Search

Background Although cardiovascular diseases in particular Pulmonary Arterial Hypertension (PAH) is associated with, high morbid-mortality in chronic hemodialysis, but its magnitude remains paradoxically unknown in sub-Saharan Africa. The aim of this study was to evaluate the prevalence of PAH and associated factors in chronic hemodialysis in Sub-Saharan African population. Method In a cross-sectional study, patients treated with HD for at least 6 months in 4 hemodialysis centers were examined. PAH was defined as estimated systolic pulmonary arterial pressure (sPAP) ≥ 35 mmHg using transthoracic Doppler echocardiography performed 24 h after the HD session. Results Eighty-five HD patients were included; their average age was 52.6 ± 15.9 years. Fifty-seven patients (67.1%) were male. Mean duration of HD was 13.3 ± 11 months. With reference to vascular access, 12 (14.1%), 29 (34.1%) and 44 (51.8%) patients had AVF, tunneled cuff and temporary catheter, respectively. The underlying cause of ESRD was diabetes in 30 patients (35.3%). The prevalence of PAH was 29.4%. Patients with PAH had more hyponatremia (11 (44%) vs 10 (16.7%), p = 0.010). In multivariate analysis, unsecured healthcare funding (aOR 4, 95% CI [1.18–6.018]), arrhythmia (aOR 3, 95% CI [1.29–7.34]), vascular access change (aOR 4, 95% CI [1.18–7.51]) and diastolic dysfunction (aOR 5, 95% CI [1.35–9.57] were independently associated with PAH. Conclusion One third of hemodialysis patients exhibit PAH, which is independently associated with low socioeconomic status (unsecured funding, vascular access change) and cardiovascular complications (arrhythmia, diastolic dysfunction).

Contexte et Objectifs. Le nombre des patients hémodialisés en Afrique subsaharienne en constante augmentation ; justifiant de ce fait une meilleure prise en charge de ces patients. La présente étude détermine la prévalence de l’infection par le virus de l’hépatite C en en determinant les génotypes ainsi que les facteurs y associés dans ce groupe de patients. Méthodes. 127 patients hémodialisés chroniques ont subis des tests sérologiques à la recherche des anticorps anti-VHC dans plusieurs centres de Kinshasa de février à juin 2018. Le génotype viral a été déterminé par la RT-PCR. Résultats. La fréquence des anticorps anti-VHC a varié de 0 à 52,9 % dans ce groupe. Les génotypes le plus fréquents ont été le 4 (18/22) et le 2 (2/22) ; étant sumultanément rétrouvé chez un patient, et indéterminé chez un autre sujet. Avoir reçu au moins 4 transfusions [7,21 (1,09-10,61; p=0.040)], ne pas être sous EPO [5,81(1,47-12,96); p=0.012)], être en hémodialyse depuis au moins 14 mois [3,63(1,60-5,05); p=0.035)] et être dialysé dans un centre surchargé [2,06 (0,83-5,86); p=0.073)] étaient associés à un risque plus élevé d’infection par le VHC. Conclusion. Ses principaux déterminants sont : le nombre des transfusions sanguines et la durée d'HD ; d’où la nécessité de réduire les transfusions sanguines chez les sujets dialysés par l'administration d'EPO, étant donné le coût prohibitif du traitement contre le VHC dans notre contexte. Context and objective. The steady increase in the number of chronic hemodialysis patients in sub-Saharan Africa (SSA) calls for improved management of those patients. The present study aimed to determine the frequency of hepatitis C virus (HCV) infection, the prevalent genotypes, and the risk factors associated with HCV in hemodialysis patients in Kinshasa (DR Congo). Methods. A cross-sectional study was conducted from February to June 2018 in all hemodialysis centers in Kinshasa. Blood samples were collected from 127 chronic hemodialysis patients and tested for the presence of antibodies against HCV. The HCV genotype was identified by real-time polymerase chain reaction (RT- PCR). Results. Twenty-two (17.3 %) patients were positive for anti-HCV antibodies, ranging from 0 % to 52.9 % in different centers. Genotype 4 was detected in 18/22 (81.8 %), followed by genotype 2 in 2/22 (9.1%), and both genotypes 2 and 4 in one patient (4.5%). One patient had an undetermined genotype (4.5 %). Having received at least 4 transfusions [7,21 (1,09-10,61); p=0.040)], not being under EPO treatment [5,81(1,47-12,96); p=0.012)], being on hemodialysis for at least 14 months [3,63(1,60-5,05); p=0.035)]and being dialyzed in an overloaded center [2,06(0,83-5,86); p=0.073)] were associated with a greater risk of HCV infection. Conclusion. This high HCV prevalence (17.3 %) represents a substantial health burden in HD patients from Kinshasa, DR Congo. It is largely driven by the number of blood transfusions, the duration time in hemodialysis. Observations from the present study underscore the need of reducing the number of blood transfusions in people on dialysis through the administration of erythropoietin, given the unaffordable cost of HCV therapy for most individuals in DR Congo.

BackgroundThe objective of our retrospective study was to establish a comparison between the first and the second waves of demographic and clinical characteristics as well as mortality and its determinants.MethodsA total of 411 COVID-19 patients were enrolled in Kinshasa University Hospital and categorized into two groups according to the pandemic pattern, demographics, and disease severity. The clinical characteristics were compared according to the two waves. To describe survival from the first day of hospitalization until death, we used Kaplan Meier’s method. We used the Log Rank test to compare the survival curves between the two waves. The Cox regression was used to identify independent predictors of mortality.ResultsDuring the study period, 411 patients with confirmed COVID-19 were admitted to the hospital. The average age of patients in the 2nd wave was higher than in the first wave (52.4 ±17.5 vs 58.1 ±15.7, p=0.026). The mean saturation was lower in the first wave than in the second. The death rate of patients in the first wave was higher than in the second wave (p=0.009). Survival was reduced in the first wave compared to the second wave. In the first wave, age over 60 years, respiratory distress, law oxygen saturation (≤89%) and severe stage of COVID-19 emerged as factors associated with death, while in the second wave it was mainly respiratory distress, law oxygen saturation (≤ 89%) and severe stage. The predictors of mortality present in both the first and second waves were respiratory distress and severe COVID-19 stage.ConclusionMortality decreased in the second wave. Age no longer emerged as a factor in mortality in the second wave. Health system strengthening and outreach to those at high risk of mortality should continue to maintain and improve gains.

IntroductionThe steady increase in the number of chronic hemodialysis patients in sub-Saharan Africa (SSA) calls for improved management of those patients. The present study aimed to determine the frequency of hepatitis C virus (HCV) infection, the prevalent genotypes and the risk factors associated with HCV in hemodialysis patients in Kinshasa (DR Congo). MethodsA cross sectional study was conducted from February to June 2018 in all hemodialysis centers in Kinshasa. Blood samples were collected from 127 chronic hemodialysis patients and tested for the presence of antibodies against HCV. The HCV genotype was identified by real time polymerase chain reaction (RT- PCR). ResultsTwenty-two (17.3 %) patients were anti-HCV positive, ranging from 0 % to 52.9 % in different centers. Genotype 4 was detected in 18/22 (81.8 %), followed by genotype 2 in 2/22 (9.1%), and both genotypes 2 and 4 in one patient (4.5%). One patient had an undetermined genotype (4.5 %). Having received at least 4 transfusions [7,21 (1,09-10,61); p=0.040)], not being under EPO treatment [5,81(1,47-12,96); p=0.012)], being on hemodialysis for at least 14 months [3,63(1,60-5,05); p=0.035)]and being dialyzed in an overloaded center [2,06(0,83-5,86); p=0.073)] were associated with a greater risk of HCV infection.ConclusionThis study highlights the importance of strategies to prevent HCV infection in hemodialysis patients in Kinshasa. This issue is important for SSA countries which are facing several economic and logistical challenges.

Background: Cardiovascular diseases in particular Pulmonary arterial hypertension (PAH) is associed a high morbi-mortality in chronic hemodialysis, but it’s magnitude remains paradoxically unknown in sub-Saharan Africa. The aim of this study was to evaluate the prevalence of PAH and associated factors in chronic hemodialysis patients. Patients and method: In a cross-sectional study, patients treated with HD for at least 6 months in 4 hemodialysis centers were examined. PAH was defined as estimated systolic pulmonary arterial pressure (sPAP) ≥ 35 mmHg using transthoracic Doppler echocardiography performed 24 hours after the session. Results: A total of 85 HD patients were included. Their average age was 54.6 ± 14.3 years. 57 patients (67.1%) were male. Mean duration of HD was 13.3 ± 11 months. With reference to vascular access, 12 (14.1%), 29 (34.1%) and 44 (51.8%) patients had AVF, tunneled cuff and temporary catheter, respectively. The underlying cause of ESRD was diabetes in 30 patients (35.3%). The prevalence of PAH was 29.4%. In multivariate analysis, no secure healthcare funding (adjusted OR 5, 95% CI [1.24-8.27]), hyponatremia (adjusted OR 2, 95% CI [1.61-10.01]), arrhythmia (aOR 3, 95% CI [1.06 -5.85]), vascular access change (aOR 4, 95% CI [1.12-6.23]) and diastolic dysfunction (aOR 5, 95% CI [1.35-9.57] were independently associated with PAH. Conclusion: One third of hemodialysis patients exhibit PAH, which is associated with diastolic dysfunction and arrhythmia. Therefore, early detection and control of PAH and associated factors may help to tackle PAH associated morbidity and mortality in maintenance hemodialysis patients. Keywords: Pulmonary hypertension, Hemodialysis, Systolic pulmonary arterial pressure, Cardiovascular disease.

Background Stroke is the third leading cause of cardiovascular mortality in dialysis patients. The objective of this study was to assess the extent of stroke in chronic hemodialysis patients. Methods Historical cohort of patients enrolled in two hemodialysis (HD) centers from January 1, 2010 to December 31, 2011, including 191 patients (mean age 52 years, 68% men). Incidence curves and survival time analysis between the first day of HD and the end of the study were described by the Kaplan-Meier method. Independent stroke predictors were identified by multiple logistic regression analysis. P

Context and objective In the estimation of glomerular filtration rate (GFR), ethnicity is an important determinant. However, all existing equations have been built solely from Caucasian and Afro-American populations and they are potentially inaccurate for estimating GFR in African populations. We therefore evaluated the performance of different estimated GFR (eGFR) equations in predicting measured GFR (mGFR). Methods In a cross-sectional study, 93 healthy adults were randomly selected in the general population of Kinshasa, Democratic Republic of the Congo, between June 2015 and April 2016. We compared mGFR by plasma clearance of iohexol with eGFR obtained with the Modified Diet in Renal Disease (MDRD) equation with and without ethnic factor, the Chronic Kidney Disease Epidemiology (CKD-EPI) serum creatinine (SCr)-based equation, with and without ethnic factor, the cystatin C-based CKD-EPI equation (CKD-EPI SCys) and with the combined equation (CKD-EPI SCrCys) with and without ethnic factor. The performance of the equations was studied by calculating bias, precision and accuracy within 30% (P30) of mGFR. Results There were 48 women and 45 men. Their mean age was 45.0±15.7 years and the average body surface area was 1.68±0.16m2. Mean mGFR was 92.0±17.2 mL/min/1.73m2 (range of 57 to 141 mL/min/1.73m2). Mean eGFRs with the different equations were 105.5±30.1 and 87.2±24.8 mL/min/1.73m2 for MDRD with and without ethnic factor, respectively; 108.8±24.1 and 94.3x20.9 mL/min/1.73m2 for CKD-EPI SCr with and without ethnic factor, respectively, 93.5±18.6 mL/min/1.73m2 for CKD-EPI SCys; 93.5±18.0 and 101±19.6 mL/min/ 1.73m2 for CKD-EPI SCrCys with and without ethnic factor, respectively. All equations slightly overestimated mGFR except MDRD without ethnic factor which underestimated by -3.8±23.0 mL/min /1.73m2. Both CKD-EPI SCr and MDRD with ethnic factors highly overestimated mGFR with a bias of 17.9±19.2 and 14.5±27.1 mL/min/1.73m2, respectively. There was a trend for better P30 for MDRD and CKD-EPI SCr without than with the ethnic factor [86.0% versus 79.6% for MDRD (p = 0.21) and 81.7% versus 73.1% for the CKD-EPI SCr equations (p = 0.057)]. CKD-EPI SCrCys and CKD-EPI SCys were more effective than creatinine-based equations. Conclusion In the Congolese healthy population, MDRD and CKD-EPI equations without ethnic factors had better performance than the same equations with ethnic factor. The equations using Cys C (alone or combined with SCr) performed better than the creatinine-based equations.

Background Oxidative stress is thought to be involved in the pathogenesis of microalbuminuria in Sickle cell anemia (SCA). Antioxidant enzymes such as glutathione peroxidase (GPx) and Cu-Zn superoxide dismutase (SOD) may play an important protective role. This study aimed to evaluate the association between albuminuria and these two antioxidant enzymes. Methods We consecutively recruited Steady state children aged between 2 and 18 years old with established diagnosis of homozygous SCA in two hospitals of Kinshasa/DR Congo. The relationship between Urinary Albumin Creatinine Ratio (UACR) and other variables of interest (age, systolic blood pressure, diastolic blood pressure, plasma GPx and Cu-Zn SOD, free plasmatic hemoglobin, LDH, indirect bilirubin, white blood cells (WBC), percentage of fetal hemoglobin, serum iron, ferritin, CRP) was analyzed by Bivariate correlation (Pearson’s correlation coefficient). Microalbuminuria was defined by urine albumin/creatinine ratio between 30 and 299 mg/g. Results Seventy Steady state Black African children with SCA (56% boys; average age 9.9 ± 4.3 years; 53% receiving hydroxyurea) were selected. Prevalence of microalbuminuria was 11.8%. LDH (r = 0.260; p = 0.033) and WBC count (r = 0.264; p = 0.033) were positively correlated with UACR whereas GPx (− 0.328; p = 0.007) and Cu-Zn SOD (− 0.210; p = 0.091) were negatively correlated with UACR. Conclusions Albuminuria is associated with decreased antioxidant capacity and increased levels of markers of hemolysis and inflammation. Therefore, strategies targeting the reduction of sickling and subsequent hemolysis, oxidative stress and inflammation could help preventing or at least delaying the progression of kidney disease in SCA children.

Introduction Bien que la denutrition soit connue associee a une forte morbi-mortalite chez les hemodialyses chroniques, les donnees y relatives sur l’ampleur sont paradoxalement rares, en Republique democratique du Congo. Les objectifs de la presente etude etaient d’evaluer la frequence et les determinants de la denutrition chez les hemodialyses chroniques. Methodes Une etude transversale portant sur les hemodialyses chroniques consecutifs, recrutes dans 4 centres d’hemodialyse. Le statut nutritionnel a ete evalue a partir des donnees biologiques (albuminemie) et anthropometriques (poids corporel et le poids corporel ideal) ayant permis de calculer le Geriartric Nutritionnal Risk Index (GNRI). L’analyse statistique a recouru au test de χ2 et a la regression logistique multivariee. Le seuil de signification statistique etait 0,05. Resultats obtenus ou attendus Quatre-vingt cinq patients (hommes 67 %, âge moyen 52,8 ± 15,9 ans). La frequence de la denutrition etait de 37,6 % (dont 8 % avec un risque faible, 23 % modere et 6 % eleve). Les donnees biologiques ont revele chez les denutris une protidemie moyenne de 60,3 ± 6,2 g/L, une albuminemie moyenne de 31,7 ± 4,5 g/L. Les donnees anthroprometriques des denutris ont montre : un poids moyen de 59,2 ± 9 Kg, un IMC moyen de 21,5 ± 2,4 Kg/m2. Les facteurs associes a la denutrition etaient : sous dialysance (Kt/v 6 mg/L) [ORa : 3, IC a 95 % (1,75–6,56), P = 0,016]. Conclusion Pres d’un patient sur quatre souffre de la denutrition et est a haut risque de mortalite. De survenue tres precoce, la denutrition a pour determinants des facteurs lies a l’HD et aux patients.

Introduction En depit de multiples benefices de preservation de la diurese residuelle (DR) chez les hemodialyses chroniques, les donnees y relatives sont fragmentaires en Afrique Sub-saharienne. L’objectif de la presente etude etait de rechercher l’impact de la DR reduite sur la dysfonction diastolique (DDVG) et systolique du ventricule gauche (DSVG). Patients et methodes Dans une etude transversale, tous les patients suivis dans 4 centres d’HD de Kinshasa ont ete examines entre mars 2016 et octobre 2017. La DSVG (FE Resultats Soixante et onze patients (âge moyen 51,7 ± 16,6 ans ; 67,1 % d’hommes ; 35,2 % diabetiques ; 38 avec DR reduite et 33 avec DR preservee) ont participe a l’etude. Les determinants associes a la DSVG etaient l’hypertension arteielle [ORa : 7, IC a 95 % (1,11–9,49), p = 0,023], l’hyperphosphatemie [ORa : 18, IC a 95 % (1,15–22,61), p = 0,024] et la DR reduite [ORa : 2, IC a 95 % (1,69–4,76), p = 0,017] et pour la DDVG : le diabete sucre [ORa : 8, IC a 95 % (1,89–17,15), p = 0,025], le tabac [ORa : 9, IC a 95 % (1,20–18,57), p = 0,015], la PAS [ORa : 3, IC a 95 % (1,09–5,66), p = 0,020], la Veine cave inferieure [ORa : 1, IC a 95 % (0,77–0,99), p = 0,029] et la DR reduite [ORa : 3, IC a 95 % (1,61–5,19), p = 0,019]. Conclusion La DR reduite est associee a la dysfonction systolique/diastolique du VG chez les hemodialyses chroniques.

Cardiovascular disease (CVD) risk in type 2 diabetes mellitus (T2DM) increases with the development of albuminuria and is related in part to dyslipidemia. The present analysis assessed lipid profile and patterns of dyslipidemia in T2DM patients according to albuminuria status. This was a post hoc analysis of data from 181 T2DM patients seen at a tertiary health-care hospital and enrolled in a cross-sectional study of albuminuria status. Abnormal albuminuria was defined as microalbuminuria [albumin to creatinine ratio (ACR) 30-299.9 mg/g] or macro-albuminuria (ACR ≥300 mg/g). Atherogenic dyslipidemia was defined as triglycerides (TGs) ≥150 mg/dL and/or high-density lipoprotein-cholesterol (HDL-c)

Introduction Le stress oxydatif est implique dans la pathogenese de la microalbuminurie chez les drepanocytaires. Les enzymes antioxydantes telles que la glutathion peroxydase (GPx) et la Cu–Zn superoxide dismutase (Cu–Zn SOD) pourraient jouer un role protecteur important. Cette etude se propose d’evaluer la relation entre l’albuminurie et ces 2 enzymes. Patients et methodes Recrutement consecutif des enfants drepanocytaires (d’âge variant entre 2 et 18 ans), en etat de stabilite intercritique et suivis dans 2 hopitaux de la ville de Kinshasa/DR Congo. La relation entre l’albuminurie (rapport albumine–creatinine urinaire = UAC) et d’autres variables d’interets (âge, pression arterielle systolique, pression arterielle diastolique, GPx, Cu–Zn SOD, hemoglobine, bilirubinemie indirecte, globules blancs (GB), pourcentage de l’hemoglobine fœtale, taux de fer serique, de ferritine et de CRP, lactate deshydrogenase = LDH, taux d’hemoglobine libre plasmatique) a ete etudiee en analyse bivariee (coefficient de correlation de Pearson). Resultats Au total, 70 enfants drepanocytaires homozygotes, tous de race noire (56 % de garcons ; moyenne d’âge : 9,9 ± 4,3 ans ; 53 % recevant de l’hydroxyuree) etaient selectionnes. La prevalence de la microalbuminurie (UAC entre 30–299 mg/g) etait de 11,8 %. La LDH (r = 0,260 ; p = 0,033) et la numeration des GB (r = 0,264 ; p = 0,033) etaient positivement correlees a l’albuminurie tandis que la GPx (–0,328 ; p = 0,007) et la Cu–Zn SOD (–0,210 ; p = 0,091) etaient correlees negativement. Discussion Nos resultats sont en accord avec d’autres travaux qui indiquent que la nephropathie sicklanemique est une vasculopathie dont la physiopathologie implique le stress oxydatif et l’hemolyse intravasculaire. Conclusion Chez les enfants drepanocytaires, l’albuminurie est associee a une reduction de la capacite antioxydante enzymatique et a une augmentation des marqueurs de l’hemolyse et de l’inflammation. Ainsi, les strategies visant a reduire la falciformation et subsequemment l’hemolyse, le stress oxydatif et l’inflammation pourraient aider a prevenir et a terme arreter la progression de la maladie renale chez l’enfant drepanocytaire.

Background: Protease inhibitors (PI) and stavudine are frequently associated with abnormalities of the body composition. The present study aimed to evaluate the body fat composition of HIV-infected Congolese patients receiving antiretroviral other than PI or stavudine. Patients and Methods: Anthropometric measures and body composition of 125 HIV-infected Congolese patients (average age 41 years, 76% women, 74% on antiretroviral therapy) attending a primary healthcare center was cross-sectionally evaluated. Patients receiving PI and/or stavudine were excluded. Subclinical abnormalities of body composition, evaluated by bioimpedance (BIA), were defined as elevated percentage of fat mass (FM) and perivisceral fat mass (PVF) and low percentage of total FM. Results: Clinically evaluated abnormalities of fat distribution were rarely seen, with any case of obesity or lipodystrophy. Overweight (16%) and central obesity (6.3%) were present only in a few women. BIA parameters of body fat composition were similar among antiretroviral naive and treated patients. An average higher percentage of FM (28% vs. 12.1%; p

Introduction Les therapies antiretrovirales hautement actives (TARHA) ont revolutionne le profil evolutif des PVV, au point d’augmenter leur nombre et leur survie en hemodialyse chronique (HD). Les donnees relatives sont quasi-inexistantes en Afrique subsaharienne. L’objectif de la presente etude etait de determiner la frequence de l’infection au VIH dans les centres d’HD de Kinshasa, et de comparer le profil clinicobiologique et la survie des PVV vs patients non PVV. Patients et methodes Cohorte historique ayant inclus 250 patients suivis dans 2 centres d’HD de Kinshasa entre 2007 et 2013. Le diagnostic de l’infection au VIH confirme par la methode Elisa etait pose a l’admission en HD. La survie a ete evaluee par la methode de Kaplan-Meier. Resultats Douze patients de la cohorte etaient des PVV (frequence de 4,8 %). Ces derniers (100 % recevant la TARHA) avaient une moyenne d’âge (49 ± 8 ans vs 53 ± 13 ans ; p = 0,266), d’Hb (8,3 ± 2,7 g/dL vs 8,5 ± 2,2 g/dL ; p = 0,796), d’albuminemie (34 ± 11 g/L vs 37 ± 8 g/L ; p = 0,361), de KT/V (1,35 vs 1,31 ; p = 0,289) et de co-morbidite (4 vs 3 ; p = 0,259) non differente vs patients non PVV. Le recours a la fistule arterioveineuse pour acces vasculaire etait peu frequent dans les deux groupes (17 % vs 19 % ; p = 0,601). La mortalite globale etait de 33,3 % chez les PVV vs 43,2 % chez les patients non PVV (p = 0,617). La survie a 5 mois, 10 mois et 25 mois etait de 77 %, 63 % et 63 % chez les PVV vs 74 %, 53 % et 45 % chez les patients non PVV (log rank p = 0,667). Discussion Nonobstant un schema de premiere ligne n’integrant pas les antiproteases, nos resultats corroborent les donnees de la litterature en ce sens que les patients PVV sous ARV suivis en HD ont une survie comparable avec les autres patients. Conclusion La frequence de l’infection au VIH dans les centres d’HD de Kinshasa n’est pas differente de celle observee ailleurs. La survie des PVV sous TARHA semble statistiquement comparable a celle des patients non PVV. Ces observations meritent d’etre confirmees par des etudes ulterieures plus larges integrant plusieurs parametres susceptibles d’influencer la mortalite en HD.

Introduction L’accident vasculaire cerebral (AVC) represente la troisieme cause de mortalite cardiovasculaire des patients en dialyse. Cependant les donnees sur son ampleur dans les centres d’hemodialyse (HD) des pays en voie de developpement sont rares. L’objectif de la presente etude etait d’evaluer l’incidence et les facteurs de risque associes a la survenue de l’AVC dans les centres d’HD de Kinshasa. Patients et methodes Il s’agit d’une etude de cohorte historique et multicentrique ayant inclus 191 patients (moyenne d’âge de 52 ans, 68 % d’hommes) admis dans deux centres d’HD du 1er janvier 2007 au 31 decembre 2013. Les donnees demographiques, cliniques, biologiques et d’imageries ont ete collectees. L’AVC etait defini suivant l’American Stroke Association (ASA). Les courbes d’incidence ont ete estimees par la methode de Kaplan-Meier. Un modele de regression logistique a ete construit pour etablir l’association entre l’AVC et les facteurs enregistres au debut de la dialyse. Le seuil de signification statistique etait p Resultats L’incidence cumulee etait de 6,3 % pour une periode totale de suivie de 764 patients-annees impliquant un taux d’incidence de 1570,7 AVC-patient-annee. L’incidence annuelle etait plus elevee durant la premiere annee en HD (4,2 %). Seuls l’hypertension arterielle (OR = 5,9 ; IC95 % : 1,68–13,02), l’antecedent d’AVC (OR = 3,4 ; IC95 % : 1,22–8,51), l’antecedent de chirurgie urologique (OR = 2,4 ; IC95 % : 1,38–15,29) et l’HVG (OR = 7,2 ; IC95 % : 1,45–35,65) emergeaient comme determinants independants de l’AVC. Discussion L’incidence de l’AVC dans notre cohorte est comparable a celle rapportee dans la majorite des etudes variant entre 5,8 et 6,7 %. Ces etudes s’accordent toutes sur une incidence 7 a 10 fois plus elevee en HD comparativement a la population generale. Comme dans la population generale, l’HTA constitue le principal facteur de risque. Conclusion L’incidence de l’AVC dans les centres d’HD de Kinshasa est elevee, plus la premiere annee apres initiation de la dialyse. Le controle de l’hypertension arterielle et de l’hypertrophie ventriculaire gauche constituent les moyens pour reduire cette incidence.

OBJECTIVE To evaluate the prevalence of low estimated glomerular filtration rate (eGFR), proteinuria, and associated risk factors among HIV-infected black patients at primary health care. METHODS A cross-sectional screening involving consecutive HIV-infected patients 18 years and older was done. Eighty-eight percent of patients were receiving highly active antiretroviral therapy (94% on first-line regimen: zidovudine + lamivudine + nevirapine). Simplified Modification of Diet in Renal Disease Study and Cockroft-Gault (CG) equations were used to estimate glomerular filtration rate and creatinine clearance, respectively. Determinants of dipstick proteinuria and low kidney function (

Background Despite the growing incidence of acute kidney injury (AKI) worldwide, there is little data on the burden and outcomes of AKI in intensive care unit (ICU) in low resource settings. The present study assessed the incidence of AKI and its impact on mortality in ICU in Kinshasa (Democratic Republic of Congo). Methods In a prospective cohort study, 476 consecutive critically ill patients (mean age 52 years, 57 % male) were screened for the presence of AKI in seven ICU from January 1st to March 30th, 2015. Serum creatinine was measured by the enzymatic method (Cobas C111 device®). AKI and its stages (no AKI, AKI 1, AKI 2 and AKI 3) were defined according to AKIN recommendations. The primary outcome was 28 days mortality. Survival (time-to death) curves were built using the Kaplan Meier methods. Predictors of mortality were assessed by Cox proportional hazards regression models. p