clove and Kidney-Failure--Chronic

Initiation of emergency dialysis is a critical situation responsible for high morbidity and mortality. This study describes the characteristics of emergency hemodialysis patients in a hospital in Madagascar.. It is a descriptive study over a period of 7 months, from September 1, 2018 to March 31, 2019, on emergency hemodialysis patients in the hemodialysis department of the University Hospital of Joseph Raseta Befelatanana, Antananarivo. Emergency hemodialysis was defined as dialysis performed immediately or within the first 48 hours of hospitalisation in a life-threatening situation.. Among 124 haemodialysis patients, 52 patients (41.93%) had started dialysis as an emergency. The mean age of patients was 50.5 years and the sex ratio (male/female) was 1.08. Hypertension (51.92%) and diabetes (34.61%) were the main comorbidities. Chronic kidney disease was found in 82.7%. The majority of patients were unprepared and had initiated dialysis with a central venous catheter. The most frequent indication was Kussmaul's breathing (32.6%) followed by anuria (28.84%). The mortality rate was 23.08% and the prognosis was influenced by their condition on arrival.. The predominance of chronic kidney disease and the absence of a permanent vascular approach can be explained by the late referral to nephrologists of patients with chronic kidney disease. Efforts need to be made to increase the proportion of scheduled dialysis patients with a permanent approach.. L’initiation de la dialyse en urgence est une situation critique responsable d’une morbi-mortalité élevée. Cette étude décrit les caractéristiques des patients hémodialysés en urgence dans un centre hospitalier de Madagascar.. Il s’agit d’une étude descriptive sur une période de sept mois, du 1er septembre 2018 au 31 mars 2019, portant sur les patients hémodialysés en urgence dans le service d’hémodialyse du centre hospitalier Joseph Raseta Befelatanana, Antananarivo. L’hémodialyse en urgence était définie par une dialyse réalisée dans l’immédiat ou dans les 48 premières heures d’hospitalisation devant une situation mettant en jeu le pronostic vital.. Parmi les 124 patients hémodialysés, 52 patients (41,93 %) avaient démarré la dialyse en urgence. L’âge moyen des patients était de 50,5 ans et le sex-ratio (hommes/femmes) était de 1,08. L’hypertension artérielle (51,92 %) et le diabète (34,61 %) étaient les principales comorbidités. L’insuffisance rénale chronique a été trouvée dans 82,7 %. La majorité des patients n’étaient pas préparés et avaient initié la dialyse avec un cathéter veineux central. L’indication la plus fréquente était la dyspnée de Kussmaul (32,6 %) suivie de l’anurie (28,84 %). Le taux de mortalité était de 23,08 % et le pronostic était influencé par l’état à l’arrivée.. La prédominance de l’insuffisance rénale chronique et l’absence d’abord vasculaire permanent peuvent s’expliquer par la référence tardive aux néphrologues des patients ayant une insuffisance rénale chronique. Des efforts doivent être faits pour augmenter la proportion de patients dialysés programmés avec une approche permanente.

Topics: Female; Hospitalization; Hospitals, University; Humans; Kidney Failure, Chronic; Madagascar; Male; Middle Aged; Renal Dialysis; Renal Insufficiency, Chronic

Chronic renal failure is a global public health problem. In developed countries, this disease occurs mainly in the elderly, but in Africa it rather affects active young subjects. This disease need for expensive treatments in a low income country, because of its costs. Our aim is to describe the epidemiology of new cases of chronic renal failure in Madagascar. This is a retrospective, descriptive study of 239 patients with chronic renal failure over a 3 year period, starting from 1 January 2007 to 31 December 2009, in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo. The incidence was 8.51% among patients hospitalized in the Department. The average age of patients was 45.4 years with extremes of 16 and 82 years and a sex ratio 1,46. The main antecedent was arterial hypertension (59.8%). Chronic renal failure was terminal in 75.31% of the cases (n=180). The causes of chronic renal failure were dominated by chronic glomerulonephritis (40.1%), nephroangiosclerosis (35.5%). Hemodialysis was performed in 3 patients (1.26%), no patient was scheduled for a renal transplantation. Mortality rate in the Department was 28.87%. Chronic renal failure is a debilitating disease with a dreadful prognosis which affects young patients in Madagascar. Its treatment remains inaccessible to the majority of patients. The focus must be mainly on prevention, especially on early effective management of infections, arterial hypertension and diabetes to reduce its negative impacts on the community and public health. The project on renal transplantation: living donor, effective and less expensive treatment compared to hemodialysis could also be a good solution for these Malagasy young subjects.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Hospitals, University; Humans; Hypertension; Incidence; Kidney Failure, Chronic; Kidney Transplantation; Madagascar; Male; Middle Aged; Prognosis; Renal Dialysis; Retrospective Studies; Young Adult

Topics: Adult; Female; Humans; Infant, Newborn; Kidney Failure, Chronic; Madagascar; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Renal Dialysis

Pregnancy brought to term is rare in patients undergoing haemodialysis. Both mother and foetus are exposed to lethal from complications frequently caused by hypertension and anaemia. We are reporting the first case of pregnancy observed in an haemodialysis centre in Antananarivo, Madagascar. In spite of the modest means of the centre (use of acetate, lack of recombinant erythropoietin, limited biological controls) the foetus could be kept by intensification of the dialysis. No complication occurred to the mother when in the literature its frequency is 16%. The baby was premature and low weighted. His mental and physical development was normal. This success is the consequence of heavy management especially for the patient.

Topics: Adult; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Kidney Failure, Chronic; Madagascar; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Renal Dialysis