Journal de néphrologie et thérapeutique

Kidney Diseases and Use of Hemodialysis in Intensive Care at the Cnhu-Hkm of Cotonou from 2015-2019

Abstract

VIGAN Jacques1*, SEMILINKO Thomas-Cedric Dezonatchia1, AGBOTON Bruno Leopold1, SABI Kossi Akomola2, TIA Weu Melanie3, AHOUI Séraphin4, MEWANOU Serge5, HOUNKPE Pierre-Claver5, ZOUMENOU Eugène5

Introduction: Intensive care units are often confronted with the management of kidney diseases.

Objective: To study kidney diseases in the intensive care unit of the CNHU-HKM of Cotonou from 2015 to 2019.

Methods: This is a retrospective study with descriptive and analytical aims. We included all patients older than 18 years with acute kidney injury (AKI) or chronic kidney disease (CKD) and/or proteinuria, hematuria, leukocyturia ≥ one cross. AKI being defined by an increase in creatinine level ≥ 26μmol/L (3 mg/L) in 48 h or ≥ 50% in 7 days with or without diuresis ≤ 0.5 ml/kg/h for 6 to 12 h and CKD by an estimated glomerular filtration rate (GFR) <60 ml/min evolving for more than 3 months. Risk factors for death were searched by logistic regression; significance level p <5%.

Results: Out of 4049 admissions, 372 had presented with kidney damage, representing 9.19%. AKI predominated with 63.40%, against 35.50% for CKD. Proteinuria was observed in 08.60% and hematuria in 2.69%. A female predominance was observed with a sex ratio of 0.69. The mean age was 42.50 ± 18.60 years. KDIGO3 stage constituted 48.18% of AKIs. End stage of CKD accounted for 68.18%. Hemodialysis was prescribed in 25.30% of cases, but only 57.40% of patients had access to it. Mortality accounted for 66.10% of overall patients. The use of hemodialysis (p=0.002) and blood transfusion (p=0.003) appeared to be protective factors, whereas the use of respiratory assistance (p <0.0001) and vasoactive amines (p <0.00001) were risk factors for death.

Conclusion: Kidney diseases are relatively common in intensive care units, with an excessively high mortality. Hemodialysis, which reduces this mortality, is not sufficiently accessible to the population. It is important to make the use of hemodialysis free.