[Profile of chronic renal failure in diabetes at initiation of hemodialysis in the nephrology and dialysis service of the military hospital in Rabat, Morocco]

Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review

OBJECTIVES

While increasing attention is paid to the rising prevalence of chronic diseases in Africa, there is little focus on chronic kidney disease (CKD). This systematic review assesses CKD burden among the general population and high-risk groups on the entire African continent.

DESIGN, SETTING AND PARTICIPANTS

We searched Medline and PubMed databases for articles published between 1 January 1995 and 7 April 2017 by sensitive search strategies focusing on CKD surveys at the community level and high-risk groups. In total, 7918 references were evaluated, of which 7766 articles were excluded because they did not meet the inclusion criteria. Thus, 152 studies were included in the final analysis.

OUTCOME MEASUREMENT

The prevalence of CKD in each study group was expressed as a range and pooled prevalence rate of CKD was calculated as a point estimate and 95% CI. No meta-analysis was done. Data were presented for different populations.

RESULTS

In the community-level studies, based on available medium-quality and high-quality studies, the prevalence of CKD ranged from 2% to 41% (pooled prevalence: 10.1%; 95% CI 9.8% to 10.5%). The prevalence of CKD in the high-risk groups ranged from 1% to 46% (pooled prevalence: 5.6%; 95% CI 5.4% to 5.8%) in patients with HIV (based on available medium-quality and high-quality studies), 11%-90% (pooled prevalence: 24.7%; 95% CI 23.6% to 25.7%) in patients with diabetes (based on all available studies which are of low quality except four of medium quality) and 13%-51% (pooled prevalence: 34.5%; 95 % CI 34.04% to 36%) in patients with hypertension (based on all available studies which are of low quality except two of medium quality).

CONCLUSION

In Africa, CKD is a public health problem, mainly attributed to high-risk conditions as hypertension and diabetes. The poor data quality restricts the validity of the findings and draws the attention to the importance of designing future robust studies.

[Chronic kidney disease: associated factors, etiologies, clinical and biological parameters at Lubumbashi city in Democratic Republic of Congo]

INTRODUCTION

Chronic kidney disease is fast becoming a worldwide public health problem due to the increase of hypertension and diabetes mellitus, its main risk factors. In countries like DRC where majority of population are in the low income bracket, very few studies about this disease, usually diagnosed at a very advanced stage have been conducted. As a result of such, cases are not always properly taken care of and managed.

METHODS

We opted for a descriptive cross-sectional study and it was conducted during the period from July 2014 to July 2015 at CMDC dialysis service. Were included all patients with glomerular filtration rate lower than 60ml / min / 1,73 m2 or high level of creatinine longer than three months during the study period Goal. This study aims at describing the sociodemographic characteristics, risk factors and biological parameters of patients admitted for kidney failure.

RESULTS

We selected 60 patients. The average age was 51, 38 + / _ 13, 47 with the most affected included age group between 50-59 years. 51, 67% had completed secondary education and 40% higher. Risk factors of renal damage were the HTA 66, 64%, 25% diabetes mellitus, use of nephrotoxic products 35%, HIV infection 11, 67%, 10% obesity, sickle cell disease 3, 3%. The birth weight birth of our patients as well as existing renal disease in family were unknown factors. 85% of our patients had hemoglobin levels below 12 g%.

CONCLUSION

From this observation, it appears that the age of our patients did not differ from that observed in other low-income communities. The level of education of our patients is higher compared to other studies. It would be better to develop strategies for early detection of kidney disease to avoid ending hemodialysis remains a very expensive treatment.

The cost-utility of treating anemia with continuous erythropoietin receptor activator or Epoetin versus routine blood transfusions among chronic hemodialysis patients

OBJECTIVE

The purpose of this study was to determine the cost-utility of treating anemic dialysis patients with continuous erythropoietin receptor activator (CERA) once monthly or Epoetin Beta (EpoB) thrice weekly compared with a reference strategy of managing anemia with red blood cell transfusion (RBCT).

METHODS

Cost-utility analysis study design. Decision analysis model, National health care payer, over 1 year with the publicly funded health care system. Chronic hemodialysis patients with renal anemia were included. The outcome marker of this study was the incremental cost per quality-adjusted life-year (QALY) gained (incremental cost-utility ratio [ICUR]) of CERA or EpoB relative to RBCT.

RESULTS

The total cost per patient (in US$) was estimated at $2,176.37, $4,107.01, and $4,356.69 for RBCT, CERA, and EpoB, respectively. The cost-utility ratio was calculated at 4,423.52, 6,955.50, and 7,406.38 $/QALY for RBCT, CERA, and EpoB, with an ICUR of CERA and EpoB in relation to RBCT at 19,606.40 and 22,466.09 $/QALY, respectively. In sensitivity analysis, the model was most sensitive to hospitalization costs, hospital stay, and annual number of RBCT units. Also, assuming utility and survival improvement with erythropoiesis stimulating agents use resulted in a decrease in ICUR at 13,429 $/QALY for CERA and 15,331 $/QALY for EpoB. In probabilistic sensitivity analysis, the main results of our model were unchanged; CERA and EpoB were more costly and more effective than RBCT below a threshold of 19,500 $/QALY. CERA was the best option for a willingness to pay over 19,500 $/QALY.

LIMITATIONS

Some model parameters were obtained from observational data, the comparator RBCT is not the standard of care.

CONCLUSION

Our study suggests that managing anemia in dialysis patients with CERA or EpoB may result in better outcomes with higher overall costs. Considering different assumptions, we found substantial variability in the estimates of the cost-utility and incremental of using CERA or EpoB.

[Profile of diabetic in chronic hemodialysis: a multicenter study in Morocco]

Introduction

Le diabète représente la première cause de mortalité par insuffisance rénale au Maroc. Sa prévalence selon l'Enquête Nationale sur la Population et la Santé Familiale de 2011 est de 3,3% [1]. Le but de ce travail est de déterminer la prévalence et d’étudier le profil clinique des diabétiques en hémodialyse chronique au Maroc.

Méthodes

Il s'agit d'une étude transversale multicentrique incluant 2066 hémodialysés chroniques dans les 39 centres d'hémodialyse de quatre régions marocaines.

Résultats

La prévalence du diabète en hémodialyse est 21,6%. L’âge moyen 59±13,2 ans (26-87). Le sex-ratio est de 1,9. L'IMC moyen est de 24,5 ± 4,4 kg/m² (15-41). 42 patients sont porteurs d′une hépatite virale. La durée moyenne en HD est 39,3± 67 mois. 57% des patients gardent une diurèse résiduelle versus 43% chez les non diabétiques. Par rapport à ces derniers, nous avons noté plus d'HTA (64% versus 45%), plus de complications cardiovasculaires (23% versus 12%), un âge plus avancé à l'initiation de l'hémodialyse (55,5 versus 47 ans) et un taux de FAV proximales plus important.

Conclusion

La prévalence des diabétiques en hémodialyse est relativement élevée au Maroc sans tenir compte des patients qui ne bénéficient pas d’épuration extra-rénale pour des raisons socio-économiques. Le taux élevé de mortalité est imputable au retard et/ou à l'absence de la prise en charge néphrologique des diabétiques. Dans nos régions où le système sanitaire dispose de faible moyen, l'accent doit être mis sur le dépistage précoce de la néphropathie chez le diabétique.