Introduction Glomerular hyperfiltration is highly frequent, theoretically dependent on cardiac output, low systemic vascular resistance and hemolysis markers. In sickle cell disease (SCD), hyperfiltration is an extremely common phenomenon and occurred in young and early adult patients. Despite the fact that the glomerular hyperfiltration is known as the early manifestations of sickle cell nephropathy, its burden among adult sickle cell disease in sub-Saharan is poor studied. This study aimed to determine the prevalence and associated factors of hyperfiltrationMethods This was an analytical multicentric cross-sectional study involving stable adult sickle cell patients in Kinshasa, recruited between March and October 2023. Parameters of interest encompasses demographic, clinical, biological, echocardiographic and pulse wave measurement data. Hyperfiltration was defined using the CDK-EPI equation based on cystatin C; eGFR >130 for women and >140 ml/min/1.73m2 for men. We used multivariate logistic regression analysis to search determinants of glomerular hyperfiltration.Results Two hundred and fourty six (246) patients with SCD were enrolled. The prevalence of hyperfiltration was 20.7%. In multiple logistic regression analysis, hyperfiltration status was independently associated with age (< 25 years) [3.57 (1.78-7.49); p = 0.027)], female sex [4.36 (2.55-5.62); p = 0.031), CRP (< 6 mg/l) [0.77 (0.61-0.97); p = 0.028)], central systolic pressure (< 100 mmHg) and central diastolic pressure (< 60 mmHg) [0.86(0.74-0.98), p = 0.028)], [(0.83 (0.71-0.98); p = 0.032)].Conclusion One out of five SS adults exhibits hyperfiltration, which is associated with young age and female sex, whereas low CRP and blood pressure were negative risk factors.

Despite rhabdomyolysis is known as a potential etiology of Acute kidney injury in SARS-COV-2 patients, the burden of rhabdomyolysis in COVID-19 hospitalized patients is scarce. The objective of the present study was to assess the prevalence and risk factors of rhabdomyolysis in SARS-COVID-2 patients.

Contexte et Objectifs. Le nombre des patients hémodialisés en Afrique subsaharienne en constante augmentation ; justifiant de ce fait une meilleure prise en charge de ces patients. La présente étude détermine la prévalence de l’infection par le virus de l’hépatite C en en determinant les génotypes ainsi que les facteurs y associés dans ce groupe de patients. Méthodes. 127 patients hémodialisés chroniques ont subis des tests sérologiques à la recherche des anticorps anti-VHC dans plusieurs centres de Kinshasa de février à juin 2018. Le génotype viral a été déterminé par la RT-PCR. Résultats. La fréquence des anticorps anti-VHC a varié de 0 à 52,9 % dans ce groupe. Les génotypes le plus fréquents ont été le 4 (18/22) et le 2 (2/22) ; étant sumultanément rétrouvé chez un patient, et indéterminé chez un autre sujet. Avoir reçu au moins 4 transfusions [7,21 (1,09-10,61; p=0.040)], ne pas être sous EPO [5,81(1,47-12,96); p=0.012)], être en hémodialyse depuis au moins 14 mois [3,63(1,60-5,05); p=0.035)] et être dialysé dans un centre surchargé [2,06 (0,83-5,86); p=0.073)] étaient associés à un risque plus élevé d’infection par le VHC. Conclusion. Ses principaux déterminants sont : le nombre des transfusions sanguines et la durée d'HD ; d’où la nécessité de réduire les transfusions sanguines chez les sujets dialysés par l'administration d'EPO, étant donné le coût prohibitif du traitement contre le VHC dans notre contexte. Context and objective. The steady increase in the number of chronic hemodialysis patients in sub-Saharan Africa (SSA) calls for improved management of those patients. The present study aimed to determine the frequency of hepatitis C virus (HCV) infection, the prevalent genotypes, and the risk factors associated with HCV in hemodialysis patients in Kinshasa (DR Congo). Methods. A cross-sectional study was conducted from February to June 2018 in all hemodialysis centers in Kinshasa. Blood samples were collected from 127 chronic hemodialysis patients and tested for the presence of antibodies against HCV. The HCV genotype was identified by real-time polymerase chain reaction (RT- PCR). Results. Twenty-two (17.3 %) patients were positive for anti-HCV antibodies, ranging from 0 % to 52.9 % in different centers. Genotype 4 was detected in 18/22 (81.8 %), followed by genotype 2 in 2/22 (9.1%), and both genotypes 2 and 4 in one patient (4.5%). One patient had an undetermined genotype (4.5 %). Having received at least 4 transfusions [7,21 (1,09-10,61); p=0.040)], not being under EPO treatment [5,81(1,47-12,96); p=0.012)], being on hemodialysis for at least 14 months [3,63(1,60-5,05); p=0.035)]and being dialyzed in an overloaded center [2,06(0,83-5,86); p=0.073)] were associated with a greater risk of HCV infection. Conclusion. This high HCV prevalence (17.3 %) represents a substantial health burden in HD patients from Kinshasa, DR Congo. It is largely driven by the number of blood transfusions, the duration time in hemodialysis. Observations from the present study underscore the need of reducing the number of blood transfusions in people on dialysis through the administration of erythropoietin, given the unaffordable cost of HCV therapy for most individuals in DR Congo.

Context and objective. Despite progress in hemodialysis (HD), intradialytic hypotension (IDH) remains common. This study aimed to determine the frequency, risk factors and outcome of IDH during acute hemodialysis. Methods. We compiled the records of acute HD sessions in 2 HD centers of Kinshasa between 2008 and 2018. IDH was defined by blood systolic pressure 750 ml [p=0.017; aOR 1.97 (1.12-4.21)], anuria [p=0.021; aOR 2.72 (1.33-6.19)], a session of more than 3 hours [p=0.025; aOR 2.78 (1.48-6.05)], sepsis [p=0.020; aOR 3.89 (1.24-12.18)], lower initial systolic blood pressure [p<0.001; aOR 0.97 (0.96-0.98)] and hydration status [p=0.032; aOR 5.57 (1.16-26.64)]. No deaths have been reported, but we had 3 ICU admissions. Conclusion. In the event of acute dialysis, approximately 1 session in 12 is complicated by IDH with a good prognosis. This depends on factors related to the patient and to the dialysis method itself. Key-words: Intradialytic hypotension, Kinshasa, acute kidney injury Received: April 7th, 2021 Accepted: July 28th, 2021

Proprotein Convertase Subtilisin/Kexin type 9 (PCSK-9), the new biomarker interfering in lipid homeostasis, has not been explored among sub-Saharan African receiving maintenance hemodialysis. The aim of this study was to investigate the association between PCSK-9, dyslipidemia and risk of cardiovascular events in a population of black Africans.

Introduction The steady increase in the number of chronic hemodialysis patients in sub-Saharan Africa (SSA) calls for improved management of those patients. The present study aimed to determine the frequency of hepatitis C virus (HCV) infection, the prevalent genotypes and the risk factors associated with HCV in hemodialysis patients in Kinshasa (DR Congo). Methods A cross sectional study was conducted from February to June 2018 in all hemodialysis centers in Kinshasa. Blood samples were collected from 127 chronic hemodialysis patients and tested for the presence of antibodies against HCV. The HCV genotype was identified by real time polymerase chain reaction (RT- PCR). Results Twenty-two (17.3 %) patients were anti-HCV positive, ranging from 0 % to 52.9 % in different centers. Genotype 4 was detected in 18/22 (81.8 %), followed by genotype 2 in 2/22 (9.1%), and both genotypes 2 and 4 in one patient (4.5%). One patient had an undetermined genotype (4.5 %). Having received at least 4 transfusions [7,21 (1,09-10,61); p=0.040)], not being under EPO treatment [5,81(1,47-12,96); p=0.012)], being on hemodialysis for at least 14 months [3,63(1,60-5,05); p=0.035)]and being dialyzed in an overloaded center [2,06(0,83-5,86); p=0.073)] were associated with a greater risk of HCV infection. Conclusion This study highlights the importance of strategies to prevent HCV infection in hemodialysis patients in Kinshasa. This issue is important for SSA countries which are facing several economic and logistical challenges.

Objective Early identification of atherosclerosis using a non-invasive tool like ankle–brachial index (ABI) could help reduce the risk for cardiovascular disease among long-term hemodialysis patients. The study objective was to assess the frequency and impact of abnormal ABI as a marker of subclinical peripheral artery disease (PAD) in chronic hemodialysis patients. Methods This was a historic cohort study of kidney failure patients on long-term hemodialysis for at least 6 months. The ABI, measured with two oscillometric blood pressure devices simultaneously, was used to assess subclinical atherosclerosis of low limb extremities. Abnormal ABI was defined as ABI <0.9 or >1.3 (PAD present). Survival was defined as time to death. Independent factors associated with abnormal ABI were assessed using multiple logistic regression analysis. Kaplan–Meier method (log-rank test) was used to compare cumulative survival between the two groups; a P value <0.05 was statistically significant. Results Abnormal ABI was noted in 50.6% (n=43) of the 85 kidney failure patients included in the study; 42.4% (n=36) had a low ABI, and 8.2% (n=7) had a high ABI. Factors associated with PAD present were cholesterol (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 1.01–1.04; P=0.019), inflammation (AOR, 9.44; 95% CI, 2.30–18.77; P=0.002), phosphocalcic product (AOR, 6.25; 95% CI, 1.19–12.87; P=0.031), and cardiac arrhythmias (AOR, 3.78; 95% CI, 1.55–7.81, P=0.009). Cumulative survival was worse among patients with PAD present (log-rank; P=0.032). Conclusion The presence of PAD was a common finding in the present study, and associated with both traditional and emerging cardiovascular risk factors as well as a worse survival rate than patients without PAD.

Abstract Background Although cardiovascular diseases in particular Pulmonary Arterial Hypertension (PAH) is associated with, high morbid-mortality in chronic hemodialysis, but its magnitude remains paradoxically unknown in sub-Saharan Africa. The aim of this study was to evaluate the prevalence of PAH and associated factors in chronic hemodialysis in Sub-Saharan African population. Method In a cross-sectional study, patients treated with HD for at least 6 months in 4 hemodialysis centers were examined. PAH was defined as estimated systolic pulmonary arterial pressure (sPAP) ≥ 35 mmHg using transthoracic Doppler echocardiography performed 24 h after the HD session. Results Eighty-five HD patients were included; their average age was 52.6 ± 15.9 years. Fifty-seven patients (67.1%) were male. Mean duration of HD was 13.3 ± 11 months. With reference to vascular access, 12 (14.1%), 29 (34.1%) and 44 (51.8%) patients had AVF, tunneled cuff and temporary catheter, respectively. The underlying cause of ESRD was diabetes in 30 patients (35.3%). The prevalence of PAH was 29.4%. Patients with PAH had more hyponatremia (11 (44%) vs 10 (16.7%), p = 0.010). In multivariate analysis, unsecured healthcare funding (aOR 4, 95% CI [1.18–6.018]), arrhythmia (aOR 3, 95% CI [1.29–7.34]), vascular access change (aOR 4, 95% CI [1.18–7.51]) and diastolic dysfunction (aOR 5, 95% CI [1.35–9.57] were independently associated with PAH. Conclusion One third of hemodialysis patients exhibit PAH, which is independently associated with low socioeconomic status (unsecured funding, vascular access change) and cardiovascular complications (arrhythmia, diastolic dysfunction).

Objectives To describe the clinical characteristics of patients infected with SARS-CoV-2 at Clinique Ngaliema, a public hospital, in Kinshasa, in the Democratic Republic of Congo (DRC). Methods This retrospective study analyzed medical records including socio-demographics, past medical history, clinical manifestation, comorbidities, laboratory data, treatment and disease outcome of 160 hospitalized COVID-19 patients, with confirmed result of SARS-CoV-2 viral infection. Results The median age of patients was 54 years (IQR: 38-64), and there was no significant gender difference (51% of male). The most common comorbidities were hypertension (55 [34%]), diabetes (31 [19%]) and obesity (13 [8%]). Fever (93 [58%]), cough (92 [57%]), fatigue (87 [54%]), shortness of breath (72 [45%]) and myalgia (33 [21%]) were the most common symptoms, upon admission. Patients were categorized into mild (92 [57%]), moderate (19 [12%]) and severe (49 [31%]). Severe patients were older and were more likely to have comorbidities, compared to mild ones. The majority of patients (92% [147 of 160]) patients received hydroxychloroquine or chloroquine phosphate. Regression model revealed that older age, lower SpO2, higher heart rate and elevated AST at admission were all risk factors associated with in-hospital death. The prevalence of COVID-19 and malaria co-infection was 0.63% and 70 (44%) of all patients received antimalarial treatment before hospitalization. Conclusion Our findings indicated that the epidemiological and clinical feature of COVID-19 patients in Kinshasa are broadly similar to previous reports from other settings. Older age, lower SpO2, tachycardia, and elevated AST could help to identify patients at higher risk of death at an early stage of the illness. Plasmodium spp co-infection was not common in hospitalized COVID-19 patients.

Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the present study was aimed to assess the diagnostic performance of 24-hours ABPM vs. dialysis unit BPs for the diagnosis of ECG-LVH in steady state chronic hemodialysis black patients. Methods: From March 31 to September 30, 2018, interdialytic ABPM was performed after a mid-week hemodialysis session for 24 hours using a Spacelab 90207 ABPM monitor in the non-access arm in 45 stable chronic hemodialysis black patients (age ≥ 20 years, hemodialysis for at least 3 months and informed consent) attending 3 hemodialysis centers in Kinshasa. Ambulatory BP was recorded every 20 minutes during the day (6 AM to 10 PM) and every 30 minutes during the night (10 PM to 6 AM). ECG-LVH was defined using Cornell product criteria. ROC curve method was used to assess the performance of dialysis unit BPs vs. interdialytic 24-hours ABPM in diagnosing ECG-LVH. P 0.05 defined the level of statistical significance. Results: Whatever the method of BP measurement, all the SBP values were related to ECG-LVH with similar AUC and overlapping 95% CI; however, they were not significantly different from each other. 24-hours interdialytic ambulatory SBP (AUC 0.748; 95% CI 0.58 - 0.94) had the highest area under the curve. Conclusion: The present study showed that although all the two BP measurement methods equally detected ECG-LVH, 24-hours ABPM tended to have the highest diagnostic performance.

Les déterminants de l’infection par le virus de l’hépatite C (VHC) en hémodialyse (HD) ont été largement rapportés dans le monde, mais très peu en République démocratique du Congo. Nos objectifs étaient de déterminer la prévalence de l’infection par le VHC, d’identifier les génotypes et les déterminants. Étude transversale et analytique menée dans 6 centres d’HD entre mars et juin 2018. La recherche des Ac anti-VHC a été faite par la méthode Elisa de 3e génération. L’identification de l’ARN viral et du génotype a été recherchée par PCR en temps réel. Les déterminants de la prévalence ont été recherchés par la régression logistique. Au total, 127 patients (âge : 54 ± 14 ans ; 65 % d’hommes ; durée en HD : 22,5 ± 21,3 mois) ont été sélectionnés. La prévalence globale de l’infection à VHC dans cette série a été de 17,3 %. Seuls 2 centres avaient une faible prévalence (0 % et 4,5 %) versus 3 autres centres une prévalence intermédiaire (11,2 %, 16,6 % et 18,8 %) et un centre une prévalence très élevée (52,9 %). Parmi les 22 patients infectés, 20 étaient porteurs du génotype 4 (91 %) ; un patient avait un double portage (génotypes 2 et 4) et chez un patient, le génotype était indéterminé. Les déterminants étaient : la polytransfusion > 4 [ORa : 7, IC 95 % 1,09–10,61)], l’absence de prise d’EPO [ORa : 6, IC 95 % 1,47–12,96)], une durée en HD > 14 mois [ORa : 4, IC 95 % 1,60–5,05)], l’accès vasculaire type cathéter [ORa : 5,89 IC 95 % 1,72–46,16)] et le traitement dans un centre à vocation caritative [ORa : 8 IC 95 % 2,75–25,59)]. La prévalence de l’infection par le VHC est très élevée dans certains centres avec des facteurs de risque qui rendent compte d’une prise en charge médicale sous-optimale et d’un financement limité des soins de santé.