Journal of Nephrology & Therapeutics

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.

Introduction: The prevalence of chronic pain is high on hemodialysis patients. It can alter the quality of life of these patients who are already exposed to numerous comorbidities. This study aimed to determine the characteristics, the psycho-affective impact and the chronic pain-related factors.

Patients and Methods: We conducted a cross-sectional, multicentre study of descriptive and analytical purposes in 3 centres in Senegal including 110 chronic haemodialysis patients. Sociodemographic, biological and therapeutic patterns were studied. The pain was considered chronic when it lasted more than 3 months. The intensity of the pain was explored according to the degree of understanding of the patients by different assessment scales.

Results: The mean age of our patients was 48.15 ± 13.71 years and a sex ratio (M/F) of 1.07. The main causative nephropathy was nephroangiosclerosis in 43.6% and the mean duration of haemodialysis was 76 ± 46.4 months. The prevalence of chronic pain was 39.09% (43/110). It was experienced as mild (11.6%), moderate (30.2%), severe (41.9%) and unbearable (16.3%) according to the visual analogue scale (VAS). It was permanent, intermittent, daily and rare in 27.91%, 25.58%, 27.91% and 18.60% respectively. The site of the pain was multiple in 60.47% with a predominance of osteoarticular pain in 81.39%. The psycho-affective impact was certain in 51%. Analgesic use was noted in 55.81%, with the use of level 1 (79.2%) and level 2 (25%). The response of analgesics to chronic pain was unchanged (4.16%), reduced (54.16%) and amended (41.66%). Analgesic dependence was noted in 20.83%. In univariate analysis, only calcium levels were statistically significantly related to chronic pain. In multivariate analysis, the factors associated with pain were age, length of time on haemodialysis and blood calcium.

Conclusion: The prevalence of chronic pain is relatively high. It requires a special attention by all chronic haemodialysis staff. Hence, the use of valid assessment tools in dialysis patients would allow a better estimation of the prevalence.

The ESRD Conditions for Coverage outline the duties of a dialysis unit medical director, which include several quality, safety, and educational domains. Many of these roles involve leadership abilities that are neither obvious nor learned during the medical director's education. Patients and staff feel free to express their concerns about suboptimal systems without fear of retaliation, and there is a continual iterative process of quality improvement and safety that appreciates input from all stakeholders, thanks to the efforts of a competent medical director. Because policies and procedures make it easier to do the right thing, this eventually reduces the use of shortcuts and workarounds that may threaten patient safety and quality. Communications skills, employee empowerment, resource allocation, mentoring, team building, and strategic vision are all important aspects of the medical director's leadership. To transmit a sense of accessibility and dedication, the medical director must be present in the dialysis unit for extended durations. Many dialysis medical directors would benefit from leadership training, whether it came from within or outside their dialysis organisation.