No abstract

Background: Despite the enormous strides in haemodialysis technology and patient care in high-income countries, patients still experience a lot of symptoms which impair their quality of life (QoL). Data on symptom burden is lacking in low-income countries where the haemodialysis population is younger and access to care is limited. Objectives: To assess the symptom burden in patients on maintenance haemodialysis, its associated factors, patients’ attitude, and practice. Materials and Methods: All consenting patients on maintenance haemodialysis for at least 3 months in 2 referral hospitals in Yaoundé, Cameroon, were screened for symptoms. We excluded patients with dementia or those with acute illness. We used the Dialysis symptom index (DSI) and the modified Subjective Global Assessment tool to assess symptom burden and nutritional status, respectively. We analysed the data using Statistical Package for Social Science (SPSS) 26.0. A dialysis symptom index above the 75th percentile was considered a higher symptom burden. Results: we enrolled 181 participants (64.1% males) with a mean ±SD age of 46.46±14.19years. The median (IQR) dialysis vintage was 37[12-67.5] months and 37% (n=67) were on recombinant erythropoietin. All patients experienced at least a symptom with a median (IQR) of 12[8.0 – 16.0] symptoms per patient. Feeling tired/lack of energy (79%, n=143), decreased interest in sex (73.5%, n=133), dry skin (70.2%, n=127), difficulty becoming sexually aroused (62.4%, n=113), worrying (60.2%, n=109), bone/joint pain (56.4%, n=102), feeling nervous (50.8%, n=92), muscle cramps (50.8%, n=92) and dry mouth (50.3%, n=91) were the most frequent symptoms. The median (IQR) DSI severity score was 41[22.5-58.5] with 24.9% (n=45) having a higher symptom burden. Diabetes mellitus (AOR 5.50; CI 4.66-18.28, p=0.005), malnutrition (AOR 17.68; CI 3.02-103.59, p=0.001), poorly controlled diastolic blood pressure (AOR 4.19; CI 1.20-14.62, p=0.025) and less than 2 weekly sessions of dialysis (AOR 9.05, CI 2.83-28.91, p=<0.001) were independently associated with a higher symptom burden. Out of every 10 patients, 3 did not report their symptoms to the physicians with cost concern as the most reason (70.4%, n=38). Conclusion: In this young population where access to dialysis is limited, the symptom burden is high (100%). Active screening and management of enabling factors may reduce symptom burden and cost concern is the frequent reason symptoms are not reported to physicians.

Conclusions: Ketogenic diet seems to be safe and effective to reduce weight in obese CKD patients without enhancing CKD progression. This case is hypothesis generating and further research is needed before we can recommend KD for obese CKD patients.

Background: With the improvement of life expectancy in developing countries, there is a growing population of elderly admitted on maintenance hemodialysis. This study assessed the survival among incident elderly patients on maintenance hemodialysis in Cameroon. Patients and method: We carried out a retrospective cohort study of 6.3 years in the main hemodialysis units of Cameroon. All incident chronic hemodialysis patients of at least 65 years of age at dialysis initiation were included. Participants were followed for a minimum of 4 months up until death or abandon of dialysis. Their baseline characteristics and survival outcome were assessed. Results: A total of 107 patients were included in this study, representing a cumulative incidence of hemodialysis among elderly patients of 10.9% during the study period. The median age at dialysis initiation was 68 years [IQR 66-72]. The median modified Charlson Comorbidity Index (mCCI) was 2 [IQR 2-5], and 35 (33%) patients had a comorbidity index greater than 3. Emergency dialysis at initiation was noted in 71 (69%) participants. Twenty four (22.5%) patients were hospitalized, mainly because of sepsis. The median survival time was 19.5 months [IQR 42-6]. Survival rates at 1 year and 2 year were 65.4% and 41.5%, respectively. The lowest survival time (4 months) was observed in the very elderly (> 80 years) with high comorbidity index. Patients with a history of hospitalization and those with emergency dialysis initiation also had low survival rates. Conclusion: In our setting, one out of ten incident hemodialysis patients is an elderly. Nearly two-thirds of elderly are still alive one year after hemodialysis initiation. Comorbidity, emergency dialysis initiation and hospitalization are the main factors associated with mortality.