Meremo Alfred J, Ngilangwa David P, Mwashambwa Masumbuko Y, Masalu Matobogolo B, Kapinga Janet, Tagalile Rehema, Sabi Issa
School of Medicine & Dentistry, College of Health Sciences, The University of Dodoma, P.O Box 395, Dodoma, Tanzania.
Haemodialysis Unit, The University of Dodoma, P.O Box 259, Dodoma, Tanzania.
BMC Nephrol. 2017 Jul 4;18(1):212. doi: 10.1186/s12882-017-0634-2.
Kidney Diseases contribute a significant proportion to the global burden of non-communicable diseases. Haemodialysis services as the main modality of renal replacement therapy in most resource limited countries is only available in few cities and at higher costs. The aim of this study was to determine the challenges and outcomes of patients who were on haemodialysis at the University of Dodoma (UDOM) haemodialysis unit in Tanzania.
In this retrospective study; we reviewed haemodialysis registers and charts of 116 patients dialyzed from January 2013 to June 2015 at The UDOM haemodialysis unit. Data were descriptively and inferentially analysed using Stata version 11 software.
Of the 116 patients, 52 (44.9%) were male, and 38(32.8%) were married. Their median age was 45 years. Thirty-two (27.6%) had acute kidney injury, of them 26 (81.3%) patients had recovery of renal function after haemodialysis. Indications for hemodialysis were anuria (18), intoxications (14), electrolyte imbalance (9), uraemia (7) infections (6) and fluid overload (4). Eighty-four (72.4%) patients had End Stage Renal Diseases (ESRD), of which 37 (44.1%) absconded/lost to follow up, 15 (17.9%) died, 22 (26.2%) were referred to Muhimbili National Hospital (MNH), 12 for possible kidney transplant abroad after haemodialysis, and 10 (11.9%) were still attending our unit for haemodialysis. Residing outside Dodoma was predictive for poor outcomes while on haemodialysis (OR 5.2, 95% CI 3.2-8.6, p < 0.001). In addition the odds ratio for poor outcomes was 7.3 times for a patient ESRD (OR7.34, 95% CI 3.26-18.17, p < 0.001). Patients who had no National Health Insurance Fund (NHIF) coverage (OR 6.6, 95% CI 5.4-12.7, p < 0.001) also had higher odds of poor outcomes after starting haemodialysis.
Unavailability and high costs related to utilization of haemodialysis services among patients needing dialysis are the challenges for better outcomes. Therefore, haemodialysis and renal transplants services should be made easily available in regional referral hospitals at reasonable costs. In addition, members of the public should be educated on joining health insurance schemes and on making healthy life style choices for preventing chronic kidney disease and its progression.
肾脏疾病在全球非传染性疾病负担中占很大比例。在大多数资源有限的国家，血液透析服务作为肾脏替代治疗的主要方式，仅在少数城市提供，且成本较高。本研究的目的是确定在坦桑尼亚多多马大学（UDOM）血液透析单元接受血液透析的患者所面临的挑战和治疗结果。
在这项回顾性研究中，我们查阅了2013年1月至2015年6月在UDOM血液透析单元接受透析的116例患者的血液透析登记册和病历。使用Stata 11版软件对数据进行描述性和推断性分析。
116例患者中，52例（44.9%）为男性，38例（32.8%）已婚。他们的中位年龄为45岁。32例（27.6%）患有急性肾损伤，其中26例（81.3%）患者在血液透析后肾功能恢复。血液透析的指征为无尿（18例）、中毒（14例）、电解质失衡（9例）、尿毒症（7例）、感染（6例）和液体过载（4例）。84例（72.4%）患者患有终末期肾病（ESRD），其中37例（44.1%）失访/随访丢失，15例（17.9%）死亡，22例（26.2%）被转诊至穆希姆比利国家医院（MNH），12例在血液透析后可能到国外进行肾脏移植，10例（11.9%）仍在我们单位接受血液透析。居住在多多马以外地区是血液透析治疗效果不佳的预测因素（比值比5.2，95%可信区间3.2 - 8.6，p < 0.001）。此外，ESRD患者治疗效果不佳的比值比为7.3倍（比值比7.34，95%可信区间3.26 - 18.17，p < 0.001）。没有国家健康保险基金（NHIF）覆盖的患者（比值比6.6，95%可信区间5.4 - 12.7，p < 0.001）在开始血液透析后治疗效果不佳的几率也更高。
需要透析的患者难以获得血液透析服务以及与使用该服务相关的高成本是实现更好治疗效果的挑战。因此，应在地区转诊医院以合理成本轻松提供血液透析和肾脏移植服务。此外，应教育公众加入健康保险计划，并做出健康的生活方式选择以预防慢性肾病及其进展。
