Journal de néphrologie et thérapeutique

Chronic Haemodialysis in Befelatanana, Madagascar and its Bacterial Complication

Abstract

Eliane Mikkelsen Ranivoharisoa*,Benja Ramilitiana,Olivah Henintsoa Rakotonirainy,Harinjara Razanakoto,Fahafahantsoa Rapelanoro Rabenja,Willy Franck Harilalaina Randriamarotia

Patients with Chronic kidney Disease (CKD) are fragile. Hemodialysis, the most useful Renal Replacement Therapy in the world is the only treatment available in Madagascar. It is an invasive act exposing several complications. This study aims to assess the prevalence of the bacterial complication in hemodialysis. We conducted a retrospective, exhaustive, descriptive single centre study. Record based study was carried in Befelatanana Hemodialysis Centre, in Antananarivo, the Capital. All chronic hemodialyzed patients who presented an infection were included. Over 136 infections have been suspected but only 33.8% benefited a bacterial identification. In 42.65% of cases, infection begun in 20 days following the first hemodialysis session. Access vascular using catheter is the principal source of infection in 49.06%, followed by pulmonary infection. Staphylococcus aureus (34.3%) was the bacteria frequently en-countered. Sepsis appeared in 98.52% of cases and any patients presented a septic choc. All patients received an adjusted antibiotherapy according to susceptibility testing. The survival rate was in 100%. Treatment of chronic kidney disease is very expensive in Madagascar and 3% of patients have the opportunity to do hemodialysis. That explains our few studied population. In our cohort, access vascular related to femoral catheter represents the common source of infection (49.06%). This prevalence is higher than another American studies. Patients arrived lately at hospital with End-stage of chronic kidney Disease imposing starting hemodialysis in emergency with catheter. Another source of infection has been seen in another site. Patients can also contract infection independently of hemodialysis. Antibiotherapy allowed favorable evolution. To conclude, using access vascular with catheter is inescapable in our center. To fix that, promoting native fistula with early nephrology medical follows-up could be a good solution. Renal transplantation with living donor, the best and less expensive treatment than chronic hemodialysis is now in progress, in collaboration with the Malagasy Government.