Developing nephrology services in low income countries: a case of Tanzania

Ruggajo

et al. 2020

Preprint

Background: Malnutrition, inflammation, and the combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods: This was a prospective cross-sectional observational study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess MICS and its severity. Data analysis was done using the SPSS 20 software. Results: Of the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%). Long-term haemodialysis (>4years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p<0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01-0.97), p<0.05]. Patients with MICS had significantly lower mean body mass index, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy did not correlate with MICS. Conclusion: Malnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients.

Section: Discussioncontrasting

confidence: 74%

Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis at Muhimbili National Hospital in Tanzania: A Cross-Sectional Study

Ruggajo

et al. 2020

Preprint

Organ Donation and Transplantation

“…Tanzania started kidney transplantation services locally in collaboration with hospitals in India and Japan in November 2017 [51]. Earlier, her program consisted of government-sponsored transplantation overseas.…”

Section: East Africamentioning

confidence: 99%

“…Most recipients pay OOP either personally or by relatives, employers and to a lesser extent philanthropists [45]. While the National insurance pays two-thirds of the transplant cost in Kenya [47], it is free in Tanzania [51].…”

Section: Cost Of Treatmentmentioning

confidence: 99%

Organ Donation and Transplantation in Sub-Saharan Africa: Opportunities and Challenges

Ulasi¹,

Ijoma²,

Ifebunandu³

et al. 2021

Sub-Saharan Africa (SSA), occupying about 80% of the African continent is a heterogeneous region with estimated population of 1.1 billion people in 47 countries. Most belong to the low resource countries (LRCs). The high prevalence of end-organ diseases of kidney, liver, lung and heart makes provision of organ donation and transplantation necessary. Although kidney and heart transplantations were performed in South Africa in the 1960s, transplant activity in SSA lags behind the developed world. Peculiar challenges militating against successful development of transplant programmes include high cost of treatment, low GDP of most countries, inadequate infrastructural and institutional support, absence of subsidy, poor knowledge of the disease condition, poor accessibility to health-care facilities, religious and trado-cultural practices. Many people in the region patronize alternative healthcare as first choice. Opportunities that if harnessed may alter the unfavorable landscape are: implementation of the 2007 WHO Regional Consultation recommendations for establishment of national legal framework and self-sufficient organ donation/transplantation in each country and adoption of their 2020 proposed actions for organ/transplantation for member states, national registries with sharing of data with GODT, prevention of transplant commercialization and tourism. Additionally, adapting some aspects of proven successful models in LRCs will improve transplantation programmes in SSA.

Oxidative Medicine and Cellular Longevity

“…Due to the unhealthy lifestyles, drug abuse, birth defects, infections, and other phenomena in modern people, the incidence of kidney disease is also increasing globally, which has caused widespread concern in the society. Various nephropathies, such as glomerulonephritis, renal tubular injury, and renal vascular disease, as well as some common complications, such as hypertension and diabetes, are common clinical kidney system diseases [1]. Its disability rate, death rate, and growth rate remain the top of all the chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Chinese Traditional Medicine Huaiqihuang (HQH) on the Protection of Nephropathy

Zhang

Cheng

Zhou

et al. 2020

Kidney disease is one of the common diseases with high morbidity and high mortality, which brings a huge burden to the society and the patient’s family. The pathogenesis, treatment, and prognosis of kidney diseases are related to oxidative stress, inflammation, mitochondrial damage, and immune dysfunction. However, existing treatments always cause some damage to the kidneys. Kidney disease and immunosuppressant used together often lead to drug toxicity, patients with weakened immunity, organic rupture of the normal structure of the kidney, damage to the physiological function of the kidney, etc. Huaiqihuang is a kind of traditional Chinese medicine with a history of more than one thousand years. According to research, Robinia pseudoacacia can regulate the immune function by regulating oxidative stress, calcium inflow, and mitochondrial ATP. At the same time, it is also involved in regulating the ways of cell death, such as apoptosis, autophagy, ferroptosis, pyroptosis, and clockophagy, to reduce kidney damage, which has important clinical value. This article reviews the exact mechanism and clinical application of Huaiqihuang in different types of nephropathy. The aim is to provide new ideas for the treatment of clinical nephropathy.