Markers and risk factors for chronic kidney disease in sub-Saharan Africans: baseline levels and 12-month trajectories in newly referred patients in Cameroon

Prevalence of ESBL resistance genes and fecal carriage of multidrug-resistant Pseudomonas aeruginosa isolates from patients with chronic kidney disease at the Laquintinie Hospital in Douala, Littoral Region, Cameroon

BACKGROUND

Pseudomonas aeruginosa is an opportunistic Gram-negative bacterium capable of causing severe infections in immunocompromised patients such as those suffering from chronic kidney disease (CKD). This study aimed to determine the resistance profile of Pseudomonas aeruginosa, and the prevalence of extended-spectrum β-lactamase (ESBL) resistance genes in patients with chronic kidney disease.

METHODS

The prevalence of Pseudomonas aeruginosa was investigated in 458 patients, including 197 CKD patients and 261 patients suffering from gastrointestinal infections. The study was conducted at Laquintinie Hospital in Douala from January 2022 to December 2023. Stool samples were used to isolate Pseudomonas aeruginosa on Cetrimide agar. Antibiotic susceptibility testing was carried out using the Kirby-Bauer diffusion method. extended-spectrum β-lactamase (ESBL) resistance genes were detected by the polymerase chain reaction (PCR) method.

RESULTS

The prevalence of fecal carriage of Pseudomonas aeruginosa was 9.17 % (n = 42/458), including twenty-nine (69.05 %) in patients with chronic kidney disease and thirteen (30.95 %) in patients without chronic kidney disease. The Pseudomonas aeruginosa isolates had a high rate of resistance to ceftazidime (72.41 %) in patients with CKD compared to patients without CKD (69.23 %). All isolates had a high resistance to ticarcillin (93.10 % and 92.31 %). The prevalence of multidrug-resistant (MDR) Pseudomonas aeruginosa isolates was 73.81 %. The MDR Pseudomonas aeruginosa were higher (70.97 % vs. 29.03 %) in patients suffering from CKD compared to patients without CKD. Up to 85.71 % of the Pseudomonas aeruginosa isolates harbored at least one ESBL gene. The blaTEM type gene (66.67 %) was the most frequently detected gene, followed by blaCTX-M (61.90 %) and blaSHV (47.62 %). ESBL resistance genes were more common in CKD patients (72.22 %) compared to patients without CKD (27.78 %).

CONCLUSION

These results demonstrate that antibiotics belonging to the carbapenem and aminoglycoside classes could be used for Pseudomonas aeruginosa infection. This highlights the importance of regular surveillance of multidrug resistance and extended-spectrum β-lactamase production for Pseudomonas aeruginosa infections in patients with chronic kidney disease.

Epidemiology and referral patterns of patients living with chronic kidney disease in Johannesburg, South Africa: A single centre experience

Chronic kidney disease (CKD) is a significant contributor to the global burden of non-communicable disease. Early intervention may facilitate slowing down of progression of CKD; recognition of at-risk patient groups may improve detection through screening. We retrospectively reviewed the clinical records of 960 patients attending a specialist nephrology outpatient clinic during the period 1 January 2011-31 December 2021. A significant proportion (47.8%) of patients were referred with established CKD stage G4 or G5. Non-national immigration status, previous diagnosis with diabetes, and advancing age were associated with late referral; antecedent diagnosis with HIV reduced the odds of late referral. Black African patients comprised most of the sample cohort and were younger at referral and more frequently female than other ethnicities; non-nationals were younger at referral than South Africans. Hypertension-associated kidney disease was the leading ascribed aetiological factor for CKD (40.7% of cases), followed by diabetic kidney disease (DKD) (19%), glomerular disease (12.5%), and HIV-associated kidney disease (11.8%). Hypertension-related (25.9%) and diabetic (10.7%) kidney diseases were not uncommon in people living with HIV. Advancing age and male sex increased the likelihood of diagnosis with hypertensive nephropathy, DKD and obstructive uropathy; males were additionally at increased risk of HIV-associated kidney disease and nephrotoxin exposure, as were patients of Black African ethnicity. In summary, this data shows that hypertension, diabetes, and HIV remain important aetiological factors in CKD in the South African context. Despite the well-described risk of CKD in these disorders, referral to nephrology services occurs late. Interventions and policy actions targeting at-risk populations are required to improve referral practices.

Frequency and determinants of phytotherapy use in patients with type 2 diabetes in the Dschang Health District, Cameroon: a cross-sectional study

Introduction

phytotherapy is widely used in Africa for the management of many diseases. Data on the use of phytotherapy in people with type 2 diabetes are scarce. We aimed to determine the frequency and factors associated with the consumption/use of phytotherapy products among patients with type 2 diabetes in the Dschang Health District.

Methods

we conducted a cross-sectional study from January to May 2022, including community-dwelling or hospitalized patients with type 2 diabetes who had lived in the Dschang Health District for at least one year. Informed consent was obtained from all patients. Data were collected using a pre-designed questionnaire. Variables collected included socio-demographic characteristics, diabetes knowledge and practices, and perceptions of care.

Results

we included 403 (249 women) patients with type 2 diabetes with a mean (SD) age of 63 (± 14.86) years). Among them, 240 (59.55%) used phytotherapy, either in combination with conventional treatment (168 (41.69%) participants) or not (72 (17.86%) participants), to treat diabetes. The most common reasons for using phytotherapy were easy accessibility and belief in its efficacy. Most patients used both treatments because they thought the combination was more effective. In univariable analysis, we observed a statistically significant association between level of education (p=0.003), socioeconomic level (p<0.001), place of residence (p=0.003), duration of diabetes (p=0.007), and use of phytotherapy. In multivariable analysis, only age between 51 and 60 years (OR: 0.50, 95% CI 0.298 - 0.8521; p=0.01) was associated with the use of phytotherapy.

Conclusion

people living with T2D in the Dschang Health District frequently use phytotherapy as an antidiabetic remedy, especially those aged between 51 and 60 years, those with low education level, low socioeconomic level and medium duration of diabetes. There is a need to evaluate its effectiveness in treating diabetes and its adverse effects.

Prevalence, correlates and in-hospital outcomes of kidney dysfunction in hospitalized patients with heart failure in Buea-Cameroon

Background

Kidney dysfunction is common in patients with heart failure (HF) and has been associated with poor outcomes. This study aimed to determine the prevalence, correlates, and prognosis of kidney dysfunction in patients with HF in Cameroon, an understudied population.

Methods

We conducted a cross-sectional study in consecutive patients hospitalized with HF between June 2016 and November 2017 in the Buea Regional Hospital, Cameroon. Kidney dysfunction was defined as an estimated glomerular filtration rate < 60 ml/min/1.73m². Prognostic outcomes included death and prolonged hospital stay (> 7 days). We also performed a sensitivity analysis excluding racial considerations.

Results

Seventy four patients (86.1% of those eligible) were included. Their median age was 60 (interquartile range: 44–72) years and 46.0% (n = 34) were males. Half of patients (n = 37) had kidney dysfunction. Correlates of kidney dysfunction included previous diagnosis of HF (adjusted odds ratio [aOR]4.3, 95% CI: 1.1–17.5) and left ventricular hypertrophy (aOR3.4, 95% CI: 1.1–9.9). Thirty-six (48.9%) had prolonged hospital stay, and seven (9.5%) patients died in hospital. Kidney dysfunction was not associated with in-hospital death (aOR 0.4, 95% CI: 0.1–2) nor prolonged hospital stay (aOR 2.04, 0.8–5.3). In sensitivity analysis (excluding racial consideration), factors associated with Kidney dysfunction in HF were; anemia (aOR: 3.0, 95% CI: 1.1–8.5), chronic heart failure (aOR: 4.7, 95% CI: 0.9–24.6), heart rate on admission < 90 bpm (aOR: 3.4, 95% CI: 1.1–9.1), left atrial dilation (aOR: 3.2, 95% CI: 1.04–10), and hypertensive heart disease (aOR: 3.1, 95% CI: 1.2–8.4). Kidney dysfunction in HF was associated with hospital stay > 7 days (OR: 2.6, 95% CI: 1–6.8).

Conclusion

Moderate-to-severe kidney dysfunction was seen in half of the patients hospitalized with HF in our setting, and this was associated with a previous diagnosis of HF and left ventricular hypertrophy. Kidney dysfunction might not be the main driver of poor HF outcomes in this population. In sensitivity analysis, this was associated with anemia, chronic heart failure, heart rate on admission less than 90 bpm, left atrial dilatation, and hypertensive heart disease. Kidney dysfunction was associated with hospital stay > 7 days.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02641-2.