Renal replacement therapy (RRT) in Rwanda: benefits, challenges and recommendations

Worldwide, non-communicable diseases (NCDs) are a global health problem as they contribute to approximately 60% of deaths. There is limited data on the management of NCDs including kidney diseases at all levels of health care delivery in Rwanda. Yet renal replacement therapy (RRT), which seems to be the only option to provide an acceptable quality of life to patients with end stage renal disease (ERSD), is yet to be well established in Rwanda. Although there are policies and guidelines on renal replacement modalities in Rwanda, inadequate human and financial resources in the area of nephrology care remains a challenge. The purpose of the paper is to document an overview of kidney diseases and Renal Replacement Therapy (RRT) in Rwanda and highlight the benefits, challenges and recommendations to provide future directions for nephrology care. Improved knowledge about renal conditions and their risk factors is the initial step to create major interventions for improved kidney quality of life (KQoL) among patients with end stage renal disease. Notwithstanding, the Government of Rwanda has established several dialysis centers intended to provide services and for maintenance of the health status of patients with renal conditions. Further studies are necessary to provide evidence on the outcomes of RRT

Calcific uraemic arteriolopathy (calciphylaxis) in patients on renal replacement therapy

Background. Calcific uraemic arteriolopathy (calciphylaxis) is an unusual and potentially fatal condition characterised by small-vessel calcification and ischaemic skin necrosis. It mainly affects patients with end-stage renal disease (ESRD) on haemodialysis, but may rarely occur in the absence of ESRD in conditions such as primary hyperparathyroidism, malignancy, alcoholic liver disease and connective tissue disease.Methods. We reviewed the records of all patients diagnosed with calciphylaxis while on renal replacement therapy at Tygerberg Hospital, Cape Town, South Africa, between 1990 and 2014, to describe its presentation, course and final outcome.Results. Nineteen patients developed calciphylaxis over this period. Their median age was 34 years and 13 (68.4%) were female. Fifteen (78.9%) had received a kidney transplant. All patients had painful skin lesions that rapidly progressed to infarction. Small-vessel calcification was seen on skin biopsy in 13 patients. Twelve patients had hyperparathyroidism. Several of the transplanted patients had been treated for graft rejection in the year preceding the diagnosis. Treatment consisted of good wound care and efforts to normalise serum calcium and phosphate levels. Five patients received an urgent parathyroidectomy. The outcome was fatal in 17 patients, with sepsis being the main cause of death.Conclusions. In our patients, calciphylaxis carried a worse prognosis than previously reported internationally. It should always be considered in the differential diagnosis of painful skin lesions in the dialysis or transplant patient

Mise au point sur l'insuffisance renale chronique : Interet de depistage et ses consequences

L'insuffisance renale chronique est une maladie progressive et longtemps silencieuse. Elle necessite au stade terminal; un traitement de suppleance par dialyse ou transplantation renale. Dans pres de 30% de cas; la prise en charge de l'insuffisance renale chronique se fait a un stade terminal; dans un contexte d'urgence avec risque de deces en l'absence de prise en charge specialisee de nephrologie ou de reanimation (disposant de structures adaptees) [3]. Il existe pourtant a l'heure actuelle; des moyens considerables pour ralentir la progression de l'insuffisance renale chronique; par une meilleure prise en charge de certaines pathologies; comme l'HTA et le diabete; mais aussi de certaines maladies glomerulaires revelees par une proteinurie [5;8]. Ainsi le depistage de l'insuffisance renale chronique a un stade precoce est un objectif essentiel de sante publique [7]

Exploring the Bio-Psychosocial Effects of Renal Replacement Therapy amongst Patients in a State Hospital in South Africa

This article described a qualitative study that investigated the bio-psychosocial effects of renal replacement therapy on patients in a state hospital in South Africa. The study aimed to investigate the level of debility experienced by patients undergoing haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) and to explore how this debility affects their bio-psychosocial functioning. Respondents comprised a small sample of HD and CAPD patients. Using an interview schedule as the research tool allowed rich data to be uncovered. Content analysis and reducing data into themes facilitated data analysis. Although the study was not quantitative and thus did not allow for comparative analysis; themes regarding the levels of stress emerged amongst participants. The HD group voiced greater concerns regarding the degree of debility and psychosocial distress than the CAPD group. Governmental support for holistic kidney disease treatment and careful teaming of key role players to reduce the severity and far-reaching bio-psychosocial effects of HD and CAPD treatment are recommended

Psychological Disorders and Quality of Life among Sudanese Dialysis Patients and Renal Transplant Recipients

Introduction: Psychiatric illness is common among patients with chronic disorders; particularly in those with end-stage renal disease on renal replacement therapy (RRT). Patients with a functioning renal allograft have an improved quality of life (QOL) compared to patients on dialysis. Objective: to evaluate the psychological disorders and QOL among dialysis patients and renal transplant recipients. Patients and Methods: This is a prospective cross-sectional study that included 168 patients on RRT. Their psychological health status was assessed through clinical examination and relevant designed questionnaires .The data obtained were fed to the SPSS for analysis. Significance was assumed at P 0.05. Results: Out of 168 ESRD Sudanese patients; 43 (25.6) received renal allograft. The frequency of depression was 90 (72) and nine (25.6) of patients on dialysis; and kidney transplant recipients respectively. Anxiety was reported with significant difference (p 0.001) in the dialyzed patients compared to kidney transplant recipients. Sleep disorders were experienced by 81 (64.8) of dialyzed; and nine (20.9) of kidney transplant recipients (P0.001). Conclusion: Psychological disorders in dialyzed ESRD patients have significant effect on the quality of life and may have a tremendous impact on mortality and morbidity. For this reason; supportive management by psychologist and or psychiatrist is recommended for early detection and alleviation of symptoms of mood and mind disturbances. For most patients with ESRD kidney transplantation offers the greatest potential for restoring healthy productive life