Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

Burden of COVID-19 in a Hemodialysis Center in Sub-Saharan Africa

Background: The current COVID-19 pandemic remains a great challenge to healthcare workers, especially caregivers of patients with chronic diseases. Despite the advances in knowledge on COVID-19, data on COVID-19 in haemodialysis (HD) remains rare in Africa. Methods: We conducted a review of records from 2020 May 13th to 2021 June 24th in the HD center of Yaoundé General Hospital. All staff and patients in the HD unit were included. Sociodemographic, clinical, laboratory, and radiological data and patient outcome data were collected. All statistical analyses were performed with SPSS 21.0 software (Chicago, IL). Results: In all 30 HD patients and 3 staff members were positive for COVID-19 during the period. The median age of the infected population was 56 years (37.25 - 62). The median dialysis vintage was 42 months (24 - 96). Hypertension (73.3%) and diabetes (36.6%) were frequent comorbidities. About 10% (n = 3) were asymptomatic whereas those who were symptomatic had a mean duration of symptoms of 7 ± 5.6 days. Fatigue (23/30), fever (21/30), cough (14/30) and diarrhoea (11/30) were the main symptoms. Oxygen saturation was low in 36.6% (n = 11) ranging from 82% - 89%. About 50% were admitted in hospital for social isolation;there was no admission in intensive care unit. Three patients (10%) died: 2 for respiratory distress and 1 for severe anaemia. Laboratory test was done in 60% (n = 18) of case and revealed in 72.2% (n = 13) patients low lymphocytes count (median 896/mm3 [800 - 1513]) and anaemia in 77.7% (median 8.5 g/dl [7.5 - 9.8]). Conclusions: HD patients are highly susceptible and HD centres are high risk areas during the outbreak of COVID-19 pandemic.