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African Journal of Nephrology
Number of Followers: 2

This is an Open Access Journal

Open Access journal
ISSN (Print) 2306-8205 - ISSN (Online) 2518-4601
Published by Stellenbosch University

[12 journals]

Editorial note: Welcome to the year 2023 and Volume 26 - Are we ready for
the next disaster'
- Authors: Alain G Assounga
  Pages: 1 - 1
  Abstract: On behalf of the Editors and the Editorial Board of the African Journal of Nephrology (AJN), I wish all authors, reviewers and readers a blessed and prosperous New Year! I wish to express my sincere gratitude to Prof Fergus Caskey, for his great contribution to AJN as Associate Editor. He left the Journal last year. We wish him great success in his new and future endeavours. I am proud of the AJN publications for Volume 25, published last year. Indeed, AJN is progressing very well to establish itself as the journal of choice for publishing African nephrology research. In 2022, we published three excellent reviews covering hyperuricaemia in chronic kidney disease, the measurement of GFR in Africa and a road map for kidney care in Africa. Eighteen original articles from diverse African countries were also published last year. We were pleased to publish the 2020 annual report for the South African Renal Registry, and we call on other African countries to submit their registry reports for publication. The international community has decreed that this year’s World Kidney Day theme is: “Kidney health for all, preparing for the unexpected, supporting the vulnerable.” This theme is pertinent and should assist with the progress toward the “Health for all” goal. In nephrology, the unexpected can be very expensive. From the management of hypovolaemia to dialysis in acute kidney injury, how ready are we' At an individual level, a family level, societal level, regional level, country and continental level and finally, at a global level, we need to prepare to deal with disasters. Countries often rely on NGOs such as Médecins Sans Frontières, Gift of the Givers and others to do the work. We should commend these NGOs for their assistance. In Africa, government institutions need to improve their capacity for disaster management. The nephrology community in Africa, through AFRAN, could play a significant role together with other regional organisations. This role will require a commitment like the one we proposed in a book we published ten years ago, “Kidney disease in an African setting” [1]. The closest community to the disease must take the lead, as time is of the essence. I am encouraged by the level of cooperation in AFRAN during the COVID-19 pandemic, which produced guidelines for managing COVID-19 in Africa [2]. We should emulate that effort as a legacy of the COVID-19 experience and use the AFRAN committee structures to put together projects that bring positive progress to kidney care in Africa. I propose that this initiative be named the Antony Were COVID Legacy initiative, inspired by and in honour of our AFRAN President, who started the revival of AFRAN during the COVID-19 pandemic but could not live to witness the end of it. On a lighter note, we all remember our collective dedication during the long Sunday evening AFRAN meetings chaired by Dr Were. Let us commit ourselves to his memory and in memory of all our colleagues who lost their lives to COVID-19. Alain G Assounga
  Editor-in-Chief
  PubDate: 2023-01-24
  Issue No: Vol. 26, No. 1 (2023)
Acknowledgement to reviewers 2022
- Authors: M Razeen Davids
  Pages: 2 - 2
  Abstract: The editors of AJN wish to thank the colleagues who generously gave of their time and expertise to review manuscripts for us during 2022. We greatly appreciate their contribution to the quality of the work that we publish.
  PubDate: 2023-01-24
  Issue No: Vol. 26, No. 1 (2023)
Vascular access in Senegalese patients starting chronic haemodialysis
- Authors: Moustapha Faye, Ismail Raqui, Maria Faye, Bacary Ba, Ahmed Tall Lemrabott, Sidy Mohamed Seck, Abdou Niang, Elhadji Fary Ka
  Pages: 3 - 8
  Abstract: Introduction: It is recommended that patients should start chronic haemodialysis using an arteriovenous fistula (AVF). We aimed to determine the proportion of Senegalese patients who used an AVF at the start of haemodialysis and examined the factors associated with its use. Methods: We conducted a cross-sectional study from 1 June 2021 to 2 October 2021 among patients on chronic haemodialysis in 10 centres in the Dakar and Thiès regions. Clinical and laboratory data were collected from medical records and also via patient interviews. Results: The patients (n = 543) had a median age of 50 years [interquartile range (IQR) 40–62 years] and 50.6% were male. The socio-economic level was low in two-thirds of cases. The median duration of haemodialysis was 40 (IQR 17–76) months. Hypertension was noted in 92% and diabetes in 13%. Hypertensive kidney disease was the cause of kidney failure in 33%. Only 47 patients (9%) had started dialysis using an arteriovenous fistula. Factors associated with its use at haemodialysis initiation were socio-economic level (OR 0.48; 95% confidence interval (CI) 0.25–0.94 for low socio-economic level) and duration of pre-dialysis follow-up by a nephrologist for >4 months (OR 7.82; 95% CI 3.05–26.50). In 65% of prevalent patients, the vascular access used was an AVF, a tunnelled central venous catheter in 28%, an arteriovenous graft in 2% and a temporary central venous catheter in 4.4%. Conclusions: The proportion of Senegalese patients with an AVF at the start of haemodialysis was low. AVF use was associated with socio-economic level and pre-dialysis follow-up by a nephrologist for >4 months.
  PubDate: 2023-01-24
  DOI: 10.21804/26-1-5381
  Issue No: Vol. 26, No. 1 (2023)
Patterns of biopsy-proven kidney disease amongst South African adults from
1995 to 2017
- Authors: Ahmed Mushtak Esmail, William D Bates, Mazhar Hussein Amirali, Thabiet Jardine, Mogamat Razeen Davids
  Pages: 9 - 16
  Abstract: Introduction: Little data is available on biopsy-proven kidney disease in African countries. In this study, we have described the patterns of biopsy-proven kidney disease amongst South African adults encountered over a 23-year period and report whether these have changed over time. Methods: This retrospective study included all adults who underwent a native kidney biopsy at Tygerberg Hospital in Cape Town from January 1995 to December 2017. Only the first biopsy for each patient was included in the analysis. From patient records, we extracted demographic and clinical information and details of the kidney biopsies, including the indications and the final histopathological diagnosis. Results: During the study period, 2227 first native kidney biopsies were performed. The median age of the patients was 38.0 years (interquartile range 30.0–48.1 years), and 53.3% were female. The most common indication for biopsy was nephrotic syndrome (38.6%). Glomerulonephritis (GN) was the most common pattern of kidney disease, with similar numbers of cases of primary and secondary glomerular disease. Among the primary glomerular diseases, mesangiocapillary GN (34.5%) was the most common, followed by focal segmental glomerulosclerosis (22.3%) and membranous nephropathy (15.8%). Among the secondary glomerular diseases, lupus nephritis was the most common (39.1%), followed by human immunodeficiency virus-associated nephropathy (HIVAN, 22.1%), and diabetic nephropathy (14.4%). IgA nephropathy was uncommon, accounting for only 2.0% of all glomerular disease, as was hypertensive kidney disease, which was diagnosed in only 1.3% of all our biopsies. Conclusions: Over the last two decades, mesangiocapillary GN was the most common primary glomerular disease and lupus nephritis the most common secondary glomerular disease. There was a steady increase in the number of patients with HIVAN. Hypertensive nephropathy was an uncommon histological diagnosis, and IgA nephropathy remains rare.
  PubDate: 2023-02-01
  DOI: 10.21804/26-1-5376
  Issue No: Vol. 26, No. 1 (2023)
Investigating toxic aluminium levels in haemodialysis patients after
“Day Zero” drought in Cape Town, South Africa
- Authors: Bianca Southon, Jody A Rusch, Helena W Vreede, Bianca Davidson, Daniel Mweli, Nicola Wearne, Malini Chetty, Erika SW Jones
  Pages: 17 - 23
  Abstract: Introduction: Aluminium is the most abundant metallic element in the earth’s crust and can be consumed through water, medications, and by using metallic cooking utensils. Aluminium levels become a concern when they are above biological exposure limits and can present with multiple clinical complications. When patients have chronic kidney disease and are on haemodialysis, impaired aluminium excretion can lead to its accumulation. Significantly elevated serum aluminium levels were noted in patients with chronic kidney disease (stage 5) on haemodialysis at Groote Schuur Hospital, Cape Town, South Africa. This coincided with one of the worst water crises ever experienced in this metropolitan area, with extreme water restrictions being imposed and alternative water sources being accessed.
  Method: A multidisciplinary task force performed a systematic evaluation of aluminium concentrations throughout the dialysis water system. Additionally, a thorough investigation was performed to assess the quality of the laboratory results.
  Results: Possible areas of contamination and potential sources of exposure were excluded. The laboratory results were verified, and potential sources of error were excluded. The investigation verified that aluminium was truly elevated in the serum of patients, and concluded that dialysis was not the cause. Subsequently, patients’ results have declined to baseline, making it possible that there was increased environmental exposure during the drought.
  Conclusion: This report serves as a reminder to clinicians of acceptable serum aluminium levels in people on dialysis, and in the water system. Furthermore, it highlights the importance of a multidisciplinary collaborative team approach for the investigation of unexpected results or changes in trends.
  PubDate: 2023-01-31
  DOI: 10.21804/26-1-5423
  Issue No: Vol. 26, No. 1 (2023)
Saliva urea nitrogen dipsticks to predict acute kidney injury in Malawian
trauma patients
- Authors: Erica Bjornstad, William Muronya, Zachary H Smith, Manly Kamija, Rhys Evans, Amy K Mottl, Yvonne M Golightly, Keisha Gibson, Anthony Charles, Emily W Gower
  Pages: 24 - 29
  Abstract: Background: Many low-resource settings have limited access to serum creatinine tests necessary for kidney disease identification. Among Malawian patients who are hospitalized after trauma, we evaluated the use of point-of-care saliva urea nitrogen (SUN) dipsticks to predict acute kidney injury (AKI). Methods: In a nested prospective cohort study, we enrolled hospitalized acute trauma patients aged ≥6 months to evaluate AKI (defined by KDIGO criteria) and the test characteristics of SUN to predict AKI. Results: Among 335 participants (approximately three-quarters able to expectorate and 34% aged ≤18 years), 12.5% (n = 42) developed AKI. At a SUN threshold of ≥40 mg/dL, a positive dipstick test was specific (99.3%) but insensitive (14.3%) in predicting AKI, with a positive predictive value of 75% and negative predictive value of 89%. At this threshold, 2.4% of participants were dipstick-positive (SUN+), and 75% of those had AKI. Reducing the SUN threshold to ≥30 mg/dL increased participants who were SUN+ to 5.0% (n = 16) but also increased the false positive rate and missed 79% (n = 33) of AKI cases. Stratified results showed better performance among adults than children and similar results when comparing participants who could and could not expectorate. There was moderate correlation between categorized BUN values and SUN (r = 0.53) but less agreement (weighted kappa 0.27; 95% CI 0.17–0.37). Conclusions: SUN dipstick testing has good specificity and negative predictive value for ruling out AKI, but poor sensitivity. We found similar results among those who could or could not expectorate a saliva sample.
  PubDate: 2023-01-26
  DOI: 10.21804/26-1-5462
  Issue No: Vol. 26, No. 1 (2023)
From Alpha to Omicron: anatomy of the SARS-CoV-2 pandemic in an outpatient
haemodialysis unit in Johannesburg, South Africa
- Authors: Ranbir Maharaj, Chandni Dayal, Zaheera Cassimjee, Sheetal Chiba, Adekunle O Ajayi, Malcolm Davies
  Pages: 30 - 37
  Abstract: Background Recipients of kidney replacement therapy are more susceptible to severe disease and mortality from SARS-CoV-2 infection. We evaluated disease kinetics and clinical outcomes across four COVID-19 outbreak waves in the haemodialysis unit of a tertiary-level hospital in South Africa. Methods Data from 70 patients was analysed. Temporal trends in SARS-CoV-2 infection as diagnosed by nasopharyngeal RT-PCR swab were described as were severity of resultant COVID-19 disease, survival outcomes, and recurrent infections. The effect of patient-related demographic and comorbidity factors, and that of probable SARS-CoV-2 variant on disease severity and recurrence, were additionally assessed. Results Three-quarters of patients in this unit ultimately developed SARS-CoV-2 infection. The majority of infections were asymptomatic or of mild clinical presentation. The Alpha variant (first) wave and the Delta variant (third) wave accounted for the majority of infections. COVID-19 disease was more frequently severe in the Delta variant wave and all mortalities in this cohort occurred in this wave. Male sex and comorbid diabetes were associated with more severe disease. Duration of swab positivity was longer following clinically severe infection and in cases of infection with the Beta variant. Prior episodes of SARS-CoV-2 infection reduced clinical severity at subsequent re-infection and shortened duration of swab positivity. Conclusion The present study is the first description of the COVID-19 pandemic in an African haemodialysis unit. Significant temporal differences in infection rates, disease severity, and survival outcomes were demonstrated over the course of the pandemic in this vulnerable population. Evolving SARS-CoV-2 virulence and immunity potentially account for these differences.
  PubDate: 2023-01-27
  DOI: 10.21804/26-1-5395
  Issue No: Vol. 26, No. 1 (2023)
Acute kidney injury and in-hospital mortality among patients with COVID-19
in Ghana – a single centre study
- Authors: Elliot Koranteng Tannor, Emmanuel Ofori, Kojo Awotwi Hutton-Mensah, Martin Akutek, Felicia Akua Afriyie, Obed Ofori Nyarko, Yasmine Hardy, Samuel Amoabeng Kontoh, Priscilla Abrafi Opare-Addo, Divine Amenuke
  Pages: 38 - 46
  Abstract: Introduction: Acute kidney injury (AKI) occurs in patients with coronavirus disease 2019 (COVID-19) and is associated with high mortality, but this has not yet been described in Ghana. We therefore record here the proportion of COVID-19 patients with AKI, and determined the corresponding mortality, in a tertiary-level hospital in Ghana. Methods: We conducted a retrospective study of all patients admitted to the Komfo Anokye Teaching Hospital, with a diagnosis of COVID-19 proven by reverse transcriptase polymerase chain reaction (RT-PCR), from March 2020 to February 2021. Demographics, clinical findings and laboratory investigations were recorded and summary statistics used to describe the data. Predictors of mortality were established by multiple logistic regression. Results: The study involved 250 patients, of whom 129 (52%) were males, with a mean age of 56.3 ± 17.4 years. AKI occurred in 123 (49%). The most common causes of AKI were pre-renal AKI and ischaemic ATN – 65 (73%) and 37 (30%) cases, respectively. Haemodialysis was required in 6 (5%) cases. The in-hospital mortality of all the COVID-19 patients was 71 (31%). The predictors of in-patient mortality in multivariate analysis were hyperglycaemia (OR = 18.48 [95%CI (2.0 –165.2], P = 0.009), severe COVID-19 (OR = 31.3 [95% CI 1.53–635.5], P = 0.025), elevated white blood cell count (OR = 1.32 [95% CI 1.09–1.59], P = 0.004), lymphopenia (OR = 0.16. [95% CI 0.03–3.26], P = 0.027) and not AKI (OR = 0.79 [95% CI 0.45–1.34], P = 0.380). Stage 3 (severe) AKI, however, occurred in 39 (32%) cases and was significantly associated with mortality [OR = 2.41 (95% CI 1.05–5.49, P = 0.036)] as compared to those with mild–moderate AKI in a sub-analysis. Conclusions: AKI is common in hospitalized patients with COVID-19. Stage 3 AKI was associated with increased in-hospital mortality. Predictors of mortality were severe COVID-19 disease, lymphopenia and hyperglycaemia.
  PubDate: 2023-02-01
  DOI: 10.21804/26-1-4908
  Issue No: Vol. 26, No. 1 (2023)
In memoriam: Rashad Sami Barsoum
- Authors: Saraladevi Naicker, Mohamed Hany Hafez, John H Dirks
  Pages: 47 - 49
  Abstract: Rashad Sami Barsoum, a pioneer in nephrology in Egypt and Africa, and former secretary general of the International Society of Nephrology and inaugural past president of the African Association of Nephrology, died on 25 October 2022, at the age of 81.
  PubDate: 2023-01-30
  DOI: 10.21804/26-1-5733
  Issue No: Vol. 26, No. 1 (2023)
Metastatic calcinosis cutis in a dialysis patient
- Authors: Nabeel Bapoo, Mogamat-Yazied Chothia, Piers A Stead, Ismail Ally
  Pages: 50 - 52
  Abstract: Metastatic calcinosis cutis is an uncommon complication of end-stage kidney disease but has severe and disabling effects. Its development is attributed to disorders of calcium and phosphate metabolism associated with secondary hyperparathyroidism. The mainstay of treatment remains medical therapy; however, in refractory cases a parathyroidectomy is indicated. We describe the case of a 22-year-old female with refractory hyperparathyroidism treated with a subtotal parathyroidectomy resulting in complete resolution of metastatic calcinosis cutis of the hands. Clinicians should be aware that this complication can occur soon after the initiation of dialysis and that rapid complete resolution can be achieved with parathyroidectomy.
  PubDate: 2023-04-05
  DOI: 10.21804/26-1-5281
  Issue No: Vol. 26, No. 1 (2023)
Quality of life of patients with kidney failure in sub-Saharan Africa:
protocol for a systematic review of quantitative studies
- Authors: Charlotte M Snead, Charlotte C Seneschall, M Razeen Davids, Taryn Young, Fergus J Caskey, Emmanuel E Effa
  Pages: 53 - 61
  Abstract: Introduction: The burden of chronic kidney disease (CKD) is rising in sub-Saharan Africa. Access to kidney replacement therapy (KRT) remains limited and modelling suggests a significant hidden burden of kidney failure managed without KRT. Kidney failure is contributing to serious health-related suffering (SHS) at a global level. Despite this, access to palliative care remains extremely disparate. There is an urgent need for greater palliative care provision for patients with kidney failure in sub-Saharan Africa. To inform this, it is important to understand their current quality of life. This article outlines our review protocol, ensuring transparency of our planned methods and reporting. Methods and analysis: A comprehensive search will be conducted of MEDLINE (Ovid), EMBASE, CINAHL, African Index Medicus and Africa Journals Online. ProQuest Dissertations & Theses Global will be searched for grey literature. Eligible sources will be quantitative observational studies, conducted in sub-Saharan Africa, and published in English or French. The primary outcome measure will be quality of life of those with kidney failure, measured using a validated quality of life tool. Abstract screening, data extraction and risk of bias assessments will be conducted independently by two reviewers. Meta-analysis will be performed on study subgroups, if appropriate, based on heterogeneity of included studies; otherwise results will be summarised narratively. This protocol is structured according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidance. Ethics and dissemination: Ethical approval is not required because this review will synthesise published data. Findings will be disseminated in a peer-reviewed journal. PROSPERO registration ID: 275434
  PubDate: 2023-03-27
  DOI: 10.21804/26-1-4847
  Issue No: Vol. 26, No. 1 (2023)
Disordered minerals and disease of soft tissue and bones in chronic kidney
disease
- Authors: Charles R Swanepoel
  Pages: 62 - 69
  Abstract: This article briefly reviews the mineral and bone disorder (MBD) found in patients with chronic kidney disease (CKD) and should provide a useful summary for trainees in nephrology and internal medicine. The storage of minerals is one of the principal roles of our bones, which are alive and are constantly being remodelled under the influence of vitamin D and parathyroid hormone (PTH), aided and abetted by calcium and phosphates. This occurs in a controlled fashion in healthy individuals. In patients with CKD, this control is lost and either an exaggerated, ineffectual remodelling takes place, resulting in the removal (in the case of high-turnover bone disease) or inadequate (in low-turnover bone disease) deposition of minerals. Vascular (and other soft tissue) calcification accompanies MBD, with phosphate and calcium playing major roles in the pathogenesis of the condition. The development of MBD is insidious and evident by changes in blood PTH, calcium and phosphate levels seen as early as stage 3 CKD. Vascular calcification may also be observed at this early stage. Various reports have demonstrated associations between these abnormal blood levels and morbidity and mortality; however, randomised controlled studies are lacking that show definite proof of cause and effect. In resource-limited countries, the control of PTH is restricted to the use of basic, inexpensive medicines, and patients with CKD can have inadequate means to afford blood tests. The use of vitamin D must be balanced between the use of natural vitamin D (a relatively cheap option) and active vitamin D. The cost of intravenous vitamin D analogues can be prohibitive. The more expensive phosphate binders (mostly non-calcium containing) too are unaffordable for most African patients. The surgical expertise to perform parathyroidectomies is limited to only certain major centres throughout the continent.
  PubDate: 2023-03-06
  DOI: 10.21804/26-1-5668
  Issue No: Vol. 26, No. 1 (2023)
Health-related quality of life of patients undergoing haemodialysis
therapy in Dar es Salaam, Tanzania
- Authors: Daniel P Msilanga, Priyank Punatar, Paschal Ruggajo
  Pages: 70 - 75
  Abstract: Background: Patients with kidney failure on maintenance haemodialysis therapy have a lower health-related quality of life (HRQOL) than matched controls without kidney failure. HRQOL is an important predictor of clinical outcomes among patients with kidney failure, yet there is a paucity of such data in Tanzania. We determined HRQOL among Tanzanian patients with kidney failure receiving maintenance haemodialysis therapy. Methods: A cross-sectional study was conducted at Muhimbili National Hospital (MNH) in Dar es Salaam, from June to October 2020. MNH is a tertiary public sector hospital with 50 dialysis machines. Here, the Kidney Disease Quality of Life Short Form-36 questionnaire was used to assess HRQOL in 209 patients (69% male; mean age 51.9 ± 13.5 years). Their scores were categorized as low if the overall mean was ≤50, and as high if the score was >50. Factors associated with lower HRQOL were identified using multivariate logistic regression. Results: Overall HRQOL was low (mean score 48.9 ±13.9) and the factors associated with the scores recorded were having less than three haemodialysis treatment sessions per week [adjusted odds ratio (OR) 1.356, 95% CI 0.707–2.254] and urea reduction ratio <65% (OR 2.229, 95% CI 1.238–3.014). Conclusions: The overall HRQOL of patients undergoing haemodialysis was low. Receiving less than three haemodialysis sessions per week and having a urea reduction ratio of less than 65% were associated with lower scores. These findings underscore the importance of providing adequate haemodialysis treatment in improving the quality of life of patients with kidney failure.
  PubDate: 2023-05-22
  DOI: 10.21804/26-1-5725
  Issue No: Vol. 26, No. 1 (2023)
Reviving a national strategy roadmap for organ and tissue donation in
South Africa
- Authors: David Thomson, Albert Z Muranda
  Pages: 76 - 77
  Abstract: In September 2019, a two-day workshop ahead of the Southern African Transplantation Society congress brought together South African champions for organ donation and leaders from the International Society of Organ Donation and Procurement (ISODP) at a high-level workshop focused on creating a national strategy roadmap to improve organ donation in South Africa. The full report is available via the supplementary materials on the African Journal of Nephrology website.
  PubDate: 2023-06-30
  DOI: 10.21804/26-1-5811
  Issue No: Vol. 26, No. 1 (2023)
La prévalence et facteurs associés à la dysfonction érectile chez les
patients hémodialysés chroniques dans 2 centres semi-urbains du
Sénégal
- Authors: A Dieng, M Kébé, MS Diawara, M Sarr, MM Cissé
  Pages: 78 - 82
  Abstract: La dysfonction érectile (DE) est fréquente dans la population hémodialysée chronique et a un impact négatif sur leur qualité de vie. Le but de notre étude était d’évaluer la prévalence de la DE et son retentissement psycho-social, puis identifier ses principaux facteurs associés. Patients et méthode : Il s’agissait d’une étude transversale, à visée descriptive et analytique dans 2 centres du Sénégal incluant tous les patients adultes de sexe masculin, hémodialysés de plus de 03 mois et ayant consenti librement de répondre aux items du questionnaire. L’appréciation de la fonction érectile s’était basée sur un auto-questionnaire incluant l’indice international de la fonction érectile simplifié dans sa version arabe (IIEF-5). Le diagnostic de dysfonction érectile a été retenu chez tout patient ayant un score IIEF-5 entre 5 et 20. Résultats : Quarante patients ont participé à l’étude. L’âge moyen était de 51,43 ± 12,84 ans. Les principales causes des néphropathies étaient l’HTA chronique (47,5%) et indéterminée (27,5%). La durée moyenne en hémodialyse était de 45,21 ± 41,96 mois. Le score moyen se IIEF5 était de 15,0 ± 4,8 et la prévalence de la DE était de 87,5%. La DE était associée avec l’âge (p=0,043), le taux d’hémoglobine (p=0,034) et la cholestérolémie (0,027). Conclusion : Nous avons constaté que la prévalence reste toujours élevée dans notre pays et une meilleure connaissance des facteurs de risque permet d’améliorer la prise en charge.
  PubDate: 2023-08-24
  DOI: 10.21804/26-1-4978
  Issue No: Vol. 26, No. 1 (2023)
South African Renal Registry Annual Report 2021
- Authors: M Razeen Davids, Nicola Marais, Sajith Sebastian, Thabiet Jardine, Julian C Jacobs
  Pages: 83 - 94
  Abstract: This is the tenth consecutive annual report of the South African Renal Registry since it was re-established and launched with the publication of the December 2012 data on kidney replacement therapy (KRT) in South Africa. The December 2021 data reported here indicate a stabilisation of the COVID-19-related decrease in patient numbers which was recorded in the previous report. There were 849 patients who started KRT in 2021, an incidence of 14.1 per million population (pmp). Most of these patients (80%) were treated in private centres. In December 2021, the total number of patients on treatment with chronic dialysis or transplantation stood at 8 866, up from 8 734 in 2020, an overall prevalence of 147 pmp. The prevalence was 736 pmp in the private healthcare sector. In the public sector, the overall prevalence was 45 pmp, with the Western Cape being the province with the highest prevalence (166 pmp) and Mpumalanga the province with the lowest (3 pmp).
  PubDate: 2023-08-04
  DOI: 10.21804/26-1-5982
  Issue No: Vol. 26, No. 1 (2023)
The prevalence of acute kidney injury in women with hypertensive disorders
of pregnancy in Africa: a systematic review and meta-analysis
- Authors: Udeme Ekpenyong Ekrikpo, Oluseyi A Adejumo, Effiong E Akpan, Aniema I Udo, Udeme-Abasi U Nelson, Idongesit O Umoh, Martha J Amwaama, Imuetinyan R Edeki, Ayman S Moussa, Ikechukwu O Mbah, Ikechi G Okpechi
  Pages: 95 - 105
  Abstract: Background: Hypertensive disorder of pregnancy (HDP) is a leading and preventable cause of pregnancy-related acute kidney injury globally. This systematic review and meta-analysis determined the prevalence of AKI in cases of HDP in Africa. Methods: A systematic search of PubMed and African Journals Online (AJOL) was undertaken to identify articles with relevant data published between 1991 and 2022. The pooled prevalence of AKI in women with HDP was determined using meta-analytic techniques. Results: Eighteen eligible articles were included in the systematic review and meta-analysis. The studies included reported on 8 703 pregnant women with HDP with a median age of 27.7 years. Most of the studies were crosssectional and had medium or poor methodological quality. The overall prevalence of AKI was 6.0% (95% CI 3.4–9.3%, I2 = 96.7%; p-value for heterogeneity <0.001). There was no difference in AKI prevalence by African subregion. There was a higher prevalence of AKI in the post-RIFLE era compared to the pre-RIFLE era [7.1% (4.3–10.5%) versus 1.6% (0.5–3.2%); p < 0.001]. The pooled AKI prevalence was higher in the studies that used established AKI consensus criteria than those where criteria were not used [19.6% (10.7–30.3%) versus 4.8 (2.4–8.0%); p = 0.001]. Conclusion: The pooled prevalence of AKI in HDP in Africa was 6.0%. Using consensus AKI definition criteria improves the sensitivity of AKI detection in HDP. The early involvement of nephrologists, as part of a multidisciplinary team taking care of women with HDP, may enhance early AKI detection and reduce the likelihood of renal complications.
  PubDate: 2023-08-04
  DOI: 10.21804/26-1-5868
  Issue No: Vol. 26, No. 1 (2023)
C3 glomerulonephritis in Cape Town, South Africa - a case series
- Authors: Irfaan Hargey, Liezel Coetzee, William Bates, Mogamat-Yazied Chothia
  Pages: 106 - 110
  Abstract: Background C3 glomerulonephritis (C3GN) is a rare disease of the alternative complement pathway and is associated with poor kidney and patient outcomes. There are no studies from sub-Saharan Africa. We aimed to identify the incidence, describe the clinical features, and report on the time to the composite outcome of CKD, ESKD or death following kidney biopsy. Methods A retrospective cohort study of all adult patients with a kidney biopsy-confirmed diagnosis of C3GN was performed at our tertiary centre in Cape Town, South Africa, over a 16-year period. C3GN was defined as exclusive C3 positivity or a C3 stain of two orders of magnitude greater than any other immune reactant on immunofluorescence. Kaplan-Meier survival analysis was performed for the composite outcome. Results A total of 19 patients with C3GN were identified with an estimated incidence rate of 0.9 per million population per year. The composite outcome occurred in 79% (n=15) with a median survival probability of 25 months. The median age was 31 (IQR 24-45) years, most were male (79%) and 58% were hypertensive. Three quarters presented with nephritic-nephrotic syndrome. At the time of biopsy, the median creatinine was 212 (IQR 134-752) µmol/L, estimated glomerular filtration rate 33 (IQR 8-65) mL/min/1.73 m2, proteinuria of 5.8 (IQR 5-10) g/day and low C3 in 53%. Conclusion This is a first description of C3GN from sub-Saharan Africa. Overall prognosis was very poor which may be due to late presentation.
  PubDate: 2023-08-25
  DOI: 10.21804/26-1-5810
  Issue No: Vol. 26, No. 1 (2023)
Survival in elderly patients with kidney failure starting haemodialysis in
Cameroon
- Authors: Denis Georges Teuwafeu, Alex Tatang Mambap, Pih Asizeh Alake, Ronald Mbua Gobina, Marie-Patrice Halle, Gloria Ashuntantang
  Pages: 111 - 116
  Abstract: Introduction: Elderly patients have an increased risk of kidney failure due to ageing and comorbidities. This study assessed survival among elderly patients starting maintenance haemodialysis at the Buea and Bamenda regional hospitals in Cameroon. Methods: We conducted a retrospective cohort study of elderly patients (65 years of age and older) who began maintenance haemodialysis between January 2016 and December 2020. The primary outcome of interest was survival at one year. Results: The proportion of elderly patients starting dialysis was 11%. There were 81 patients included in the study. Their median age at dialysis initiation was 70 years [interquartile range (IQR) 66–73 years] and 90% had high comorbidity scores according to the Charlson Comorbidity Index. The median survival time was 7.5 months (IQR 0.7–12.0 months) and the survival rate at one year was 41%. The most common causes of death were sudden death (42%), infection/sepsis (21%) and dialysis withdrawal (17%). The lowest survival time (median 6.5 days) was observed in patients older than 85 years, with a high comorbidity index. Emergency start to dialysis [hazard ratio (HR) 1.434, P = 0.032), age ≥75 years (HR = 19.384, P = 0.001), refractory hyperkalaemia as an indication for starting dialysis (HR = 1.244, P = 0.02) and high comorbidity index (HR = 2.819, P = 0.014)] were associated with poorer survival. Conclusions: Only half of the elderly patients were still alive one year after starting maintenance haemodialysis. Comorbidity score, age, refractory hyperkalaemia and emergency start to dialysis were associated with survival.
  PubDate: 2023-09-07
  DOI: 10.21804/26-1-5921
  Issue No: Vol. 26, No. 1 (2023)
Estimating glomerular filtration rate in African populations
- Authors: June Fabian
  Pages: 117 - 126
  Abstract: Without a strong bedrock of kidney research in African populations we are vulnerable to extrapolating research findings performed in non-African ancestry populations, mostly in high-income countries, with short- and long-term implications for individual and public health. This review tracks the evolution of kidney function testing, highlighting measured and estimated glomerular filtration rate (GFR) testing. While measured glomerular filtration rate (mGFR) is the most accurate method, there are potential sources of error for each reference compound and regional preferences and availability dictate choice. Establishing measured GFR testing as a research or clinical service is challenging and remains a barrier to mGFR testing availability in Africa. Estimated GFR is more practical but less accurate, and important for clinicians to understand the trade-offs, especially in an African context. Non-GFR determinants of serum creatinine lead to random error in measurement that is not a true reflection of kidney function: hereditable factors influence biomarker metabolism and excretion; biological variation results in intra-and inter-individual error; non-renal physiological factors include sex, age, environmental temperature (especially hot climes), ingestion of animal protein, levels of exercise, acute illness, chronic liver disease, enhanced gastrointestinal excretion with declining GFR, and concomitant medication that interferes with tubular handling of creatinine. There are likely to be additional factors (still unknown) in African populations; and analytic error that includes Jaffe vs enzymatic, use of standard reference materials and methods for calibration, and adherence to internal and external quality assurance programmes. Laboratories also require age and sex-based population-appropriate reference intervals for creatinine in children, adolescents, adults, and older adults which do not exist in many African countries. While the spotlight on racialised coefficients for eGFR has been largely confined to the USA, the impact of using GFR estimates that are US-based (and their racialised coefficients), throughout Africa remains overlooked. In Africa, recommended equations overestimate GFR, fewer individuals with CKD are diagnosed, and population prevalence is underestimated. Downstream, there are fewer opportunities to investigate causes or initiate treatment to prevent progression – much more relevant since the advent of sodium-glucose co-transporter 2 (SGLT-2) and glucagon-like peptide (GLP)-1 agonists for managing early CKD.
  PubDate: 2023-10-26
  DOI: 10.21804/26-1-6108
  Issue No: Vol. 26, No. 1 (2023)