[Show abstract][Hide abstract] ABSTRACT: Scleroderma renal crisis (SRC) is defined as the new onset of accelerated arterial hypertension and /or rapidly progressive oliguric renal failure during the course of systemic sclerosis. It is a rare but life-threatening complication. This formerly serious complication has got a considerable brighter outlook since the introduction of angiotensin converting enzyme inhibitors (ACE) however the mortality is still remaining high. We report two cases of SRC which to our knowledge are the firsts described in Dakar. They were two women aged 45 and 32 years, one of them was previously following for systemic sclerosis. Both of them had malignant hypertension associated with rapidly progressive renal failure, the other was put under corticosteroid therapy four months before SRC occurrence. The histological and laboratory finding showed thrombotic microangiopathy. The height blood pressure returned to normal value after treatment with ACE inhibitors. The final outcome was undesirable with the death of one after two months due to the hemodialysis discontinuation and persistence of renal failure in the other.
Pan African Medical Journal 09/2015; 21. DOI:10.11604/pamj.2015.21.46.6344
[Show abstract][Hide abstract] ABSTRACT: Introduction: A good vascular access (VA) is an imperative for hemodialysis practice. For that different VA can be used with a variable risk of complications sometimes threatening patient's life. The objective of our study is to describe clinical patterns of VA of patients undergoing chronic hemodialysis in Senegal. Patients and method: We realized a descriptive study including 268 patients treated in hemodialysis from April 1st to June 1st 2014 at the dialysis centres in three regions. Data about patients and their VA was collected from medical dialysis records. Statistical analysis was done with Stata 12. Results: We included 268 patients. Mean age was 51.6 ±12 years (24-83 years) and sex ratio 1.17. The primary VA used for first dialysis was a temporary catheter in 76°/o of cases and native arteriovenous fistula for 14% of patients. Mean duration of the first central venous catheter was 53 ± 14 days (7-182 days). Prevalence of infectious complications was 6.5 and 0.6 per 1000 dayspatients respectively for temporary and permanent VA. Femoral position (OR= 1.02; p=0.03) and duration of catheter (OR = 1.85; p <0.01) were associated with higher risk of infection. Other complications of VA were thrombosis (2.2 per 1000 days-patients) and local bleeding (1.5 per 1000 days-patients). Twenty-nine cases of death were directly imputable to VA (21 cases of severe sepsis, 04 severe hemorrhage, 03 thrombosis and 1 compressive neck haematoma). Conclusion: Vascular access is important for dialysis quality. First hemodialysis is not scheduled for the majority of our patients because of late referral to nephrologists and the VA is often a temporary catheter placed in emergency. Most frequent complications are infections and thrombosis.
[Show abstract][Hide abstract] ABSTRACT: Patients with chronic kidney disease (CKD) experience multiple complications including erectile dysfunction (ED). It involves more than 50% of patients on dialysis or transplant. In Africa, the true extent of ED in CKD is unknown although some studies have been done in this regard.
This study aimed to determine the prevalence and identify risk factors of ED in patients on hemodialysis.
This cross-sectional multicenter study was conducted from January 2, 2012 through April 30, 2012 in four hemodialysis centers in Dakar. We included all patients on chronic hemodialysis who aged ≥ 18 years old and freely consented to participate in the study. Sociodemographic, clinical, and hemodialysis data were collected through a questionnaire. Erectile function was assessed by a short version of International Index of Erectile Function (IIEF-5).
Among a target of 80 patients, 73 met the inclusion criteria and were included in this study. Mean dialysis vintage was 27.3 months (range, 1-156). Their mean age was 53.81 ± 12.52 years, with a higher proportion of age group of 50 to 69 years old. Fifty-six patients were married (37 monogamous and 19 polygamous) and six were singles. Overall prevalence of ED was 84.9% and it was severe in 14 patients (19.2%). Hypertension and diabetes were the most frequent etiologies and antihypertensive treatment was used in 95.5%. The main factors associated with ED were age > 50 years old and polygamy.
ED is a common problem among patients on hemodialysis in Dakar with a high prevalence. Aging and diabetes represent most common causes. More efforts are needed for its early detection, prevention, and multidisciplinary management.
[Show abstract][Hide abstract] ABSTRACT: It is now established that vitamin D acts as a steroid hormone via a nuclear receptor to perform its varied functions in mineral metabolism. Very few studies in sub-Saharan Africa, and in Senegal in particular, have focused on the prevalence of low vitamin D reserves in black individuals living in this sunny region. We conducted this study to assess the prevalence of a drop in vitamin D reserves in a population of blacks undergoing intermittent hemodialysis. This descriptive study took place at three hemodialysis centers in Dakar and included 37 patients whose 25-hydroxyvitamin D (25-OH-D) levels had been assayed. The patients' mean age was 51 years, and their sex ratio 1.49. The average concentration of 25-OH-D was 70 nmol/L. Below-normal reserves were found in 23 patients (62.2%), especially among those aged 50-75 years. All patients with low 25-OH-D reserves received vitamin D3 supplementation at a dose of 100,000 IU of cholecalciferol per month. This supplementation normalized 25-OH-D levels in the 10 patients subsequently tested. Given the small sample size, a study with a larger number of patients is needed to reach a conclusion about the exact prevalence of low vitamin D reserves in this population and to investigate possible associated factors.
Medecine et sante tropicales 10/2014; 24(3). DOI:10.1684/mst.2014.0371