Does Timing of Nephrology Referral Influence Outcome among Patients on Maintenance Hemodialysis in Cameroon?

Marie Patrice Halle, Lionel Tsinga, Arnold Fokam Fottsoh, François Folefack Kaze, Albert Mouelle Sone, Gloria Ashuntantang

Abstract



ABSTRACT
Objective. To assess the influence of the timing of nephrology referral on adverse outcomes in patients undergoing chronic haemodialysis (HD) and to identified associated factors to mortality in a referral hospital of Cameroon. Methods. A retrospective study including patients with ESKD who started HD in Douala general hospital from January 2008 to December 2011. Socio demographic and relevant clinical data including date of first nephrologists’ consultation, stage of CKD at presentation, presumed aetiology of CKD and starting date of HD were reviewed. Early referral (ER) was defined as first nephrologists’ consultation at least four months before initiation of HD, and LR as less than four months prior to dialysis. Study outcomes were morbidities, type of vascular access, withdrawal and mortality at one, three, six and twelve months on dialysis. Results. We recruited 188 participants. 66.5% of them were males, and the mean age was 46.8±14.7 years. ERs accounted for 29.8% of the population. Emergency dialysis on a temporary catheter was more frequent for LRs (p=0.000). During the period of dialysis, hospitalization and withdrawal rates were similar between both group (p= 0.76 and p=0.25). From zero to six months, the cumulative survival of ER patients was better (p=0.02) but at one year the difference was no longer significant (p=0.62). Factors associated to high mortality were male sex (p=0.007), diabetes mellitus (p= 0,006) hospitalization (p=0,002) and pulmonary oedema at initiation (p=0,004). Conclusion. One year outcome of HD patients is little modified by the timing of referral; it is more affected by co morbidity and initial morbidity.
RÉSUMÉ
Objectif. Décrire l’influence du moment du transfert en néphrologie sur le devenir des patients hémodialysés et identifier les facteurs associés à la mortalité de ces patients. Méthodologie. Il s’agit d’une étude rétrospective transversale analytique incluant les dossiers médicaux des patients ayant commencé l’hémodialyse chronique à l’Hôpital Général de Douala de Janvier 2008 à Décembre 2011. Les données sociodémographiques et cliniques (date de première consultation néphrologique, stade IRC au transfert, néphropathie de base, date initiation de dialyse). Le transfert était précoce (TP) si la première consultation néphrologique était supérieure à 4 mois avant l’initiation de la dialyse et tardif (TT) si inferieur à 4 mois. Le devenir était évalué à un, trois, six et douze mois. Le seuil de significativité était fixé à p < 0.05. Résultats. 188 patients ont été inclus dont 66.5% d’hommes. L’âge moyen était de 46,8±14,7 ans. Le TP concernait 29.8% des patients. Le taux d’abandon et d’hospitalisation était similaire dans les deux groups (p= 0.76 and p=0.25). Entre zéro et six mois, la survie cumulée était meilleure dans le groupe des TP par rapport au TT (p=0.02) ; mais à 12 mois, il n’y avait plus de différence significative entre les deux groupes (p=0.62). Les facteurs associés à la mortalité étaient le sexe masculin (p=0.007), le diabète sucré (p= 0,006), l’hospitalisation (p=0,002) et l’œdème pulmonaire à l’initiation de la dialyse (p=0,004). Conclusion. Le devenir à un an des patients hémodialysés chroniques est plus influencé par les comorbidités et la morbidité à l’initiation de la dialyse que par le moment du transfert du malade en néphrologie.


Keywords


nephrology, hemodialysis, Cameroon

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References


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