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ABSTRACT
Introduction. High mortality during the course of tuberculosis (TB) has been described in patients with chronic kidney disease (CKD) with scarce data in this regard from sub-Saharan Africa. Hence, we sought to determine the impact of CKD on TB-related mortality at the Douala General Hospital (DGH), Cameroon. Methods. We conducted a retrospective cross-sectional study of adult TB patients with CKD matched with TB patients without CKD between 2009 – 2020 at the DGH. CKD was considered in any patient with a decrease in glomerular filtration rate below 60 ml/minute for more than 3 months. Data collected included socio-demographic characteristics, comorbidities, clinical data, blood test results, and patient outcome (alive vs. dead). Using SPSS version 23, multiple regression analysis was used to eliminate confounders and determine independent risk factor for mortality in TB patients with CKD. Results. We retained 126 TB patients with CKD matched to 126 without CKD. The mean age of the patients with CKD was 44.7 ± 13 years and the sex ratio was 1.42. The most common clinical form of TB was extra pulmonary, 61.9% (78/126). The median diagnostic delay was 25 days in patients with CKD and 16 days in patients without CKD (p = 0.018). Mortality was higher in the group of patients with CKD, 33.3% versus 5.6% (p<0.0001) with 27.0% and 4.8% of deaths in the first 2 months, respectively. CKD (HR=3.4; CI=1.0 - 11.1; p<0.0001) and thrombopenia (HR=5.3; CI=0.2-9.9; p=0.013) were factors independently associated with death in TB patients. Conclusion. Mortality was six-times higher in TB patients with CKD compared to TB patients without CKD. Factors independently associated with mortality of tuberculous patients to be screened and managed to curb this alarming death rate include CKD and thrombopenia.
RÉSUMÉ
Introduction. Une mortalité élevée au cours de l'évolution de la tuberculose (TB) a été décrite chez les patients atteints d'insuffisance rénale chronique (IRC) avec peu de données à cet égard en Afrique subsaharienne. Par conséquent, nous avons cherché à déterminer l'impact de l'IRC sur la mortalité liée à la tuberculose à l'Hôpital général de Douala (DGH), au Cameroun. Méthodes. Nous avons mené une étude transversale rétrospective de patients adultes tuberculeux atteints d'IRC appariés avec des patients tuberculeux sans IRC entre 2009 et 2020 à la DGH. Les données recueillies comprenaient les caractéristiques sociodémographiques, les comorbidités, les données cliniques, les résultats des tests sanguins et les résultats des patients (vivants ou décédés). À l'aide de la version 23 de SPSS, une analyse de régression multiple a été utilisée pour éliminer les facteurs de confusion et déterminer le facteur de risque indépendant de mortalité chez les patients tuberculeux atteints d'IRC. Résultats. Nous avons retenu 126 patients TB avec IRC appariés à 126 sans IRC. L'âge moyen des patients atteints d'IRC était de 44,7 ± 13 ans et le sexe ratio était de 1,42. La forme clinique la plus fréquente de TB était extrapulmonaire, 61,9% (78/126). Le délai médian de diagnostic était de 25 jours chez les patients atteints d'IRC et de 16 jours chez les patients sans IRC (p = 0,018). La mortalité était plus élevée dans le groupe des patients atteints d'IRC, 33,3 % contre 5,6 % (p<0,0001) avec respectivement 27,0 % et 4,8 % de décès au cours des 2 premiers mois. L'IRC (HR=3,4 ; IC=1,0 - 11,1 ; p<0,0001) et la thrombopénie (HR=5,3 ; IC=0,2-9,9 ; p=0,013) étaient des facteurs indépendamment associés au décès chez les patients TB. Conclusion. La mortalité était six fois plus élevée chez les patients TB avec IRC que chez les patients TB sans IRC. Les facteurs indépendamment associés à la mortalité à dépister et à gérer pour freiner ce taux de mortalité alarmant comprennent l'IRC et la thrombopénie.

Keywords

Tuberculosis Chronic Kidney Disease Mortality Death Douala Cameroon Tuberculose Insuffisance Rénale Chronique Mortalité Décès Douala Cameroun

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Laurent-Mireille Endale Mangamba, Marie Patrice Halle, Charles Lebon Mbele Onana, Joël Notakdie Tochie, Vincent Ngamby, Junie Carelle Emabe Noubibou, Adamou Dodo Balkissou, Denis Georges Tewaffeu, & Bertrand Hugo Mbatchou Ngahane. (2023). Impact of Chronic Kidney Disease on the Mortality of Tuberculosis Patients: A Cross-Sectional Study in the City of Douala. HEALTH SCIENCES AND DISEASE, 24(2). https://doi.org/10.5281/hsd.v24i2.4184
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