Nazaire Nseka - Academia.edu (original) (raw)

Papers by Nazaire Nseka

Néphrologie & Thérapeutique, 2012

Saudi Journal of Kidney Diseases and Transplantation, 2020

Valvular calcifications (VCs) are one of the major cardiovascular complications in patients on ch... more Valvular calcifications (VCs) are one of the major cardiovascular complications in patients on chronic hemodialysis (HD) due to its prevalence and predictive morbidity and mortality. The current study assessed the prevalence, location, and risk factors of VC among chronic HD Congolese patients in Kinshasa. This observational study involved three HD centers in Kinshasa between March and August 2016. Consecutive consenting adults on maintenance HD for at least six months were recruited. VCs were defined as a luminous echo on one or more cusps of the aortic or mitral valve. Risk factors of VC were determined by multivariate analysis. Sixty patients (mean age: 52.5 ± 15.9 years) were enrolled. The mean serum calcium and phosphorus were7.9 ± 1.3 mg/dL and 5.7 ± 1.7 mg/dL, respectively. VCs were encountered in 38% of the whole group in aortic and mitral valvular location in 64% and 23%, respectively. Hypertension, age >60 years, tobacco use, and hyperphosphatemia were independently associated with VC. Despite a young age of patients, VCs were a common finding and associated with both traditional and chronic kidney disease-specific risk factors.

IntroductionThe steady increase in the number of chronic hemodialysis patients in sub-Saharan Afr... more 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 tr...

BMC Nephrology, 2020

Background Although cardiovascular diseases in particular Pulmonary Arterial Hypertension (PAH) i... more 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...

Néphrologie & Thérapeutique, 2018

World Journal of Cardiovascular Diseases, 2019

Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than... more Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the present study was aimed to assess the diagnostic performance of 24-hours ABPM vs. dialysis unit BPs for the diagnosis of ECG-LVH in steady state chronic hemodialysis black patients. Methods: From March 31 to September 30, 2018, interdialytic ABPM was performed after a midweek hemodialysis session for 24 hours using a Spacelab 90207 ABPM monitor in the non-access arm in 45 stable chronic hemodialysis black patients (age ≥ 20 years, hemodialysis for at least 3 months and informed consent) attending 3 hemodialysis centers in Kinshasa. Ambulatory BP was recorded every 20 minutes during the day (6 AM to 10 PM) and every 30 minutes during the night (10 PM to 6 AM). ECG-LVH was defined using Cornell product criteria. ROC curve method was used to assess the performance of dialysis unit BPs vs. interdialytic 24-hours ABPM in diagnosing ECG-LVH. P < 0.05 defined the level of statistical significance. Results: Whatever the method of BP measurement, all the SBP values were related to ECG-LVH with similar AUC and overlapping 95% CI; however, they were not significantly different from each other. 24-hours interdialytic ambulatory SBP (AUC 0.748; 95% CI 0.58-0.94

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

Cardiovascular disease (CVD) risk in type 2 diabetes mellitus (T2DM) increases with the developme... more 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) <40 mg/dL in men and <50 mg/dL in women using international consensus criteria. High levels of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), HDL-c, non-HDL-c, TG, and low level of HDL-c were defined according to 2012 American Association of Clinical Endocrinologi...

PloS one, 2018

In the estimation of glomerular filtration rate (GFR), ethnicity is an important determinant. How... more 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). 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 th...

BMC nephrology, Jan 20, 2018

Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). H... more Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). However, few studies have examined RUV in patients on HD in Sub-Saharan Africa. The aim of this study was to identify predictors of RUV among incident hemodialysis patients in Kinshasa. This historical cohort study enrolled 250 patients with ESRD undergoing hemodialysis between January 2007 and July 2013 in two hemodialysis centers in Kinshasa. RUV were collected over 24 h at the initiation of HD and 6 and 12 months later during the interdialytic period. We compared the baseline characteristics of the patients according to their initial RUV (≤ 500 ml/day vs > 500 ml/day) using Student's t, Mann-Whitney U and Chi2 tests. Linear mixed-effects models were used to search for predictors of decreased RUV by adding potentially predictive baseline covariates of the evolution of RUV to the effect of time: age, sex, diabetes mellitus, hypertension, diastolic blood pressure, diuretics, angio...

BMC Nephrology, 2017

Background: Stroke is the third leading cause of cardiovascular mortality in dialysis patients. T... more 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 < 0.05 defined the level of statistical significance. Results: 12 incident stroke were recorded during the study period, with 1622.1 person-months (PM), a stroke incidence rate of 7.4 cases per 1000 PM (95% CI = 7.35-7.44) at the point date. The incidence of stroke at 6 months, 12 months and 24 months was 9.8%, 11.9% and 13%, respectively. Only the absence of arterial hypertension (RR = 5.7, 95% CI: 1.52-21.42) emerged as an independent determinant of stroke. Conclusion: The high incidence of stroke in Kinshasa HD centers is partially explained by reverse epidemiology. Efforts must be made to understand this phenomenon in order to reduce its impact.

Journal of clinical laboratory analysis, Jan 19, 2017

The prevalence of sickle cell trait is extremely high in sub-Saharan Africa. Recent studies have ... more The prevalence of sickle cell trait is extremely high in sub-Saharan Africa. Recent studies have reported the impact of sickle cell carriers on renal function. However, data on renal abnormalities in children with sickle cell trait in this part of the world are unknown. In this report, we assess the glomerular function of children with sickle cell trait (SCT). A case control study was conducted to assess the glomerular function in 43 Congolese children with sickle cell trait (Hb-AS) matched for age to 65 children with sickle cell anemia in steady state (Hb-SS) and 67 normal controls (Hb-AA). There was a significant difference in the blood pressure levels between the Hb-AS group vs Hb-SS group (P<.05). The estimated glomerular filtration rate (eGFR) corrected for body surface area was increased in Hb-AS group compared to Hb-AA group, but there was no significant difference between the two groups (P=.48). At the same time, the eGFR was decreased, but no significantly so, in the Hb-...

Néphrologie & Thérapeutique, 2016

Discussion Le LMNH est une hémopathie fréquente, les atteintes rénales sont rares au regard. Le c... more Discussion Le LMNH est une hémopathie fréquente, les atteintes rénales sont rares au regard. Le cas présent tire son originalité du fait qu'une infiltration rénale des lymphocytes B avec GNMP sans aucun signe patent de LMNH, révélé par un syndrome néphrotique et une insuffisance rénale et que seul le phénotype des cellules a permis le diagnostic. Conclusion L'atteinte glomérulaire secondaire au LMNH est très rarement décrite, dont l'évolution rénale est favorable si l'hémopathie est bien contrôlée sous chimiothérapie. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.

BMC Nephrology, 2016

Background: Despite the multiple benefits of maintaining residual urine volume (RUV) in hemodialy... more Background: Despite the multiple benefits of maintaining residual urine volume (RUV) in hemodialysis (HD), there is limited data from Sub-Saharan Africa. The aim of this study was to assess the impact of RUV decline on the survival of HD patients. Methods: In a retrospective cohort study, 250 consecutive chronic HD patients (mean age 52.5 years; 68.8% male, median HD duration 6 months) from two hospitals in the city of Kinshasa were studied, between January 2007 and July 2013. The primary outcome was lost RUV. Preserved or lost RUV was defined as decline RUV < 25 (median decline) or ≥ 25 ml/day/month, respectively. The second endpoint was survival (time-to death). Survival curves were built using the Kaplan-Meier methods. We used Log-rank test to compare survival curves. Predictors of mortality were assessed by Cox proportional hazards regression models. Results: The cumulative incidence of patients with RUV decline was 52, 4%. The median (IQR) decline in RUV was 25 (20.8-33.3) ml/day/month in the population studied, 56.7 (43.3-116.7) in patients deceased versus 12.9 (8.3-16.7) in survivor patients (p < 0.001). Overall mortality was 78 per 1000 patient years (17 per 1000 in preserved vs 61 per 1000 lost RUV). Forty six patients (18.4%) died from withdrawal of HD due to financial constraints. The Median survival was 17 months in the whole group while, a significant difference was shown between lost (10 months, n = 119) vs preserved RUV group (30 months, n = 131; p = 0001). Multivariate Cox proportional hazards models showed that, decreased RUV (adjusted HR 5.35, 95% CI [2.73-10.51], p < 0.001), financial status (aHR 2.23, [1.11-4.46], p = 0.024), hypervolemia (a HR 2.00, [1.17-3.40], p = 0.011), lacking ACEI (aHR 2.48, [1.40-4.40], p = 0.002) or beta blocker use (aHR 4.04, [1.42-11.54], p = 0.009), central venous catheter (aHR 6.26, [1.71-22.95], p = 0.006), serum albumin (aHR 0.93, [0.89-0.96], p < 0.001) and hemoglobin (aHR 0.73, [0.63-0.84], p < 0.001) had emerged as the independent predictors of all-cause mortality. Conclusion: More than half of HD patients in this cohort study experienced fast RUV decline which contributed substantially to increase mortality, highlighting the need for its prevention and management.

Néphrologie & Thérapeutique, 2016

Identifier les pré dicteurs du degré d'incapacité physique chez les patients en hé modialyse chro... more Identifier les pré dicteurs du degré d'incapacité physique chez les patients en hé modialyse chronique à Kinshasa. Me´thodes.-É tude analytique bicentrique, entre janvier 2007 et juillet 2013. L'incapacité physique a é té é valué e à 6 mois d'hé modialyse selon l'é chelle de Rosser. La ré gression logistique a recherché les pré dicteurs d'une incapacité physique nulle ou lé gè re (Rosser < 3) vs modé ré e à maximale (Rosser ! 3). p é tait fixé à 0,05. Re´sultats.-Cent vingt-sept patients (127) patients ont bé né ficié d'au moins 6 mois d'hé modialyse (53,3 AE 11 ans ; 73,2 % masculin), 79 (62,2 %) avaient une incapacité physique nulle ou lé gè re et 48 (37,8 %) modé ré e à maximale. Les pré dicteurs d'une moindre incapacité physique en analyse univarié e ont é té : financement sé curisé , niveau socio-é conomique é levé , absence du diabè te sucré , poids corporel é levé , pressions arté rielles systolique et diastolique normales, diurè se ré siduelle 3 mois aprè s, hé moglobine et hé matocrite, faible comorbidité , fistule arté rio-veineuse, é rythropoïé tine, au moins 12 heures hebdomadaires d'hé modialyse et absence de complications intradialytiques. Aprè s ré gression logistique, une DR é levé e à 3 mois d'hé modialyse s'est ré vé lé e un pré dicteur indé pendant d'une moindre incapacité physique (OR 0,998 ; p = 0,024) à côté de l'absence du diabè te sucré (OR 0,239 ; p = 0,024), du bon contrôle des chiffres tensionnels systolique (OR 0,958 ; p = 0,013) et diastolique (OR 1,089 ; p = 0,003) et du recours à l'é rythropoïé tine (OR 5,687 ; p = 0,004). Conclusion.-La pré servation de la diurè se ré siduelle est associé e à une moindre incapacité physique et doit occuper une place de choix dans le suivi en hé modialyse. ß 2016 Association Socié té de né phrologie. Publié par Elsevier Masson SAS. Tous droits ré servé s.

Néphrologie & Thérapeutique, 2012

Saudi Journal of Kidney Diseases and Transplantation, 2020

Valvular calcifications (VCs) are one of the major cardiovascular complications in patients on ch... more Valvular calcifications (VCs) are one of the major cardiovascular complications in patients on chronic hemodialysis (HD) due to its prevalence and predictive morbidity and mortality. The current study assessed the prevalence, location, and risk factors of VC among chronic HD Congolese patients in Kinshasa. This observational study involved three HD centers in Kinshasa between March and August 2016. Consecutive consenting adults on maintenance HD for at least six months were recruited. VCs were defined as a luminous echo on one or more cusps of the aortic or mitral valve. Risk factors of VC were determined by multivariate analysis. Sixty patients (mean age: 52.5 ± 15.9 years) were enrolled. The mean serum calcium and phosphorus were7.9 ± 1.3 mg/dL and 5.7 ± 1.7 mg/dL, respectively. VCs were encountered in 38% of the whole group in aortic and mitral valvular location in 64% and 23%, respectively. Hypertension, age >60 years, tobacco use, and hyperphosphatemia were independently associated with VC. Despite a young age of patients, VCs were a common finding and associated with both traditional and chronic kidney disease-specific risk factors.

IntroductionThe steady increase in the number of chronic hemodialysis patients in sub-Saharan Afr... more 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 tr...

BMC Nephrology, 2020

Background Although cardiovascular diseases in particular Pulmonary Arterial Hypertension (PAH) i... more 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...

Néphrologie & Thérapeutique, 2018

World Journal of Cardiovascular Diseases, 2019

Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than... more Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the present study was aimed to assess the diagnostic performance of 24-hours ABPM vs. dialysis unit BPs for the diagnosis of ECG-LVH in steady state chronic hemodialysis black patients. Methods: From March 31 to September 30, 2018, interdialytic ABPM was performed after a midweek hemodialysis session for 24 hours using a Spacelab 90207 ABPM monitor in the non-access arm in 45 stable chronic hemodialysis black patients (age ≥ 20 years, hemodialysis for at least 3 months and informed consent) attending 3 hemodialysis centers in Kinshasa. Ambulatory BP was recorded every 20 minutes during the day (6 AM to 10 PM) and every 30 minutes during the night (10 PM to 6 AM). ECG-LVH was defined using Cornell product criteria. ROC curve method was used to assess the performance of dialysis unit BPs vs. interdialytic 24-hours ABPM in diagnosing ECG-LVH. P < 0.05 defined the level of statistical significance. Results: Whatever the method of BP measurement, all the SBP values were related to ECG-LVH with similar AUC and overlapping 95% CI; however, they were not significantly different from each other. 24-hours interdialytic ambulatory SBP (AUC 0.748; 95% CI 0.58-0.94

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

Cardiovascular disease (CVD) risk in type 2 diabetes mellitus (T2DM) increases with the developme... more 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) <40 mg/dL in men and <50 mg/dL in women using international consensus criteria. High levels of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), HDL-c, non-HDL-c, TG, and low level of HDL-c were defined according to 2012 American Association of Clinical Endocrinologi...

PloS one, 2018

In the estimation of glomerular filtration rate (GFR), ethnicity is an important determinant. How... more 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). 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 th...

BMC nephrology, Jan 20, 2018

Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). H... more Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). However, few studies have examined RUV in patients on HD in Sub-Saharan Africa. The aim of this study was to identify predictors of RUV among incident hemodialysis patients in Kinshasa. This historical cohort study enrolled 250 patients with ESRD undergoing hemodialysis between January 2007 and July 2013 in two hemodialysis centers in Kinshasa. RUV were collected over 24 h at the initiation of HD and 6 and 12 months later during the interdialytic period. We compared the baseline characteristics of the patients according to their initial RUV (≤ 500 ml/day vs > 500 ml/day) using Student's t, Mann-Whitney U and Chi2 tests. Linear mixed-effects models were used to search for predictors of decreased RUV by adding potentially predictive baseline covariates of the evolution of RUV to the effect of time: age, sex, diabetes mellitus, hypertension, diastolic blood pressure, diuretics, angio...

BMC Nephrology, 2017

Background: Stroke is the third leading cause of cardiovascular mortality in dialysis patients. T... more 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 < 0.05 defined the level of statistical significance. Results: 12 incident stroke were recorded during the study period, with 1622.1 person-months (PM), a stroke incidence rate of 7.4 cases per 1000 PM (95% CI = 7.35-7.44) at the point date. The incidence of stroke at 6 months, 12 months and 24 months was 9.8%, 11.9% and 13%, respectively. Only the absence of arterial hypertension (RR = 5.7, 95% CI: 1.52-21.42) emerged as an independent determinant of stroke. Conclusion: The high incidence of stroke in Kinshasa HD centers is partially explained by reverse epidemiology. Efforts must be made to understand this phenomenon in order to reduce its impact.

Journal of clinical laboratory analysis, Jan 19, 2017

The prevalence of sickle cell trait is extremely high in sub-Saharan Africa. Recent studies have ... more The prevalence of sickle cell trait is extremely high in sub-Saharan Africa. Recent studies have reported the impact of sickle cell carriers on renal function. However, data on renal abnormalities in children with sickle cell trait in this part of the world are unknown. In this report, we assess the glomerular function of children with sickle cell trait (SCT). A case control study was conducted to assess the glomerular function in 43 Congolese children with sickle cell trait (Hb-AS) matched for age to 65 children with sickle cell anemia in steady state (Hb-SS) and 67 normal controls (Hb-AA). There was a significant difference in the blood pressure levels between the Hb-AS group vs Hb-SS group (P<.05). The estimated glomerular filtration rate (eGFR) corrected for body surface area was increased in Hb-AS group compared to Hb-AA group, but there was no significant difference between the two groups (P=.48). At the same time, the eGFR was decreased, but no significantly so, in the Hb-...

Néphrologie & Thérapeutique, 2016

Discussion Le LMNH est une hémopathie fréquente, les atteintes rénales sont rares au regard. Le c... more Discussion Le LMNH est une hémopathie fréquente, les atteintes rénales sont rares au regard. Le cas présent tire son originalité du fait qu'une infiltration rénale des lymphocytes B avec GNMP sans aucun signe patent de LMNH, révélé par un syndrome néphrotique et une insuffisance rénale et que seul le phénotype des cellules a permis le diagnostic. Conclusion L'atteinte glomérulaire secondaire au LMNH est très rarement décrite, dont l'évolution rénale est favorable si l'hémopathie est bien contrôlée sous chimiothérapie. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.

BMC Nephrology, 2016

Background: Despite the multiple benefits of maintaining residual urine volume (RUV) in hemodialy... more Background: Despite the multiple benefits of maintaining residual urine volume (RUV) in hemodialysis (HD), there is limited data from Sub-Saharan Africa. The aim of this study was to assess the impact of RUV decline on the survival of HD patients. Methods: In a retrospective cohort study, 250 consecutive chronic HD patients (mean age 52.5 years; 68.8% male, median HD duration 6 months) from two hospitals in the city of Kinshasa were studied, between January 2007 and July 2013. The primary outcome was lost RUV. Preserved or lost RUV was defined as decline RUV < 25 (median decline) or ≥ 25 ml/day/month, respectively. The second endpoint was survival (time-to death). Survival curves were built using the Kaplan-Meier methods. We used Log-rank test to compare survival curves. Predictors of mortality were assessed by Cox proportional hazards regression models. Results: The cumulative incidence of patients with RUV decline was 52, 4%. The median (IQR) decline in RUV was 25 (20.8-33.3) ml/day/month in the population studied, 56.7 (43.3-116.7) in patients deceased versus 12.9 (8.3-16.7) in survivor patients (p < 0.001). Overall mortality was 78 per 1000 patient years (17 per 1000 in preserved vs 61 per 1000 lost RUV). Forty six patients (18.4%) died from withdrawal of HD due to financial constraints. The Median survival was 17 months in the whole group while, a significant difference was shown between lost (10 months, n = 119) vs preserved RUV group (30 months, n = 131; p = 0001). Multivariate Cox proportional hazards models showed that, decreased RUV (adjusted HR 5.35, 95% CI [2.73-10.51], p < 0.001), financial status (aHR 2.23, [1.11-4.46], p = 0.024), hypervolemia (a HR 2.00, [1.17-3.40], p = 0.011), lacking ACEI (aHR 2.48, [1.40-4.40], p = 0.002) or beta blocker use (aHR 4.04, [1.42-11.54], p = 0.009), central venous catheter (aHR 6.26, [1.71-22.95], p = 0.006), serum albumin (aHR 0.93, [0.89-0.96], p < 0.001) and hemoglobin (aHR 0.73, [0.63-0.84], p < 0.001) had emerged as the independent predictors of all-cause mortality. Conclusion: More than half of HD patients in this cohort study experienced fast RUV decline which contributed substantially to increase mortality, highlighting the need for its prevention and management.

Néphrologie & Thérapeutique, 2016

Identifier les pré dicteurs du degré d'incapacité physique chez les patients en hé modialyse chro... more Identifier les pré dicteurs du degré d'incapacité physique chez les patients en hé modialyse chronique à Kinshasa. Me´thodes.-É tude analytique bicentrique, entre janvier 2007 et juillet 2013. L'incapacité physique a é té é valué e à 6 mois d'hé modialyse selon l'é chelle de Rosser. La ré gression logistique a recherché les pré dicteurs d'une incapacité physique nulle ou lé gè re (Rosser < 3) vs modé ré e à maximale (Rosser ! 3). p é tait fixé à 0,05. Re´sultats.-Cent vingt-sept patients (127) patients ont bé né ficié d'au moins 6 mois d'hé modialyse (53,3 AE 11 ans ; 73,2 % masculin), 79 (62,2 %) avaient une incapacité physique nulle ou lé gè re et 48 (37,8 %) modé ré e à maximale. Les pré dicteurs d'une moindre incapacité physique en analyse univarié e ont é té : financement sé curisé , niveau socio-é conomique é levé , absence du diabè te sucré , poids corporel é levé , pressions arté rielles systolique et diastolique normales, diurè se ré siduelle 3 mois aprè s, hé moglobine et hé matocrite, faible comorbidité , fistule arté rio-veineuse, é rythropoïé tine, au moins 12 heures hebdomadaires d'hé modialyse et absence de complications intradialytiques. Aprè s ré gression logistique, une DR é levé e à 3 mois d'hé modialyse s'est ré vé lé e un pré dicteur indé pendant d'une moindre incapacité physique (OR 0,998 ; p = 0,024) à côté de l'absence du diabè te sucré (OR 0,239 ; p = 0,024), du bon contrôle des chiffres tensionnels systolique (OR 0,958 ; p = 0,013) et diastolique (OR 1,089 ; p = 0,003) et du recours à l'é rythropoïé tine (OR 5,687 ; p = 0,004). Conclusion.-La pré servation de la diurè se ré siduelle est associé e à une moindre incapacité physique et doit occuper une place de choix dans le suivi en hé modialyse. ß 2016 Association Socié té de né phrologie. Publié par Elsevier Masson SAS. Tous droits ré servé s.