Halle Marie Patrice, Ashuntantang Gloria, Kaze Francois Folefack, Takongue Christian, Kengne Andre-Pascal
Department of clinical sciences, Faculty of medicine and pharmaceutical science, University of Douala, Douala, Cameroon.
Department of internal medicine, Douala General Hospital, Douala, Cameroon.
BMC Nephrol. 2016 Nov 3;17(1):165. doi: 10.1186/s12882-016-0377-5.
End-Stage Renal disease (ESRD) is associated with increased morbidity and mortality. We assessed the occurrence, time-trend and determinants of fatal outcomes of haemodialysis-treated ESRD patients over a 10-year period in a major referral hospital in Cameroon.
Medical records of ESRD patients who started chronic haemodialysis at the Douala General Hospital between 2002 and 2012 were reviewed. Baseline characteristics and fatal outcomes on dialysis were recorded. Accelerated-failure time and logistic regression models were used to investigate the determinants of death.
A total of 661 patients with 436 (66 %) being men were included in the study. Mean age at dialysis initiation was 46.3 ± 14.7 years. The median [25-75 percentiles] duration on dialysis was 187 [34-754] days. A total of 297 (44.9 %) deaths were recorded during follow-up with statistical difference over the years (p < 0.0001 for year by year variation) but not in a linear fashion (p = 0.508 for linear trend), similarly in men and women (p = 0.212 for gender*year interaction). The death rate at 12 months of follow-up was 26.8 % (n = 177), with again similar variations across years (p < 0.0001). In all, 34 % of deaths occurred within the first 120 days. Year of study and background nephropathies were the main determinants of mortality, with the combination of diabetes and hypertension conveying a 127 % (95 % CI: 40-267 %) higher risk of mortality, relative to hypertension alone.
Mortality in dialysis is excessively high in this setting. Because most of these premature deaths are potentially preventable, additional efforts are needed to offset the risk and maximise the benefits from the ongoing investments of the government to defray the cost of haemodialysis. Potential actions include sensitisation of the population and healthcare practitioners, early detection and referral of individuals with CKD; and additional subsidies to support the cost of managing co-morbidities in patients with CKD in general.
终末期肾病（ESRD）与发病率和死亡率的增加相关。我们评估了喀麦隆一家主要转诊医院中接受血液透析治疗的ESRD患者在10年期间死亡结局的发生率、时间趋势及决定因素。
回顾了2002年至2012年期间在杜阿拉总医院开始慢性血液透析的ESRD患者的病历。记录了基线特征及透析时的死亡结局。采用加速失效时间模型和逻辑回归模型来研究死亡的决定因素。
共有661例患者纳入研究，其中436例（66%）为男性。开始透析时的平均年龄为46.3±14.7岁。透析持续时间的中位数[25 - 75百分位数]为187[34 - 754]天。随访期间共记录到297例（44.9%）死亡，多年间存在统计学差异（逐年变化p < 0.0001），但并非呈线性趋势（线性趋势p = 0.508），男性和女性情况类似（性别*年份交互作用p = 0.212）。随访12个月时的死亡率为26.8%（n = 177），多年间同样存在类似变化（p < 0.0001）。总体而言，34%的死亡发生在最初120天内。研究年份和基础肾病是死亡率的主要决定因素，糖尿病和高血压并存相对于单纯高血压而言，死亡风险高出127%（95%置信区间：40 - 267%）。
在这种情况下，透析患者的死亡率过高。由于这些过早死亡大多是可预防的，需要做出更多努力来降低风险，并使政府为支付血液透析费用所进行的持续投入效益最大化。可能的行动包括提高公众和医护人员的认识、早期发现和转诊慢性肾脏病患者；以及提供额外补贴以支持一般慢性肾脏病患者合并症的管理费用。
