A Single-Center 7-Year Experience with End-Stage Renal Disease Care in Nigeria—A Surrogate for the Poor State of ESRD Care in Nigeria and Other Sub-Saharan African Countries: Advocacy for a Global Fund for ESRD Care Program in Sub-Saharan African Countries
Identifieur interne : 001843 ( Ncbi/Merge ); précédent : 001842; suivant : 001844A Single-Center 7-Year Experience with End-Stage Renal Disease Care in Nigeria—A Surrogate for the Poor State of ESRD Care in Nigeria and Other Sub-Saharan African Countries: Advocacy for a Global Fund for ESRD Care Program in Sub-Saharan African Countries
Auteurs : Datonye Dennis Alasia [Nigeria] ; Pedro Emem-Chioma [Nigeria] ; Friday Samuel Wokoma [Nigeria]Source :
- International Journal of Nephrology [ 2090-214X ] ; 2012.
Abstract
Url:
DOI: 10.1155/2012/639653
PubMed: 22811906
PubMed Central: 3395225
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A Single-Center 7-Year Experience with End-Stage Renal Disease Care in Nigeria—A Surrogate for the Poor State of ESRD Care in Nigeria and Other Sub-Saharan African Countries: Advocacy for a Global Fund for ESRD Care Program in Sub-Saharan African Countries</title><author><name sortKey="Alasia, Datonye Dennis" sort="Alasia, Datonye Dennis" uniqKey="Alasia D" first="Datonye Dennis" last="Alasia">Datonye Dennis Alasia</name><affiliation wicri:level="1"><nlm:aff id="I1">Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001, Nigeria</nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001</wicri:regionArea><wicri:noRegion>Port Harcourt 50001</wicri:noRegion></affiliation></author><author><name sortKey="Emem Chioma, Pedro" sort="Emem Chioma, Pedro" uniqKey="Emem Chioma P" first="Pedro" last="Emem-Chioma">Pedro Emem-Chioma</name><affiliation wicri:level="1"><nlm:aff id="I1">Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001, Nigeria</nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001</wicri:regionArea><wicri:noRegion>Port Harcourt 50001</wicri:noRegion></affiliation></author><author><name sortKey="Wokoma, Friday Samuel" sort="Wokoma, Friday Samuel" uniqKey="Wokoma F" first="Friday Samuel" last="Wokoma">Friday Samuel Wokoma</name><affiliation wicri:level="1"><nlm:aff id="I1">Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001, Nigeria</nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001</wicri:regionArea><wicri:noRegion>Port Harcourt 50001</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22811906</idno><idno type="pmc">3395225</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395225</idno><idno type="RBID">PMC:3395225</idno><idno type="doi">10.1155/2012/639653</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">000F07</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F07</idno><idno type="wicri:Area/Pmc/Curation">000F06</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000F06</idno><idno type="wicri:Area/Pmc/Checkpoint">001F87</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001F87</idno><idno type="wicri:Area/Ncbi/Merge">001843</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A Single-Center 7-Year Experience with End-Stage Renal Disease Care in Nigeria—A Surrogate for the Poor State of ESRD Care in Nigeria and Other Sub-Saharan African Countries: Advocacy for a Global Fund for ESRD Care Program in Sub-Saharan African Countries</title><author><name sortKey="Alasia, Datonye Dennis" sort="Alasia, Datonye Dennis" uniqKey="Alasia D" first="Datonye Dennis" last="Alasia">Datonye Dennis Alasia</name><affiliation wicri:level="1"><nlm:aff id="I1">Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001, Nigeria</nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001</wicri:regionArea><wicri:noRegion>Port Harcourt 50001</wicri:noRegion></affiliation></author><author><name sortKey="Emem Chioma, Pedro" sort="Emem Chioma, Pedro" uniqKey="Emem Chioma P" first="Pedro" last="Emem-Chioma">Pedro Emem-Chioma</name><affiliation wicri:level="1"><nlm:aff id="I1">Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001, Nigeria</nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001</wicri:regionArea><wicri:noRegion>Port Harcourt 50001</wicri:noRegion></affiliation></author><author><name sortKey="Wokoma, Friday Samuel" sort="Wokoma, Friday Samuel" uniqKey="Wokoma F" first="Friday Samuel" last="Wokoma">Friday Samuel Wokoma</name><affiliation wicri:level="1"><nlm:aff id="I1">Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001, Nigeria</nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001</wicri:regionArea><wicri:noRegion>Port Harcourt 50001</wicri:noRegion></affiliation></author></analytic><series><title level="j">International Journal of Nephrology</title><idno type="ISSN">2090-214X</idno><idno type="eISSN">2090-2158</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic>Background</italic>. A single-center ESRD care experience in a Nigerian teaching hospital is presented as a surrogate case to demonstrate the prevailing ESRD care situation in Nigeria and most SSA countries. <italic>Methods</italic>. The data of 320 consecutive ESRD patients undergoing maintenance haemodialysis treatment during a seven-year period were retrospectively analyzed. <italic>Results</italic>. Over 80% of the subjects funded dialysis treatments from direct out of pocket payment. The mean duration on dialysis before dropout was 5.2 ± 7.6 weeks, with majority 314 (98.1%) of the patients unable to sustain dialysis above 12 weeks. Total dialysis sessions during the 7-year period was 1476 giving an average weekly dialysis session of 0.013 (0.05 hour/week) per patient per week. One hundred and twenty-eight (40%) patients died within 90 days of entry into dialysis care. <italic>Conclusions</italic>. ESRD care in this single centre was characterized by gross dialysis inadequacy and case fatality due to the inability to access and afford care. The opportunities for kidney transplantation are also very low. Poverty and the absence of government support for ESRD care are responsible for the poor outcomes. A global focus on ESRD care in SSA countries has thus become imperative.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Barsoum, Rs" uniqKey="Barsoum R">RS Barsoum</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sumaili, Ek" uniqKey="Sumaili E">EK Sumaili</name></author><author><name sortKey="Cohen, Ep" uniqKey="Cohen E">EP Cohen</name></author><author><name sortKey="Zinga, Cv" uniqKey="Zinga C">CV Zinga</name></author><author><name sortKey="Krzesinski, Jm" uniqKey="Krzesinski J">JM Krzesinski</name></author><author><name sortKey="Pakasa, Nm" uniqKey="Pakasa N">NM Pakasa</name></author><author><name sortKey="Nseka, Nm" uniqKey="Nseka N">NM Nseka</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Akinsola, W" uniqKey="Akinsola W">W Akinsola</name></author><author><name sortKey="Odesanmi, Wo" uniqKey="Odesanmi W">WO 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Nephrol</journal-id><journal-id journal-id-type="iso-abbrev">Int J Nephrol</journal-id><journal-id journal-id-type="publisher-id">IJN</journal-id><journal-title-group><journal-title>International Journal of Nephrology</journal-title></journal-title-group><issn pub-type="ppub">2090-214X</issn><issn pub-type="epub">2090-2158</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22811906</article-id><article-id pub-id-type="pmc">3395225</article-id><article-id pub-id-type="doi">10.1155/2012/639653</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical Study</subject></subj-group></article-categories><title-group><article-title>A Single-Center 7-Year Experience with End-Stage Renal Disease Care in Nigeria—A Surrogate for the Poor State of ESRD Care in Nigeria and Other Sub-Saharan African Countries: Advocacy for a Global Fund for ESRD Care Program in Sub-Saharan African Countries</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Alasia</surname><given-names>Datonye Dennis</given-names></name><xref ref-type="aff" rid="I1"></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Emem-Chioma</surname><given-names>Pedro</given-names></name><xref ref-type="aff" rid="I1"></xref></contrib><contrib contrib-type="author"><name><surname>Wokoma</surname><given-names>Friday Samuel</given-names></name><xref ref-type="aff" rid="I1"></xref></contrib></contrib-group><aff id="I1">Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt 50001, Nigeria</aff><author-notes><corresp id="cor1">*Datonye Dennis Alasia: <email>datonye.alasia@uniport.edu.ng</email></corresp><fn fn-type="other"><p>Academic Editor: J. Kevin Tucker</p></fn></author-notes><pub-date pub-type="ppub"><year>2012</year></pub-date><pub-date pub-type="epub"><day>28</day><month>6</month><year>2012</year></pub-date><volume>2012</volume><elocation-id>639653</elocation-id><history><date date-type="received"><day>2</day><month>3</month><year>2012</year></date><date date-type="accepted"><day>10</day><month>5</month><year>2012</year></date></history><permissions><copyright-statement>Copyright © 2012 Datonye Dennis Alasia et al.</copyright-statement><copyright-year>2012</copyright-year><license license-type="open-access"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p><italic>Background</italic>. A single-center ESRD care experience in a Nigerian teaching hospital is presented as a surrogate case to demonstrate the prevailing ESRD care situation in Nigeria and most SSA countries. <italic>Methods</italic>. The data of 320 consecutive ESRD patients undergoing maintenance haemodialysis treatment during a seven-year period were retrospectively analyzed. <italic>Results</italic>. Over 80% of the subjects funded dialysis treatments from direct out of pocket payment. The mean duration on dialysis before dropout was 5.2 ± 7.6 weeks, with majority 314 (98.1%) of the patients unable to sustain dialysis above 12 weeks. Total dialysis sessions during the 7-year period was 1476 giving an average weekly dialysis session of 0.013 (0.05 hour/week) per patient per week. One hundred and twenty-eight (40%) patients died within 90 days of entry into dialysis care. <italic>Conclusions</italic>. ESRD care in this single centre was characterized by gross dialysis inadequacy and case fatality due to the inability to access and afford care. The opportunities for kidney transplantation are also very low. Poverty and the absence of government support for ESRD care are responsible for the poor outcomes. A global focus on ESRD care in SSA countries has thus become imperative.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Chart showing causes of CKD in study subjects. *Miscellaneous disorders: Analgesic nephropathy(1), Multiple myeloma(1), chronic pyelonephritis(1), inadvertent nephrectomy(1), sickle nephropathy(1), and indeterminate(1).</p></caption><graphic xlink:href="IJN2012-639653.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Chart showing sources of funding for ESRD care.</p></caption><graphic xlink:href="IJN2012-639653.002"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Showing the age distribution of subjects.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Age group (years)</th><th align="center" rowspan="1" colspan="1">Number of subjects</th><th align="center" rowspan="1" colspan="1">Percentages</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">10–19</td><td align="center" rowspan="1" colspan="1">40</td><td align="center" rowspan="1" colspan="1">12.6</td></tr><tr><td align="left" rowspan="1" colspan="1">20–29</td><td align="center" rowspan="1" colspan="1">55</td><td align="center" rowspan="1" colspan="1">17.2</td></tr><tr><td align="left" rowspan="1" colspan="1">30–39</td><td align="center" rowspan="1" colspan="1">44</td><td align="center" rowspan="1" colspan="1">13.8</td></tr><tr><td align="left" rowspan="1" colspan="1">40–49</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">14.9</td></tr><tr><td align="left" rowspan="1" colspan="1">50–59</td><td align="center" rowspan="1" colspan="1">60</td><td align="center" rowspan="1" colspan="1">18.9</td></tr><tr><td align="left" rowspan="1" colspan="1">60–69</td><td align="center" rowspan="1" colspan="1">59</td><td align="center" rowspan="1" colspan="1">18.4</td></tr><tr><td align="left" rowspan="1" colspan="1">70–79</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">2.3</td></tr><tr><td align="left" rowspan="1" colspan="1">>80</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">2.3</td></tr><tr><td align="left" colspan="3" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Total</td><td align="center" rowspan="1" colspan="1">320</td><td align="center" rowspan="1" colspan="1">100</td></tr></tbody></table></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Annual income data for a cohort of 40 subjects.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Income group</th><th align="center" rowspan="1" colspan="1">Social class</th><th align="center" rowspan="1" colspan="1">Number</th><th align="center" rowspan="1" colspan="1">Percentage</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">I-II (14000–26667 USD per annum)</td><td align="center" rowspan="1" colspan="1">Upper</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">15</td></tr><tr><td align="left" rowspan="1" colspan="1">III-IV (4677–7337 USD per annum)</td><td align="center" rowspan="1" colspan="1">Middle</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">40</td></tr><tr><td align="left" rowspan="1" colspan="1">V-VI (800–2460 USD per annum)</td><td align="center" rowspan="1" colspan="1">Lower</td><td align="center" rowspan="1" colspan="1">18</td><td align="center" rowspan="1" colspan="1">45</td></tr><tr><td align="left" colspan="4" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">40</td><td align="center" rowspan="1" colspan="1">100</td></tr></tbody></table></table-wrap><table-wrap id="tab3" orientation="portrait" position="float"><label>Table 3</label><caption><p>Baseline characteristics of study subjects at first presentation.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Baseline variable</th><th align="center" rowspan="1" colspan="1">Mean<break></break>(Standard deviation)</th><th align="center" rowspan="1" colspan="1">Range</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">e-GFR (mL/min/1.73 m<sup>2</sup>)</td><td align="center" rowspan="1" colspan="1">8.2 (5.8)</td><td align="center" rowspan="1" colspan="1">2.7–12.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Haematocrit (%)</td><td align="center" rowspan="1" colspan="1">20.8 (6.8)</td><td align="center" rowspan="1" colspan="1">10–35</td></tr><tr><td align="left" rowspan="1" colspan="1">Sodium (mmol/L)</td><td align="center" rowspan="1" colspan="1">134.8 (6.0)</td><td align="center" rowspan="1" colspan="1">122–149</td></tr><tr><td align="left" rowspan="1" colspan="1">Potassium (mmol/L)</td><td align="center" rowspan="1" colspan="1">4.7 (1.0)</td><td align="center" rowspan="1" colspan="1">3–7</td></tr><tr><td align="left" rowspan="1" colspan="1">Bicarbonate (mmol/L)</td><td align="center" rowspan="1" colspan="1">19.4 (7.8)</td><td align="center" rowspan="1" colspan="1">8–27</td></tr><tr><td align="left" rowspan="1" colspan="1">Urea (mmol/L)</td><td align="center" rowspan="1" colspan="1">32.9 (36.2)</td><td align="center" rowspan="1" colspan="1">14–56.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Creatinine (<italic>μ</italic>mol/L)</td><td align="center" rowspan="1" colspan="1">1224.9 (557.4)</td><td align="center" rowspan="1" colspan="1">245–2505</td></tr><tr><td align="left" rowspan="1" colspan="1">Total protein (g/dL)</td><td align="center" rowspan="1" colspan="1">60.7 (4.0)</td><td align="center" rowspan="1" colspan="1">57–65</td></tr><tr><td align="left" rowspan="1" colspan="1">Albumin (g/dL)</td><td align="center" rowspan="1" colspan="1">32.0 (9.8)</td><td align="center" rowspan="1" colspan="1">25–39</td></tr><tr><td align="left" rowspan="1" colspan="1">Systolic blood pressure (mmHg)</td><td align="center" rowspan="1" colspan="1">171.2 (31.9)</td><td align="center" rowspan="1" colspan="1">107–240</td></tr><tr><td align="left" rowspan="1" colspan="1">Diastolic blood pressure (mmHg)</td><td align="center" rowspan="1" colspan="1">102.5 (27.4)</td><td align="center" rowspan="1" colspan="1">70–140</td></tr></tbody></table></table-wrap><table-wrap id="tab4" orientation="portrait" position="float"><label>Table 4</label><caption><p>Haemodialysis exposure status of subjects.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Duration of haemodialysis exposure (weeks)</th><th align="center" rowspan="1" colspan="1">Number of subjects</th><th align="center" rowspan="1" colspan="1">Percentage</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">1–12</td><td align="center" rowspan="1" colspan="1">314</td><td align="center" rowspan="1" colspan="1">98.1</td></tr><tr><td align="left" rowspan="1" colspan="1">13–24</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">0.9</td></tr><tr><td align="left" rowspan="1" colspan="1">25–36</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">0.6</td></tr><tr><td align="left" rowspan="1" colspan="1">37–52</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">0.3</td></tr><tr><td align="left" rowspan="1" colspan="1">>52</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>Nigeria</li></country></list><tree><country name="Nigeria"><noRegion><name sortKey="Alasia, Datonye Dennis" sort="Alasia, Datonye Dennis" uniqKey="Alasia D" first="Datonye Dennis" last="Alasia">Datonye Dennis Alasia</name></noRegion><name sortKey="Emem Chioma, Pedro" sort="Emem Chioma, Pedro" uniqKey="Emem Chioma P" first="Pedro" last="Emem-Chioma">Pedro Emem-Chioma</name><name sortKey="Wokoma, Friday Samuel" sort="Wokoma, Friday Samuel" uniqKey="Wokoma F" first="Friday Samuel" last="Wokoma">Friday Samuel Wokoma</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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