Kidney dysfunction (KD) and hypoxia on admission are separately associated with COVID-19 mortality. Estimation of GFR using creatinine and peripheral oxygen saturation (SpO2) may be useful for stratification of at-risk populations. We performed a two centers retrospective cohort study of 359 COVID-19 patients aged 18 years or older to explore the impact of admission kidney function and hypoxia in predicting COVID-19 mortality. KD at admission was defined as estimated glomerular filtration rate (eGFR) calculated by CKD EPI < 60 mL /min/1.73 m2 using creatinine and hypoxia as a SpO2 ˂ 90%. Survival (time-to death) curves were built using the Kaplan-Meier methods. Association between mortality, hypoxia and KD was evaluated by multivariate Cox regression models with a significance level of the p-value set at 0.05. There were 152 patients (42.3%) with an eGFR < 60 mL/min/1.73 m2 and 208 patients (74.8%) with hypoxia on admission. Overall in-hospital mortality was 27.6%, rising to 59.7% in patients with eGFR below 60 mL/min and hypoxia (p < 0.001). Survival was lower in the group of patients with a eGFR below 60 mL/min/1.73 m2 and hypoxia (p < 0.001). Predictors of mortality were eGFR ≥ 60 mL/min/1.73 m2 with hypoxia (HR 2.05 [1.01-4.16], p = 0.048), eGFR < 60 mL/min/1.73 m2 without hypoxia (HR 3.20 [1.73-5.94], p < 0.001) and eGFR < 60 mL/min/1.73 m2 with hypoxia (HR 6.55 [3.63-11.84], p < 0.001). KD on admission and hypoxia are common in COVID-19. Its association with in-hospital mortality should encourage its use in the stratification of patients at risk of death. Influence of hypoxia could suggest a pattern of kidney-lung cross talk.
BACKGROUND:Sickle cell nephropathy remains a major contributor to morbidity in adults with Sickle Cell Disease (SCD), yet proximal tubular injury remains insufficiently characterized, particularly in African settings. Alpha-1 Microglobulin (A1M), a low-molecular-weight protein, may serve as a sensitive biomarker of proximal tubular dysfunction. METHODS:The authors conducted a multicentre observational cross-sectional study among 246 adults with stable SCD in Kinshasa, Democratic Republic of the Congo. Proximal tubulopathy was defined as A1M/Cr ≥ 20 mg/g. Measured Glomerular Filtration Rate (mGFR) was assessed by plasma iohexol clearance. Associations were evaluated using a pre-specified multivariable logistic regression model with multiple imputation for missing data. RESULTS:Proximal tubulopathy was present in 48% of participants. After adjustment, vaso-occlusive crises during the previous trimester (aOR = 1.96, 95% CI 1.14-3.35), leg ulcers (aOR = 2.11, 95% CI 1.16-3.82), and albuminuria (log-transformed UACR; aOR = 1.53, 95% CI 1.24-1.88) were independently associated with elevated A1M/Cr. Hydroxyurea use was associated with lower odds of proximal tubulopathy (aOR = 0.54, 95% CI 0.31-0.95). In a model adjusted for albuminuria, no independent associations were observed for markers of hemolysis or measured GFR, suggesting that the effects of these factors on tubular injury may be mediated through glomerular injury or are closely intertwined with it. Sensitivity analyses excluding albuminuria from the model (Tables S2-S5) did show associations with leg ulcer, recent VOC, and systolic blood pressure. CONCLUSIONS:Proximal tubular dysfunction is frequent among adults with SCD in this high-burden African setting and was independently associated with markers of disease severity and renal involvement.
Background Progress toward TB control depends on timely diagnosis and treatment. Despite global efforts, people with tuberculosis (TB) in high-burden countries such as the Democratic Republic of Congo (DRC) continue to face substantial barriers throughout the TB care cascade. This study assessed barriers to accessing clinical assessment, diagnostic testing, and treatment services among TB patients in the DRC. Methods A cross-sectional study was conducted from March to April 2024 among 449 adult patients with pulmonary TB recruited from 37 health facilities in four provinces of the DRC. Participants were selected using a two-stage cluster sampling design and interviewed using a structured electronic questionnaire. Descriptive analyses accounting for the complex sampling design were performed. Results Most participants were rural residents (70.0%), male (60.4%), married (67.2%), and of low socioeconomic status (63.6%). Only 42.2% correctly identified bacteria as the cause of TB, while 57.8% held misconceptions. Although 92.3% knew TB treatment was free, only 40.3% were aware that TB screening services were free. The most frequently reported barriers across the care cascade were perceived high service costs (66.5–70.9%), transportation and related expenses (62.6–64.3%), believing symptoms did not require medical attention (62.0–68.7%), lack of information on where to seek care (60.2–65.3%), long travel distances (54.4–57.6%), and fear of stigma (43.3–47.2%). Overall, 27.9% initially sought care outside the formal health system, and approximately 22% delayed seeking care for more than one month after symptom onset. Conclusion TB patients in the DRC face important socioeconomic, geographical, informational, and stigma-related barriers that delay access to diagnosis and treatment. Addressing these barriers through patient-centered and community-based interventions is essential to improve timely access to TB services and accelerate progress toward the End TB Strategy.
Human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense has declined substantially in recent years, with many endemic areas now reporting very low prevalence levels as countries move toward elimination. In the Democratic Republic of the Congo (DRC), rapid diagnostic tests (RDTs) are increasingly used in surveillance and elimination programs; however, their performance in low-prevalence settings remains critical. This study evaluated and compared the diagnostic accuracy of two second-generation RDTs; HAT Bioline Abbott® 2.0 and HAT Sero K-Set CORIS® 2.0; using trypanolysis as the reference standard. A retrospective diagnostic accuracy study was conducted on 447 archived plasma samples (227 confirmed HAT cases and 220 controls) from a previous study in the DRC. Each sample was tested with both RDTs and trypanolysis. Sensitivity, specificity, predictive values, likelihood ratios, Cohen’s kappa coefficient, and Youden’s index were calculated with 95
