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.

Background: Renin-angiotensin system antagonists are the mainstays of blood pressure (BP) lowering strategies in people with diabetes. Perindopril a long half-life Angiotensin Converting Enzyme (ACE) inhibitor offers the advantage of a single daily dose, usually empirically taken in the morning. We therefore aimed to assess the influence of time of administration on the effect of Perindopril on circadian BP in type 2 diabetes (T2D) individuals with previously untreated stage 1 hypertension. Methods: Twenty T2D patients (9 being women) with a mean age of 58.7 years, newly diagnosed with stage 1 hypertension, were randomly allocated to receive perindopril 10 mg/day as monotherapy either in the morning or in the evening for 28 days, with crossover without washout period on day 29 th and additional 28 days follow-up. A 24hour ambulatory BP monitoring (ABPM) was performed at baseline, days 28 and 56. This study was retrospectively registered having a trial registration: ClinicalTrials.gov Identifier: NCT03393715. January 8, 2018. Results: Median diagnosed duration of diabetes was 2.0 years. At baseline, mean 24-hour systolic and diastolic BP were 137.0 mmHg and 84.5 mmHg, and mean albumin/ creatinine ratio (ACR) was 132.6 mg/g. There was no difference in the 24-hour systolic blood pressure pattern between the patients on morning perindopril and patients on evening perindopril (p = 0.61). The chronotherapeutic scheme did not influence neither ACR (p = 0.58) nor uric acid level (p = 0.32). However, the administration of 10 mg Perindopril lowered the ACR in both treatment allocation sequences; with an overall treatment effect of-41.7 (95% CI:-92.6 to 9.2) mg/g. Conclusions: The morning administration of perindopril did not prove to be superior to night time regimen for BP control in this group of sub-Saharan type 2 diabetes patients with stage 1 hypertension. However, the administration of perindopril seems to lower the ACR which is suggestive of the reno-protective effect of ACE inhibitors in patients presenting with hypertension and type 2 diabetes.