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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM ASIA–AFRICA  
Year : 2021  |  Volume : 32  |  Issue : 5  |  Page : 1450-1455
Chronic renal failure in the brazzaville university hospital center: Epidemiological, clinical and evolutionary aspects


Department of Nephrology, Brazzaville University Hospital, Brazzaville, Congo

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Date of Web Publication4-May-2022
 

   Abstract 


Chronic kidney disease (CKD) is a major global public health problem today. In Congo, we have very little epidemiological data. Our goal is to describe the epidemiological, clinical, therapeutic, and progressive aspects of IRC in Brazzaville. We carried out a retrospective and descriptive study on patients with chronic renal failure, hospitalized in the nephrology and dialysis department of the Brazzaville teaching hospital from January 1, 2016, to December 31, 2018. The data were established from patient medical records. The statistical analysis was done with the Epi info software. During our study, 953 patients were hospitalized in nephrology, of which 497 (52.1%) presented with CKD, only 407 files were usable (42.7%). Their average age was 51.8 ± 15.2 years; with a male predominance of 59.1%. The first three causal nephropathies are diabetes mellitus (23.3%), high blood pressure (21.8%), and chronic nondiabetic glomerulonephritis (15.5%). In 22.3% of cases, the causative nephropathy remained undetermined. CKD was declared terminal in 295 patients (74, 2%); 73 (19.8%) of whom were able to access dialysis. Erythropetine (EPO) was indicated in 316 patients (77%), only 8.4% received it. The mortality rate was 49.9%. Our study reveals the major health issue of IRC in the Congo. The intervention of all the actors of national public health is necessary to face this scourge, which makes us ask for help from all international and national donors.

How to cite this article:
Eyeni Sinomono DT, Loumingou R, Gassongo Koumou GC, Mahoungou GH, Mobengo JL. Chronic renal failure in the brazzaville university hospital center: Epidemiological, clinical and evolutionary aspects. Saudi J Kidney Dis Transpl 2021;32:1450-5

How to cite this URL:
Eyeni Sinomono DT, Loumingou R, Gassongo Koumou GC, Mahoungou GH, Mobengo JL. Chronic renal failure in the brazzaville university hospital center: Epidemiological, clinical and evolutionary aspects. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 May 25];32:1450-5. Available from: https://www.sjkdt.org/text.asp?2021/32/5/1450/344766



   Introduction Top


Chronic renal failure is defined as a progressive and irreversible deterioration of kidney function.[1] Today, it is a major public health problem on a global level due to its constantly increasing prevalence but also to the sociosanitary cost which it generates in particular at the terminal stage.[1] In 2015, more than 353 million people or 5% of the world population suffered from chronic renal failure and 1.2 million people died of it; an increase of 32% since 2005.[2] The prevalence varies from one country to another and access to treatment depends on the socioeconomic level of the country. In the United States, the estimated prevalence of all stages of chronic kidney disease (CKD) is close to 13% and concerns nearly 20 million Americans, the number of dialysis patients should be 650,000 in 2010.[3] Unlike developed countries where the incidence and prevalence of CKD are known from the existence of national registers, little epidemiological data exists in developing countries like the Congo. Hence, we carried out this work with the aim of describing the epidemiological, clinical, therapeutic, and progressive aspects of IRC at the CHU of Brazzaville.


   Patients and Methods Top


It is a retrospective study, descriptive of three years, carried out in the Nephrology Department of the University Hospital Center of Brazzaville. It took place from January 1, 2016, to December 31, 2018. Note that our service is the only nephrology service in our country, Congo; located in the capital Brazzaville which has nearly one million inhabitants. All patients with chronic renal insufficiency over 18 years of age were included in this study. We used the definition of chronic renal failure according to the definition of Kidney Disease Improving Global Outcomes (KDIGO) whose presence of persistent renal anomaly beyond three months whether morphological, histological, or biological associated with a decrease in the glomerular filtration rate (GFR).[4] The GFR was calculated according to the formula Modification of the Diet in Renal Diseases. Chronic renal failure was staged with the classification of KDIGO.[4] The parameters studied were age, sex, factors of cardiovascular risk, GFR, the reason for consultation, causal nephropathy, treatment of extra-renal purification, and exit modality. The cardiovascular risk factors sought were: age high blood pressure, smoking, diabetes mellitus, an underlying cardiopathy, obesity (body mass index ≥5; 27 kg/m2), the existence of a vascular accident, evaluated, apart from serum creatinine, the hemoglobin level, and the urea level. Statistical analysis was performed using the Epi-info 7 software.


   Results Top


During the study period, 953 patients were hospitalized in our department. Four hundred and ninety-seven patients (52.1%) had chronic renal failure, i.e., a hospital prevalence of 6.1%. Four hundred and seven files (42.7%) were deemed exploitable according to our inclusion criteria. We found 249 men and 158 women, a gender ratio of 1.6. The mean age was 51.8 ± 15.2 years, the youngest patient was 16 years old and the oldest was 90 years old. The distribution of our sample according to age and gender is illustrated in [Figure 1]. All social classes are concerned with a predominance for the lower class (48.6%), illustrated by [Table 1]. Three hundred and three patients (74.4%) had at least two cardiovascular risk factors; high blood pressure was encountered in 275 patients (67.6%), smoking in 56 patients (13.7%). [Table 2] summarizes all of the cardiovascular risk factors found and their proportion.
Figure 1: Distribution of patients with chronic renal failure according to age and sex.

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Table 1: Socioeconomic level in chronic renal failure patients.

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Table 2: Distribution of patients with chronic renal failure according to the type of cardiovascular risk (n = 407).

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Chronic renal failure was terminal in 72.5% of cases (n = 295), of which 61.9% (n = 252) were of recent discovery. It was severe in 16.7% of cases (n = 68), and moderate in 5.15% of cases (n = 21). The level of deterioration of renal failure is illustrated in [Table 3]. The circumstances of discovery of chronic renal failure were digestive disorders like vomiting and/or diarrhea in 31.4% of cases (n = 128), a severe anemia with signs of intolerance in 24.8% of cases (n = 101), impaired consciousness in 10.8% of cases (n = 44) and orthopnea with reduction of diuresis in 5.4% of cases (n = 22). In 27.5% (n = 112) of the cases, renal failure was incidentally discovered in patients from other departments. The causes found were diabetic nephropathy in 95 patients (23.3%), nephroangiosclerosis in 89 patients (21.8%), chronic non-diabetic glomerulonephritis in 63 patients (15.5%), and tubulointerstitial nephropathy chronic in 18 patients (4.4%). Kidney failure remained an unknown cause in 91 patients or 22.3%.
Table 3: Distribution according to the level of chronic renal failure (n=407).

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All 295 patients with end-stage chronic renal disease requiring emergency dialysis; among them, only 76 patients (25.4%) had received hemodialysis therapy, including 46 patients (15.6%) in 2018. No patient was able to benefit from peritoneal dialysis or a replacement therapy by kidney transplant. The percentage of patients with access to hemodialysis according to the year is shown in [Figure 2]. Erythropoietin (EPO) was indicated in 336 patients (82.5%), only 8.4% received it.
Figure 2: Proportion per year of patients with chronic renal failure at the stage terminal put on dialysis.

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The evolution during hospitalization throughout the study period was marked by 203 deaths, representing hospital mortality of 49.9%.


   Discussion Top


The epidemiological and clinical profile of chronic renal failure varies from country to country. If in western countries it is more documented, in sub-Saharan African countries there are very few data. In addition, African data very poorly reflect the situation of chronic renal failure in the general population because very few patients have access to the University Hospital Centers which are located especially in the big cities of African countries. Its hospital prevalence is 7.5% according to a study by Ouattara et al in Bouaké (Côte d’lvoire).[5] For Congo-Brazzaville, a Central African country, no previous study has reported the exact hospital prevalence of chronic renal failure, hence the interest of our work despite its intra-hospital monocentric nature. In total, we collected 497 patients with chronic renal failure, representing half of the nephrology hospitalizations, making a hospital prevalence of 6.1%. The gender ratio was 1.6 in our population with a male predominance, comparable to what Ouattara et al reported in their cohort.[5] This male predominance is found in other African studies.[5],[6],[7] The age in our sample varied between 16 years and 90 years with an average age of 51.8 ± 15.2 years; patients aged under 45 were the most numerous, with a proportion (gender combined) at 53.5% (n = 217), the age group over 65 represented only 13.7% (n = 56) cases. Patients with CKD in Africa are young adults. The young age of patients in Africa is a reflection of the youth of the African population. These findings are similar to that of a Malagasy study on the incidence of chronic renal failure at the Center Hospitalier Universitaire d’Antananarivo;[7] this study found a median age of 45.44 years and noted a higher prevalence before 40 years.[7] Ouattara et al in Treichville (Côte d’Ivoire) found an average age of 44 ± 10 years.[8] The data from our age study and also from other African work go[5],[7] in contrast to many European studies where the majority of patients with CKD are young. In France in 2008, the results of a study carried out had found an incidence of chronic renal failure at 12.6% between 40 and 60 years;[9] when it reached 39.4% after age 60. The Epidemiology study of Chronic Renal Insufficiency in the Nancy Agglomeration found a median age of 68 years in Lorraine.[10]

We noted that 74.4% of patients had at least two cardiovascular risk factors. The main cardiovascular risk factor found is hypertension present in 67.6% of the patients. According to the literature, the more cardiovascular risk factors there were, the higher the frequency of chronic renal failure.[10] Black kidney patients are also patients at high cardiovascular risk. Studies in several countries have also found hypertension to be the major risk factor associated with chronic renal failure.[11],[12]

Chronic renal failure has been discovered mainly in the context of digestive disorders related to uremic syndrome and severe anemia. Moreover, 69.1% in it was discovered in the terminal stage. This is explained by a delayed diagnosis of CKD due to its asymptomatic progressive nature over a long period but also by an increased ignorance of kidney disease in our region.[13]

The etiological research of chronic renal failure is a difficult stage of treatment in our regions, renal biopsy is rarely performed as well as immunological assessments. This difficulty could largely explain the high rate of undetermined causes of chronic renal failure, reporting at 22.2% in our study, and between 29.2% and 62% in other African studies.[6],[14],[15] In our series, diabetes and high blood pressure are the main causes of CKD since they both occupy almost half of the etiologies (21.8% for hypertension and 23.3% for diabetes). In most African studies, the known causes are by far dominated by nephroangiosclerosis with varying rates between 25% and 62.1%, followed by diabetic nephropathy between 11% and 20.6%.[6],[15],[16] In our study, the slight dominance of diabetes over hypertension can be explained by the intra-hospital nature of our service, which shares the same level of the building as the incrinology, service, the only service specializing in the management of diabetes in the city of Brazzaville. If numerous African studies carried out are also intra-hospital, then the special finding of the superiority of diabetes over hypertension in terms of etiology of CKD among Congolese remains to be confirmed by a large study.

Among the 295 patients in our cohort, only 76 patients (22.3%) had received occasional hemodialysis treatment. Despite the progress of medicine, dialysis is not yet a common practice in sub-Saharan African countries: it only concerns 5% of the total treatment in a study carried out by Diallo in Côte d’lvoire.[17] To date, in Brazzaville we do not have a public dialysis center even within our department. In 2018, the first public dialysis center to open, except that it is located almost 180 km from our city. The patients on dialysis mainly concern the year 2018, before this year, the patients were evacuated abroad. No patient underwent peritoneal dialysis or kidney transplantation; these two techniques are not yet feasible in our country. Chronic renal failure is a burden in sub-Saharan Africa with hospital mortality of 27.8% in Cote d’Ivoire (5.8) and 28.87% in Antananarivo;[7] this rate can sometimes reach 50% according to certain African authors.[6],[15],[16] All these African data agree with our results where almost half (49.9%) of the patients died. This high mortality is probably related to the inaccessibility to dialysis for the greatest number of patients.


   Conclusion Top


With a high mortality rate related to delayed diagnosis and the absence of a public dialysis unit in the main city of Congo; this study reveals the major health issue of CKD in our country. With the opening of the first public dialysis center in 2018, there has been a slight decrease in the mortality rate, which remains high. The intervention of all national public health actors is necessary to face this scourge, which makes us ask for help from all international and national donors for the opening of hemodialysis units in our city. In the absence of a national study in our country, the data from our study will serve as a basis for the epidemiological profile of chronic renal failure.

Conflict of interest: None declared.



 
   References Top

1.
ANAES. Moyens thérapeutiques pour ralentir la progression de l’insuffisance rénale chronique chez l’adulte; 2004.  Back to cited text no. 1
    
2.
Communiqué de press0. Journée Mondiale du rein; 2015.  Back to cited text no. 2
    
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National Institutes of Health. NI of D and D and KD US. Renal Data System; 2006.  Back to cited text no. 3
    
4.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification and stratification. Am J Kidney Dis 2002;39:S1-266.  Back to cited text no. 4
    
5.
Ouattara B, Kra O, Diby K, et al. Insuffisance rénale chronique chez l’adulte au CHU de Bouaké. Afr Biomed 2004;9:66-70.  Back to cited text no. 5
    
6.
Diouf B, Niang A, Ka EH, Badiane M, Moreira Diop T. Chronical renal failure in one Dakar Hospital Department. Dakar Med 2003;48:185-8.  Back to cited text no. 6
    
7.
Ramilitiana B, Ranivoharisoa EM, Dodo M, Razafimandimby E, Randriamarotia WF. A retrospective study on the incidence of chronic renal failure in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo (the capital city of Madagascar). Pan Afr Med J 2016;23:141.  Back to cited text no. 7
    
8.
Ouattara B, Kra O, Diby K, et al. Particularités de l’insuffisance rénale chronique chez des patients adultes noirs hospitalisés dans le service de médecine interne du CHU de Treichville. Afr Biomed 2004;9:6670.  Back to cited text no. 8
    
9.
Schiele F. L’insuffisance rénale chronique, facteur de risque indépendant de mortalité après un infarctus aigu. L’insuffisance rénale chronique, facteur de risque indépendant de mortalité après un infarctus aigu. Ann Cardiol Angéiol 2005;54:161-7.  Back to cited text no. 9
    
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Loos-Ayav C, Briançon S, Frimat L, André e JL. Incidence de l’insuffisance rénale chronique en population génerale, étude EPIRAN. Nephrol Ther 2009;5:2505.  Back to cited text no. 10
    
11.
Chuahirun T, Wesson DE. Cigarette smoking predicts faster progression of type 2 established diabetic nephropathy despite ACE inhibition. Am J Kidney Dis 2002;39:376-82.  Back to cited text no. 11
    
12.
Stengel B, Combe C, Jacquelinet C, et al. The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study. Nephrol Dial Transpl 2013;12:19.  Back to cited text no. 12
    
13.
Naicker S. Challenges for nephrology practice in Sub-Saharan Africa. Nephrol Dial Transplant 2010;25:649-50.  Back to cited text no. 13
    
14.
Diouf B, Ka EF, Niang A, Diouf ML, Mbengue M, Diop TM. Etiologies of chronic renal insufficiency in a adult internal medicine service in Dakar. Dakar Med 2000;45:62-5.  Back to cited text no. 14
    
15.
Sumaili EK, Krzesinski J, Cohen E, Nseka N. Épidémiologie de la maladie rénale chronique en République démocratique du Congo: Une revue synthétique des études de Kinshasa, la capitale. BMC Nephrol 2009;10:10-8.  Back to cited text no. 15
    
16.
Frimat L, Loos-Ayav C, Briançon SK.. Epidemiologie des maladies rénales chroniques. Encycl Med Chir Nephrol 2005;2:139-57.  Back to cited text no. 16
    
17.
Diallo AD, Niamkey E, Beda Yao B. Chronic renal insufficiency in Côte d’lvoire: Study of 800 hospital cases. Bull Soc Pathol Exot 1997; 90:346-8.  Back to cited text no. 17
    

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Correspondence Address:
Daniel Tony Eyeni Sinomono
Department of Nephrology, Brazzaville University Hospital, Brazzaville
Congo
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-2442.344766

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