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INTRODUCTION: Non-adherence behaviors are very common in chronic hemodialysis patients, it is estimated that only one patient out of two complies with medical prescriptions, these behaviors are associated with a higher risk of morbidity and adverse events as well as increased expenses for health systems. The aim of our study was to assess adherence to long-term prescribed medications in chronic hemodialysis patients, using a mobile application named TestObs, as well as to determine the main factors influencing medication adherence. METHODS: We conducted a prospective descriptive study, between January and June 2019. We developed a mobile application named TestObs, downloadable on playstore for android devices, which assesses with the Girerd questionnaire, the adherence to the main medications taken by chronic hemodialysis patients. We included adult patients, with a duration of dialysis of more than 6 months, all patients who downloaded TestObs, tested their adherence to their medication by answering the questionnaire. We created a web-based platform, where data was collected from the application and then analyzed and tabulated. Regarding the statistical analysis, the normal distribution of the variables was studied by the Kolmogorov-Smirnov test, the analysis of the qualitative variables used the Pearson's Chi2 and Fisher's statistical test, the Hosmer Lemeshow test was used to examine the quality of the final logistic regression model. RESULTS: We collected 90 adult chronic hemodialysis patients, 51 of them (56%) were selected to enter the study. We found good compliance in 46.15% of patients, minor noncompliance in 32.87%, and noncompliance in 20.98%. In multivariate analysis, the factors influencing adherence were the presence of other comorbidities (diabetes and vision problems) and the number of pills per day. DISCUSSION: In this study, we report treatment adherence problems in 53.85% of patients, our results are close to the data reported in hemodialysis patients in the literature, different factors influence the quality of treatment adherence, in our study poly-medication and the presence of other comorbidities were the statistically significant determinants. The new technology assessment instruments were used in hemodialysis patients and were able to provide real-time monitoring of adherence behaviors. CONCLUSION: We believe that mobile health technologies hold promise for assessing and improving medication adherence in hemodialysis patients, so we suggest that TestObs represents an accessible and free of charge tool, based on a validated questionnaire, that can allow patients to benefit from new technologies for medical monitoring, and may eventually constitute an interventional program to improve medication adherence; however, this technological tool should not replace traditional therapeutic education; prior targeting of non-adherent patients and an optimal combination of several tools can help improve adherence in these patients.

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BACKGROUND: The effect of COVID-19 pandemic on end stage renal disease patient who should initiated dialysis are limited in Sub-Saharan Africa is unknown. We sought to describe the epidemiologic and clinical profile of newly admitted patient in chronic haemodialysis during the COVID-19 pandemic in Cameroon and evaluate their survival between 90days of dialysis initiation. MATERIAL AND METHOD: We conducted a cohort study of 6months from April to October 2020. End stage renal disease patients newly admitted in the haemodialysis facility of the General Hospital of Douala were included. Patients with confirmed or suspected COVID-19 were identified. Socio-demographic, clinical and biological data at dialysis initiation as well as mortality between the 90days of dialysis initiation were registered. RESULTS: A total of 57 incident patients were recorded from April to October 2020 with a monthly mean of 9.5 patients. The mean age was 46.95±13.12years. Twenty-four COVID-19 were identified with a frequency of 49% among emergency admission. Pulmonary œdema (79.2% vs. 42.4%; P=0.006) and uremic encephalopathy (83.4% vs. 53.6%; P=0.022) were more common in COVID-19. The overall survival at 90days was 48% with a tendency to poor survival among COVID-19 and patients with low socioeconomic level. In Cox regression, low socioeconomic level increase the risk of instant death by 3.08. CONCLUSION: SARS-CoV2 seem to increase nephrology emergency and poor survival in haemodialysis at 90days.

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Erectile dysfunction is a common pathology in the general population. The frequency of these erectile disorders is increased in some particular populations such as patients with renal impairment in which it is estimated between 50% and 70% depending on the stage of renal failure. AIMS: Our study aims to study erectile dysfunction in chronic hemodialyzed male patients. METHOD: This is a descriptive prospective study carried out during the period from April 3 to August 31, 2017 having covered 65 chronic hemodialyzed patients for more than 12 months. RESULT: In our study the prevalence of DE was 70.8% and moderate in 13.8%, severe in 30.8%, mild in 26.2%. Testosteronemia was normal in 83.1% of cases and significantly lower in patients with sexual disorders p = 0.030. Libido disorders were observed in 57% of our patients and significantly related to a decrease in testosteronemia p = 0.001. Vascular nephropathy was the most common etiology, i.e. 50.8% of cases followed by chronic Glomerulonephritis 24.6% and in 13.8% of cases no underlying etiology was found.

la dysfonction érectile est une affection fréquente dans la population générale. La fréquence de ces troubles de l'érection est majorée dans certaines populations particulières comme les patients insuffisants rénaux chez qui elle est estimée entre 50% à 70% selon le stade de l'insuffisance rénale. BUT: Notre étude a pour objectif d'évaluer la prévalence la dysfonction érectile chez les patients hémodialysés chroniques de sexe masculin. MÉTHODE: Il s'agit d'une étude prospective descriptive réalisée durant la période du 3 Avril au31 Aout 2017 ayant porté sur 65 patients hémodialysés chroniques depuis plus de 12 mois. RÉSULTAT: Dans notre étude la prévalence de la dysfonction érectile était de 70,8 %. Elle est modérée dans 13,8 %, sévère dans 30,8 %, et légère dans 26,2%. La testosteronémie était normale dans 83,1 % des cas et significativement plus basse chez les patients présentant des troubles sexuels p = 0,030. Les troubles de la libido étaient observés chez 57 % de nos patients et significativement liés à une diminution de la testostéronémie p = 0,001. La néphropathie vasculaire était l'étiologie la plus fréquente soit 50,8 % des cas puis la glomérulonéphrite chronique 24,6% et dans 13,8 % des cas aucune étiologie sous-jacente n'a été trouvée.

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AIM: Hemodialysis is the only method of renal replacement in Mali. Purpose of this work: to study the evolution of chronic hemodialysis. PATIENTS AND METHODS: In a retrospective study, we used the medical charts of 150 patients. The studied parameters were the epidemiology and clinic profile of patients, the risk factors, the quality and the impact of the benefits on the survival. The data were analyzed on SPSS 12.0 for Windows with p <0.05 as the significance value. RESULTS: The mean age was 40.45 years (15 years and 77 years). Patients have a low income in 60%. The hemoglobin level was less than 9 g/l in 63.3%. Kidney vascular disease was the most frequent causes in 42%. Hyperphosphataemia was found in 38.6%. The lipid balance was disturbed in 73.9%. A central catheter was used directly in 78.7%. The mortality rate was of 37.3%. The death was due to hypertrophic cardiomyopathy in 35.5% (p = 0.002). Low hemoglobin (p = 0.0002), central catheterization (p=0.008), cardiovascular complications (p= 0.007) and hemodialysis duration (p = 0.00001) are the risk factors for high mortality. CONCLUSION: The duration of life in hemodialysis remains linked to the complications of renal damage and early management.

OBJECTIF: L'hémodialyse est la seule méthode de suppléance rénale au Mali. But du travail : étudier l'évolution des hémodialysés chroniques. PATIENTS ET MÉTHODES: Etude rétrospective transversale de 3 ans chez 150 patients. Les paramètres étudiés : le profil épidémioclinique, les facteurs de risques, la qualité et l'impact des prestations sur la survie. Les données ont été analysées sur SPSS 12.0 pour Windows avec p<0,05 comme valeur de significativité. RÉSULTATS: L'âge moyen des patients était de 40,45 ans. Le revenu était faible chez 60%. Le taux d'hémoglobine était inférieur à 9g/dl chez 63,3%. La néphropathie vasculaire était la principale cause 42%. L'hyperphosphorémie isolée était retrouvée chez 38,6%. Le bilan lipidique était perturbé chez 73,9%. L'abord vasculaire était le cathéter central chez 78,7%. La mortalité était de 37,3%. Le décès était dû à la cardiomyopathie hypertrophique chez 35,5% (p = 0,002). Le taux d'hémoglobine bas (p=0,0002), le KT central (p=0,008), les complications cardiovasculaires (p=0,007) et la durée en hémodialyse (p=0,00001) sont des facteurs de risques de mortalité élevée. CONCLUSION: La durée de vie en hémodialyse reste liée aux complications de l'atteinte rénale et à la prise en charge précoce.

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INTRODUCTION: The appearance of spontaneous subdural hematoma (SSDH) is a rare phenomenon in chronic hemodialysis and is burdened with significant morbidity and mortality. It's prevalence remains low in Sub-Saharan Africa, is 0.43%. We report a case of SSDH in a young hemodialysis patient with favorable outcome after medico-surgical management. CLINICAL OBSERVATION: This is a 35-year-old patient who has been hemodialysed since June 2016 for chronic renal insufficiency of hypertensive origin. He was admitted on 18 July 2018 in the nephrology department of CHU Point G for intense headaches in a context of dysarthria. They associate themselves with speech disorders, photo-phonophobia, uncontrollable nausea and vomiting. It does not report any notion of head trauma. The physical examination noted dysarthria, a right pyramidal syndrome made of right Babinsky sign, right arm deficit at 4/5, and right hemicorporeal hyperkinesia. He weighed 62 kg for 165 cm, the blood pressure was 187 / 110 mmHg. The patient had clinical signs of extracellular dehydration. Non-injected cerebral CT showed an acute left sub-dural hematoma with peri-lesional cerebral hypodensity. Surgical evacuation of the hematoma through a trephine hole is performed under local anesthesia. The postoperative course was simple. His hemodialysis sessions were done without heparin from diagnosis until 23 days post operatively. CONCLUSION: Spontaneous subdural hematoma is multifactorial and rare in the dialysis patient. Despite high morbidity and mortality, hemodialysis should not refute surgical management of subdural hematoma.

INTRODUCTION: L'apparition d'un hématome sous-dural (HSD) spontané est un phénomène rare en hémodialyse chronique et est grevé d'une morbi-mortalité importante. Sa prévalence reste faible en Afrique Sub-Saharienne soit 0,43%. Nous rapportons un cas d'HSD spontané chez un patient jeune hémodialysé avec issue favorable après une prise en charge médico-chirurgicale. OBSERVATION CLINIQUE: Il s'agit d'un patient de 35 ans, hémodialysé depuis juin 2016 pour une insuffisance rénale chronique d'origine hypertensive. Il a été admis le 18 juillet 2018 dans le service de néphrologie du CHU Point G pour des céphalées intenses dans un contexte de dysarthrie. Ils s'y associent des troubles de langage, d'une photo-phonophobie, des nausées et des vomissements incoercibles. Il ne rapporte aucune notion de traumatisme crânien. L'examen physique notait une dysarthrie, un syndrome pyramidal droit fait de signe de Babinsky droit, un déficit du bras droit à 4/5, et une hyperkinésie hémicorporelle droite. Il pesait 62 kg pour 165 cm, la pression artérielle était à 187/110 mmHg. Le patient présentait des signes cliniques de déshydratation extracellulaire. La tomodensitométrie cérébrale sans injection montrait un hématome sous-dural aigu gauche avec hypodensité cérébrale péri-lésionnelle. L'évacuation chirurgicale de l'hématome à travers un trou Trépan est réalisée sous anesthésie locale. Les suites opératoires ont été simples. Ses séances d'hémodialyse étaient faites sans héparine depuis le diagnostic jusqu'à j 23 en post opératoire. CONCLUSION: L'hématome sous-dural spontané est multifactoriel et rare chez le patient dialysé. Malgré une forte morbi-mortalité, l'hémodialyse ne doit pas réfuter une prise en charge chirurgicale de l'hématome sous-dural.

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PURPOSE: To measure lacrimal secretion and to investigate dry eye symptoms in chronic hemodialysis patients. PATIENTS AND METHODS: This was a cross-sectional descriptive study carried out in the hemodialysis center of Douala General Hospital from June to August 2016. The degree of symptomatology related to dry eye was assessed by the Ocular Surface Disease Index (OSDI) questionnaire. Lacrimal secretion was measured by the Schirmer test without anesthesia. We defined normal as wetting>10mm and hyposecretion as a value≤10mm after 5minutes. RESULTS: Thirty-five patients were involved in the study, 16 men (45.7%) and 19 women (54.3%) for a total of 70 eyes examined. The mean age was 41.9 years, with an average duration of dialysis of 35.5 months±30.2. The symptoms were "normal" for 21 patients (60%), "minimal" for 5 (14.3%), "moderate" for 8 (22.9%) and "severe" for 1 (2.8%). Lacrimal hyposecretion was found in 19 eyes (27.1%). It was severe in 8 eyes. A correlation was found between diabetes, gender and hyposecretion. CONCLUSION: Hemodialysis patients are likely to develop lacrimal hyposecretion mostly because of comorbities. It is therefore important to systematically evaluate lacrimal secretion in these patients.

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Calcific uremic arteriolopathy, also called calciphylaxis, is a rare and severe disorder that presents with skin ischemia and necrosis, sometimes it presents with systemic necrosis, the process is secondary to the obliteration of the arterioles first by sub-intimal calcium deposits and then by thrombosis. These lesions can often lead to death due to infectious complications and comorbidities such as diabetes, obesity, arteritis, diffuse vascular calcifications, heart disease and undernutrition. The diagnosis is suggested by the characteristic ischemic skin lesions and their distribution, often bilateral and painful, associeted with calcific uremic arteriolopathy risk factors (phosphocalcic abnormalities, anti-vitamin K). The presence of radiological vascular calcifications is highly suggesting the diagnosis, but remains not very specific. The indication of skin biopsy is rare and reserved for difficult diagnoses. The goals of treatment are: reduce the extension of calcification and treatment of mineral and bone metabolism disorders of end-stage renal disease, dialysis adequacy, local treatment of skin lesions, tissue oxygenation, pain management, discontinuation and contraindication of medications that may contribute to the disorder. We propose to discuss it from a review of the literature and illustrate it with five clinical cases.

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INTRODUCTION: Tumoral calcinosis is a rare benign disease, defined by the presence of calcified deposits in periarticular tissues. It can be hereditary or secondary at chronic renal failure at the stage of dialysis. This work illustrates the contribution of single-photon emission computed tomography (SPECT/CT) in the diagnosis and management of tumoral calcinoses in a chronic hemodialysis patient, based on a clinical case. CASE REPORT: A 62-year-old patient, chronic hemodialysis since 24 years, presented a mechanical pain shoulders, knees and hips with limitation of joint mobility. The clinical exam found a mass of soft tissue in the buttocks. The radiological exam showed the presence of periarticular calcifications with no bone involvement. The SPECT/CT revealed a multifocal tumoral calcinosis affecting shoulders, elbows, wrists, hips and knees, associated with alveolar and abdominal calcinosis. DISCUSSION AND CONCLUSION: Tumoral calcinosis is a distinct clinicopathological entity characterised by periarticular soft tissue calcium deposits. The SPECT/CT is important in the diagnosis, the assessment of extension and monitoring of tumoral calcinosis after treatment.

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In early 2012, due to national supply disruption, the methoxy-polyethylene glycol-epoetin beta (CERA) was no longer available and has been replaced by darbepoetin alfa (DA) in all dialysis patients. Official recommendations for the replacement of one by the other is missing or unclear. On this occasion, we wanted to examine how the shift from CERA to DA was done in terms of dose conversion factor and the other factors that could have influenced the dose of DA prescribed (hemoglobin, patient weight, dose of CERA). This retrospective multicenter open conducted in six dialysis centers in Alsace is the first large study (n=263) that evaluated the switch from CERA to DA in all chronic hemodialysis patients. We found that the instantaneous ratio of dose adjustment is close to 1 and that nephrologists are mainly based on the dose of CERA for determining the DA dose, before hemoglobin and weight. However, establishing a true dose-response ratio between the two molecules requires a long term prospective study.

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INTRODUCTION: Undernutrition (UN) in chronic hemodialysis (CHD) is a recurrent complication and constitutes a major public health problem. This work aims to evaluate the effects of our nutritional strategy (NS) developed among malnourished patients (pts) in CHD. This is a prospective observational study conducted for 12 months (M) in a cohort of 132 pts in CHD including 49 women, mean age 66 ± 16 years and the dialysis vintage 72 ± 74 months. This NS is based on the action of a multidisciplinary team; it provides for moderate UN pts one first phase of an optimization of protein and energy intake in the daily meals; then depending on the clinical course a second phase of oral supplementation at home. For severe UN pts, the optimization of daily meals and the oral supplements at home are reinforced with perdialytic oral supplementation. This modality was also prescribed for moderate UN pts with poor compliance at home. In case of loss of appetite, anorexia, gastrointestinal intolerance or inadequate oral intakes the relay is made by the intradialytic parenteral nutrition (IPN). Methods consist in the evaluation of the serum albumin (ALB), CRP, normalized PCR (nPCR), and Kt/V ratio of urea at baseline (day (D) 0) and at endpoint (M12). The ALB was measured by immunoturbidimetry. Three nutritional profiles were defined, severe UN if ALB ≤ 35 g/L, moderate UN if 35

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AIM: Pain is an unpleasant experience that deeply affects patients' quality of life and emotional state. Pain's epidemiology and characteristics in chronic hemodialysis are not well known and insufficiently analysed. The aim of our study was to assess the prevalence, characteristics, impact and treatment of pain in our hemodialysis patients and determine its related associated factors. METHODS: We performed a cross-sectional study including 93 chronic hemodialysis patients. We collected demographic data as well as the aspects of the reported pain on the basis of the concise pain questionnaire, and finally inferred the risk factors related to pain occurrence. Chronic pain was defined as a pain that has existed for over three months. RESULTS: The prevalence of pain was 70.9% (n=66), mean age 55.3±13.3 years, sex ratio 30 males/36 females, mean duration of hemodialysis 82.4±57.29 (6-252) months. This pain was permanent, daily, intermittent and rare in respectively 9%, 28.7%, 48.4% and 13.6% of cases. It was mild, moderate, severe or unbearable in respectively 42.8%, 23.8%, 19% and 14.2% of cases. Pain was multifocal in 57.4% of cases. The most frequently reported pain sites were: shoulders (47.2%), head (41.2%), knee (34.5%) and back (20%). Thus, 53.8% of patients reported using analgesics, with a daily intake, frequent or rare in respectively 28%, 44% and 28% of cases. The comparison between the group of patients reporting pain to the one without pain complaints in univariate statistical analysis found that age, Charlson's score, interdialytic weight gain and the rate of two dialysis sessions per week were linked to pain occurrence. However, in multivariate analysis, only age remained as a pain-associated factor. CONCLUSION: Pain in chronic hemodialysis patients is a very common complaint. Therefore, it is necessary to assess it regularly, using a suitable questionnaire.

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BACKGROUND: In dialysis patients, a misevaluation of dry weight may lead to an increased morbidity and mortality. The aim of this cross-sectional multicenter study was to evaluate the association between residual urinary sodium excretion and extracellular volume status in chronically treated hemodialysis patients. PATIENTS AND METHODS: Dry weight was determined clinically and by whole-body bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care) prior to a mid-week session in 40 chronic hemodialysis patients with significant residual diuresis (more than 250 mL per day) and receiving treatment in four dialysis centers. Regarding their hydration status assessed by the Body Composition Monitor and in comparison to a healthy reference population, patients were assigned to 1 of the 3 categories: overhydrated, normohydrated and dehydrated. Urine output, urinary sodium excretion and residual renal function were measured for all patients within 30 days before dry weight assessment. RESULTS: The median post-HD session FO was of-0.40 L (IQR: from-1.95 to+0.90) and the median residual urinary sodium excretion was of 64 mmol/L (IQR: 46-79). Among these patients, 16 were normohydated, 16 were dehydrated and 8 were overhydrated. There was a linear relationship between the hydration status after HD session and the urinary sodium excretion (estimate: 5.6±1.5; p<0.001). Compared with normohydrated patients, overhydrated patients had a higher residual urinary sodium excretion (estimate: 26±10; p<0.01). CONCLUSION: In this study, urinary sodium excretion is associated with the hydration status evaluated by whole-body bioimpedance spectroscopy.

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We report our experience of thrice-weekly warfarin administration, at the end of the dialysis session, in 12 patients (average age: 79 ± 5 years). In 10 cases, indication for anticoagulation therapy was atrial fibrillation, in one case a mechanical heart valve, in another case axillo femoral bypass. The International Normalized Ratio (INR) therapeutic goal was between 2 and 3, except for the patient with a mechanical aortic heart valve, whose goal was between 2.5 and 3.5. The INR was determined during the first dialysis session of the week. The thrice-weekly warfarin dose was based on this result. INR stability was assessed for each patient over an uninterrupted period of treatment of at least 6 months. The average duration of warfarin treatment was 20 ± 5 months. One in two patients had hypertensive nephropathy. The average Charlson co-morbidity score was 9 ± 1. Four patients were also taking aspirin or clopidogrel. The 10 patients with atrial fibrillation had an average CHA(2)DS(2)-VASc score of 4.4 ± 0.8. The average haemorrage risk HAS-BLED score was 3.3 ± 0.6. The average weekly warfarin dose was 23 ± 5 mg. No thrombotic events were observed. The side effects of warfarin were minor in most cases: (1) INR more than 6 in two cases without associated bleeding; (2) minor bleeding (nose, bladder) in three cases. One case of skin necrosis was observed. No cases of major bleeding (requiring blood transfusion) were observed. Only one patient was admitted into hospital as a result of warfarin treatment (the case of skin necrosis). Five hundred and forty-seven INR results were analyzed: 65% of these results were within the therapeutic goal, only 3% were either beneath 1.5 or over 4. To conclude, warfarin administration at the end of the dialysis session is efficient and associated with remarkable INR stability in the goal. It enables precise dose adaptation and optimum therapeutic observance, which in turn reduces the risk of bleeding.

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