Background: Hemodialysis (HD) is a therapy during which complications such as intradialytic hypertension (IDH) are frequent. We aimed to determine the incidence of IDH and associated factors amongst patients on maintenance hemodialysis in Cameroon. Method: It was a prospective cohort study including end stage kidney disease patients on HD. Data collected were: socio-demographic, comorbidities, current medication, weight, heart rate ultrafiltration rate (UF), albuminemia and electrocardiogram. The first blood pressure (BP) measurement was obtained at the beginning of the session and the last at the end. IDH was defined as an increase in systolic BP ≥ 10 mmHg between the first and the last measurement. Logistic regression was used to look for associated factors, p-value < 0.05 was considered significant. Results: Mean age was 49.06 ± 13.97 years with 64.2% males. Mean number of dialysis session was 11.26 ± 2.49. Incidence of IDH was 48.36%. The median number of IDH episodes was 5 (Range 0-12). Factors increasing the risk were hypertension (p = 0.003), number of antihypertensive drugs ≥ 2 (p < 0.001), blood transfusion during the session (p < 0.001), male gender (p = 0.038) and a monthly income < 35000 XAF (p = 0.033). Factors lowering the risk were age ≥ 50 years (p = 0.012), longer duration on dialysis (p < 0.001), dry weight ≥ 67 kg (p < 0.001), UF ≥ 800 ml/h (p < 0.001) and a BP ≥ 140/90 mmHg at the beginning of the session (p < 0.001). Conclusion: IDH is frequent amongst patients on maintenance hemodialysis in our setting, with various patients related factors associated.

Background: Late presentation (LP) of chronic kidney disease (CKD) patients to nephrologist is a serious problem worldwide with persistent high prevalence despite known benefits of early nephrology care. Objective : Determine the prevalence and factors associated with LP of CKD patients to nephrologists in Cameroon. Methods: A cross-sectional study from October 2015 to May 2016 at the nephrology units of the Douala General and Laquintinie hospitals, including all consenting incident CKD patients. Data collected were: socio-demographic, search of CKD diagnostic criteria during prior follow up, therapeutic itinerary, clinical and biological parameters at presentation, knowledge on CKD and attitude towards dialysis. LP was defined as eGFR < 30 ml/min/1.73 m 2 . It was physician-related whenever no CKD screening was done in the presence of risk factor or no referral to nephrologists at early stages; patient-related whenever patients did not have recourse to hospital care while symptomatic or disrespected a referral decision. p value <.05. Results: We included 130 patients, mean age 53.10 ± 14.66 years, 60.77% males, 58.70% were referred by internal medicine physicians and 10% had recourse to complementary and alternative medicine (CAM). At presentation, 70.80% were symptomatic, 53% had CKD stage five, 86.12% were poorly graded on knowledge and 49% had a negative attitude towards dialysis. The prevalence of LP was 73.90%, 50% was physician-related, 44.79% patient-related and 5.21% both. Being accompanied ( p = .038), a low level of education ( p = .025) and recourse to CAM ( p = .008) were associated with LP. Conclusion: LP is high in Cameroon, attributed to physician’s practical attitudes and patient’s socio-cultural behaviors and economic conditions.

Background: Little is known about the changes in disease makers and risk factors in patients with chronic kidney disease (CKD) under nephrological care in Africa. This study aimed to evaluate the baseline level of markers of CKD and their 12-month time-trend in newly referred patients in a tertiary hospital in Cameroon. Methods: This was a retrospective cohort study including 420 patients referred for CKD between 2006 and 2012 to the nephrology unit of the Douala General Hospital in the littoral region of Cameroon. Their disease and risk profile was assessed at baseline and every 3 months for 1 year. Estimated glomerular filtration rate (eGFR) was based on MDRD and Schwartz equations. CKD was diagnosed in the presence of eGFR< 60 ml/min/1.73 m 2 and/or proteinuria> 1+ and/or abnormal renal ultrasound persisting for ≥3 months. Data analysis used mixed linear regressions. Results: Of the 420 patients included, 66.9% were men and mean age was 53.8 (15.1) years. At referral, 37.5% of the participants were at CKD Stage 3, 30.8% at stage 4 and 26.8% at stage 5. There was 168 (40%) diabetic and 319 (75.9%) hypertensive patients. After some improvement during the first 3 months, eGFR steadily decreased during the first year of follow-up, and this pattern was robust to adjustment for many confounders. Systolic and diastolic blood pressure levels significantly fluctuated during the first twelve months of follow-up. Changes in the levels of other risk factors and markers of disease severity over time were either borderline or non-significant. Conclusion: Patients with CKD in African settings are referred to the nephrologist at advanced stages. This likely translates into a less beneficial effects of specialised care on the course of the disease.

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