The mean BMI of the sample reflects an overweight trend. Facing the high tide of the metabolic syndrome and its sequelae requires a holistic perspective and a multidisciplinary approach. The health authorities and other stakeholders need to prioritise healthcare expenditure and invest more in DM research. A national diabetes registry will serve as a key player in guiding the efforts.

Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective

Little is known regarding the ways in which chronic kidney disease (CKD) prevalence and progression differ between the sexes. Still less is known regarding how social disparities between men and women may affect access to care for CKD. In this review, we briefly describe biological sex differences, noting how these differences currently do not influence CKD management recommendations. We then describe what is known within the published literature regarding differences in CKD epidemiology between sexes; namely prevalence, progression, and access to treatment throughout the major world regions. We highlight that health care expenditure and social gender disparities ultimately may determine whether women have equitable access to care for CKD and end-stage kidney disease. Among many high- and low-income settings, women more often donate and are less likely to receive kidney transplants when compared with men. Research is needed urgently to elucidate the reasons behind these disparities, as well as to develop CKD treatment strategies tailored to women's unique health care needs.