Outcomes of Hemodialysis Patients in Public Centres in Abidjan from September 2018 to October 2021: Data from the Renal Registry of Cote D'ivoire

Abstract

Background : Hemodialysis is the most widely used of renal replacement therapy in developing countries such as Cote d'Ivoire. Objective : To study the outcome of chronic hemodialysis patients in public centres in Abidjan using data from the Renal Registry of Cote d'Ivoire (2RCI). Method : This was a prospective analytical cohort study of End Stage Kidney Disease (ESKD) patients undergoing iterative hemodialysis in the network of public hemodialysis centres in Abidjan and who had been registered in the 2RCI register by September 2018. Results : Our study involved 363 cases out of 379 patients registered in the 2RCI registry database in 2018. The mean age of the patients was 47.3±12.1 years, with a male predominance (sex ratio 1.97). In 70.24% of cases, they had no health insurance. The average duration of dialysis for our patients was 6.94 ± 4.1 years, with extremes of 2 and 28 years. This duration was less than 5 years in 44.3% of cases, between 6 and 10 years in 42.9% and more than 10 years in 12.6% of cases. The comorbidities found were hypertension in 95.6% of cases, diabetes in 7.8% and HIV in 4.6%. Anaemia was found in 68% of cases and stroke in 8.6%. During the study period, 161 deaths were observed, representing a mortality rate of 44.35%. Acute lung oedema (29.8%), stroke (6.8%) and other cardiovascular diseases (19.3%) were the main causes of death. In multivariate analysis, factors such as age ≥ 65 years (HR = 3.66; CI 95% =1.55-8.67; p=0.003), "married/coupled" status (HR = 2.02; CI 95% =1.24-3.31; p=0.005) and normal weight at the start of dialysis (OR = 9.59, CI95% = 4.19-21.95; p=0.001) were associated with the risk of death. Conclusion : Hemodialysis is performed in Abidjan on young patients. The mortality rate after three years of dialysis is very high. Hence the need to pursue the policy of decentralising public centres and optimising access to dialysis in terms of quality and quantity in order to improve patient survival.