Abstract

Research Article

Challenges of haemodialysis: A single centre experience in South West Nigeria

Samuel Ayokunle Dada*, Adebukola Bidemi Ajite, Funmilayo Abimbola Ibitoba, Awolowo Anthony Thomas, Oluwamayowa Esther Dada and Olabisi Olamide Deji-Dada

Published: 28 March, 2019 | Volume 3 - Issue 1 | Pages: 055-060

Background: Haemodialysis is the commonest method of Renal Replacement Therapy in Nigeria. Despite an advancement in the technicality and better understanding of haemodialysis, a number of complications are known to be associated with this procedure..

Objective: We aimed to highlight our experiences and share some of the uncommon complications encountered during haemodialysis and present the outcome of our patients.

Subjects and methods: A retrospective review of 101 patients during the last two years was done. Data extracted include: sociodemographic characteristic, aetiology of kidney disease, type of vascular access, intradialytic complication and outcome of treatment.

Results: The total number of dialysis session during the period was 823. Males constituted a higher proportion (64.4%) and were found to be older than female patients 49.8 vs 42.8 years (P=0.001).

Majority (89.1%) had chronic kidney disease while chronic glomerulonephritis was the main cause of CKD as seen in about 45% of the patient.

Due to the cost implication, only 2(1.98%) were able to undergo 3 sessions of dialysis per week for up to 1 month.

Vascular access was femoral (66.3%), internal jugular vein (25.7%), while only 2% used Artero-venous-fistula and one patient had femoral vessel pseudoaneurysm from frequent cannulation.

The commonest complication was hypotension which was present in 15.8%. Twenty-eight deaths were recorded, 44(43%) were either lost to follow up or absconded while 5% were transplanted at a referral centre.

Conclusion: Challenges of renal replacement therapy is overwhelming in our country due to poor human and financial resources. Early diagnosis and adequate government support are advocated.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001026 Cite this Article Read Full Article PDF

Keywords:

Renal replacement therapy; Vascular access; End stage renal disease; Nigeria

References

  1. Naicker S. Nephrology in Africa - challenges of practice in resource-limited environment. Clin Nephrol. 2016; 86: 84-89. Ref.: https://goo.gl/WEmk2g
  2. Okafor UH, Ekwem I, Wokoma FS. Challenges of kidney care in a resource poor nation: A study of private kidney care centre in Nigeria. Niger Med J. 2012; 53: 47-50. Ref.: https://goo.gl/GNkpyb
  3. Stanifer JW, Jing B, Tolan S, Helmke N, Mukerjee R, et al. The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis. Lancet. 2014; 2: 174-181. Ref.: https://goo.gl/S8Dqgr
  4. Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int. 2011; 80: 1258-1270. Ref.: https://goo.gl/JS2G3w
  5. Ekrikpo UE, Udo AI, Ikpeme EE, Effa EE. Haemodialysis in an emerging centre in a developing country: a two year review and predictors of mortality. BMC Nephrol. 2011; 12: 50. Ref.: https://goo.gl/dBX7KB
  6. Okaka EI, Unuigbe EI. Eight year review of hemodialysis: treated patients in a tertiary center in Southern Nigeria. Ann Afri Med. 2014; 13: 221-225. Ref.: https://goo.gl/7yohq6
  7. Oluyombo R, Okunola OO, Olanrewaju TO, Soje MO, Obajolowo OO, et al. Challenges of hemodialysis in a new renal care center: call for sustainability and improved outcome. Int J Nephrol Renovasc Dis 2014; 7: 347-352. Ref.: https://goo.gl/RexUmP
  8. Bello BT, Raji YR, Sanusi I, Braimoh RW, Amira OC, et al. Challenges of providing maintenance hemodialysis in a resource poor country: Experience from a single teaching hospital in Lagos, Southwest Nigeria. Hemodial Int. 2013; 17: 427-433. Ref.: https://goo.gl/xscLWy
  9. Alebiosu CO. Detrimental effects of late referral for dialysis. Afr J Health Sci. 2001; 8: 89-92. Ref.: https://goo.gl/cwAZSz
  10. Kaze FF, Ashuntantang G, Kengne AP, Hassan A, Halle MP, et al. Acute hemodialysis complications in end-stage renal disease patients: the burden and implications for the under-resourced Sub-Saharan African health systems. Hemodial Int. 2012; 16: 526-531. Ref.: https://goo.gl/SUqcQt
  11. Okunola Y, Ayodele O, Akinwusi P, Gbadegesin B, Oluyombo R. Haemodialysis practice in a resource-limited setting in the tropics. Ghana Med J. 2013; 47: 4-9. Ref.: https://goo.gl/hLcbec
  12. Shibiru T, Gudina EK, Habte B, Deribew A, Agonafer T. Survival patterns of patients on maintenance hemodialysis for end stage renal disease in Ethiopia: summary of 91 cases. BMC Nephrol. 2013; 14: 127. Ref.: https://goo.gl/b6AmNH
  13. Mtika V, Muula A, Chipolombwe J, Nyirongo J, Rajabu J. Renal replacement therapy at lilongwe Central Hospital, Malawi. Trop Doc. 2002; 32: 163-165. Ref.: https://goo.gl/gh91S5
  14. Krzanowski M, Janda K, Chowaniec E, Kusnierz-Cabala B, Sulowicz W. [Types of hemodialysis vascular access in patients on renal replacement therapy and its complications during a one year observation period]. Przegl Lek. 2011; 68: 343-347. Ref.: https://goo.gl/c72Cw6
  15. National Kidney Foundation. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update. Am J Kidney Dis. 2015; 66: 884-930. Ref.: https://goo.gl/WAQDXJ
  16. Meremo AJ, Ngilangwa DP, Mwashambwa MY, Masalu MB, Kapinga J, et al. Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma. Tanzania. BMC Nephrol. 2017; 18: 212. Ref.: https://goo.gl/RzRVPA
  17. Acchiardo SR, Hatten KW, Ruvinsky MJ, Dyson B, Fuller J, et al. Inadequate dialysis increases gross mortality rate. ASAIO J. 1992; 38: M282-M285. Ref.: https://goo.gl/o13YPt
  18. Chauhan R, Mendonca S. Adequacy of twice weekly hemodialysis in end stage renal disease patients at a tertiary care dialysis centre. Indian J Nephrol. 2015; 25: 329-333. Ref.: https://goo.gl/cRBnJc
  19. Tentori F, Zhang J, Li Y, Karaboyas A, Kerr P, et al. Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplantant. 2012; 27: 4180-4188. Ref.: https://goo.gl/pz6TVz
  20. Marshall MR, Byrne BG, Kerr PG, McDonald SP. Associations of hemodialysis dose and session length with mortality risk in Australian and New Zealand patients. Kidney Int. 2006; 69: 1229-1236. Ref.: https://goo.gl/bPVQ1x

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