Suchergebnisse

Abstract Background End-Stage Renal disease (ESRD) is associated with increased morbidity and mortality. We assessed the occurrence, time-trend and determinants of fatal outcomes of haemodialysis-treated ESRD patients over a 10-year period in a major referral hospital in Cameroon. Methods Medical records of ESRD patients who started chronic haemodialysis at the Douala General Hospital between 2002 and 2012 were reviewed. Baseline characteristics and fatal outcomes on dialysis were recorded. Accelerated-failure time and logistic regression models were used to investigate the determinants of death. Results A total of 661 patients with 436 (66 %) being men were included in the study. Mean age at dialysis initiation was 46.3 ± 14.7 years. The median [25 th –75 th percentiles] duration on dialysis was 187 [34–754] days. A total of 297 (44.9 %) deaths were recorded during follow-up with statistical difference over the years ( p < 0.0001 for year by year variation) but not in a linear fashion ( p = 0.508 for linear trend), similarly in men and women ( p = 0.212 for gender*year interaction). The death rate at 12 months of follow-up was 26.8 % ( n = 177), with again similar variations across years ( p < 0.0001). In all, 34 % of deaths occurred within the first 120 days. Year of study and background nephropathies were the main determinants of mortality, with the combination of diabetes and hypertension conveying a 127 % (95 % CI: 40–267 %) higher risk of mortality, relative to hypertension alone. Conclusion Mortality in dialysis is excessively high in this setting. Because most of these premature deaths are potentially preventable, additional efforts are needed to offset the risk and maximise the benefits from the ongoing investments of the government to defray the cost of haemodialysis. Potential actions include sensitisation of the population and healthcare practitioners, early detection and referral of individuals with CKD; and additional subsidies to support the cost of managing co-morbidities in patients with CKD in general.

Abstract Background Chronic kidney disease (CKD) is frequently unrecognized by non-nephrology physicians. There is an ongoing governmental program to create hemodialysis centers in the ten regions of Cameroon, where a previous study reported high levels of late referral to nephrologists. We aimed to assess the knowledge of physicians on CKD and their attitudes regarding referral. Methods A questionnaire based on the Kidney Disease Outcome Quality Initiative Guidelines of 2002 was self-administered to general practitioners and non-nephrology specialists working in two Cameroon cities that have hemodialysis centers (Douala and Bamenda). Results Of the 174 general practitioners and non-nephrology specialists approached, 114 (65.5 %) returned answered questionnaires. Only 58.8 % of doctors identified the correct definition of CKD. Most physicians were aware of the major risk factors of CKD (hypertension, 97.4 % and diabetes mellitus, 95.6 %). Most physicians were also aware of complications such as anemia (93.0 %), hypertension (90.4 %), uremia (85.1 %) and hyperkalemia (85.1 %). Only 44 % knew that CKD had five stages, with general practitioners 3.4 times more likely to know than specialists (p = 0.004). Even though 61.4 % of the physicians knew that the estimated glomerular filtration rate was the appropriate clinical means to diagnose CKD, 12.7 % would use serum creatinine alone for diagnosis. Also, up to 21.9 % of physicians would refer at late stage. Conclusion General practitioners and non-nephrology specialists lack general knowledge on CKD, especially on the definition and staging; they also have inadequate attitudes with regards to diagnosis and referral to the nephrologists. Educational efforts are warranted to improve on physicians' knowledge and skills on CKD in Cameroon.