Prevalence of SARS-CoV-2 antibodies in hemodialysis patients in Senegal: a multicenter cross-sectional study.

BACKGROUND: Hemodialysis patients are among high-risk groups for COVID-19. Africa is the continent with the lowest number of cases in the general population but we have little information about the disease burden in dialysis patients. OBJECTIVES: This study aimed to describe the seroprevalence of SARS-CoV-2 antibodies in the hemodialysis population of Senegal. PATIENTS AND METHODS: We conducted a multicenter cross-sectional survey, between June and September 2020 involving 10 public dialysis units randomly selected in eight regions of Senegal. After seeking their consent, we included 303 patients aged ≥ 18 years and hemodialysis for ≥ 3 months. Clinical symptoms and biological parameters were collected from medical records. Patients' blood samples were tested with Abbott SARS-CoV-2 Ig G assay using an Architect system. Statistical tests were performed with STATA 12.0. RESULTS: Seroprevalence of SARS-CoV-2 antibodies was 21.1% (95% CI = 16.7-26.1%). We noticed a wide variability in SARS-CoV-2 seroprevalence between regions ranging from 5.6 to 51.7%. Among the 38 patients who underwent nasal swab testing, only six had a PCR-confirmed infection and all of them did seroconvert. Suggestive clinical symptoms were reported by 28.1% of seropositive patients and the majority of them presented asymptomatic disease. After multivariate analysis, a previous contact with a confirmed case and living in a high population density region were associated with the presence of SARS-CoV-2 antibodies. CONCLUSION: This study presents to our knowledge the first seroprevalence data in African hemodialysis patients. Compared to data from other continents, we found a higher proportion of patients with SARS-CoV-2 antibodies but a lower lethality rate.

Hypertension treatment with Combretum micranthum or Hibiscus sabdariffa, as decoction or tablet: a randomized clinical trial.

Hibiscus sabdariffa L. (local names: bissap, karkade) and Combretum micranthum (kinkeliba) are widely known in traditional medicines and popular beliefs for their antihypertensive effect. This study assessed the clinical effectiveness of these two plants in the galenic forms of tablet and brew (decoction) in noncomplicated hypertensive patients. In total, 219 hypertensive patients with systolic blood pressure (SBP) between 140 and 180 mmHg and/or diastolic blood pressure (DBP) between 90 and 110 mmHg, without cardiovascular or renal complications, were involved in a multicentric randomized clinical trial in Senegal comparing five treatment regimens: bissap tablets (2 × 375 mg/day), bissap brew (10 g of calyx/day), kinkeliba tablets (2 × 200 mg/day), kinkeliba brew (10 g of leaves/day), and captopril (2 × 50 mg/day) as control. During the 6 months' follow-up, a significant and equivalent decrease of SBP was observed with the herbal drug approach (-19.5 ± 16.1 mmHg, p < 0.001) and control group (-19.7 ± 16.7, p < 0.001). Regarding the galenic forms, the brews tended to be slightly more effective than tablets (reduction of SBP: -20.7 ± 15.1 mmHg vs -18.7 ± 16.7). The rates of clinically significant effectiveness (decrease in SBP ≥ 10 mmHg) were 75%, 67%, and 65% with bissap, kinkeliba, and captopril, respectively. After 6 months, target blood pressure of <140/90 mmHg was attained by 49% of patients with bissap, 51% with kinkeliba and 40% with captopril. Bissap and kinkeliba appeared, at doses utilized, to be as effective as captopril over the 6 months' follow-up. In subsequent studies, brews might be started with a lower dosage.

Trends in hepatitis C infection among hemodialysis patients in Senegal: results of a decade of prevention.

Chronic kidney disease is an emerging public health issue in Africa. At end-stage renal disease (ESRD), patients need hemodialysis (HD), which may expose them to blood transmitted infections, such as the hepatitis C virus (HCV). Sub-Saharan Africa has the highest HCV prevalence in the world, but data on HD patients is scarce and shows an exceptionally high rate in Senegal. To assess the efficacy of preventive measures in reducing HCV infection among dialysis patients, we retrospectively conducted a cross-sectional study in three Senegalese HD centers, including all HD patients who performed HCV serology between 1 st and 31 st August 2011. The demographical, clinical, and biological data were collected for each patient. We included 106 patients with a mean age of 43.4±15.8 years (range from 18 to 80 years), with 52.8% males. HD vintage was 60.5±15 months (range from six to 206 months). The main causes of kidney disease included nephrosclerosis (36%) and diabetes (24%). The prevalence of HCV was 5.6%, with one patient co-infected with the hepatitis B virus. After adjusting for age and sex, HD vintage was the only risk factor for HCV infection, while nutritional status and the number of blood transfusions did not significantly correlate with HCV infection. We conclude that during the past decade, the prevalence of HCV infection in HD patients living in Senegal has declined considerably, mainly because of improved transfusion measures and better clinical practice in the HD centers. Such efforts should be maintained and reinforced to reduce the seroprevalence of HCV infection.

Mineral and bone disease in black african hemodialysis patients: a report from senegal.

BACKGROUND: Chronic kidney disease related mineral and bone disease (CKD-MBD) is a worldwide challenge in hemodialysis patients. In Senegal, number of dialysis patients is growing but few data are available about their bone disorders. OBJECTIVES: To describe patterns of CKD-MBD in Senegalese dialysis patients. PATIENTS AND METHODS: We performed a cross-sectional study including patients from three dialysis centres in Senegal. Diagnosis of different types of CKD-MBD relied on clinical, biological and radiological data collected from medical records in dialysis. RESULTS: We included 118 patients and 79 of them presented CKD-BMD (prevalence of was 66.9 %). Mean age of CKD-MBD patients was 47.8 ± 15.7 years (16-81 years) and sex-ratio (Male/Female) was 1.15. Secondary hyperparathyroidism was the most frequent disorder (57 patients) followed by adynamic bone disease (21 patients) and osteomalacia (1 patients). The main clinical manifestations were bone pain (17.5% of cases), pruritus (36.8% of cases) and pathological fractures (2.5% of cases). Bone biopsy was not available. Valvular and peripheral vascular calcification were present in 24.5% and 21.2% of patients respectively. Management of CKD-MBD included optimization of dialysis, calcium bicarbonate, sevelamer, vitamin D analogues and calcimimetics. The NKF/DOQI recommended levels of serum calcium, phosphate and parathormone PTH were not achieved in one third of patients. Six patients presented major cardiovascular events during their dialysis period. CONCLUSIONS: CKD-MBD are frequent in Senegalese hemodialysis patients and they are dominated by high turn-over disease. Clinical and biological manifestations are unspecific and accurate diagnoses are often difficult in absence of histomorphometry. Treatment is suboptimal for many patients in a context of limited resources.

The burden of erectile dysfunction in dialysis patients in Senegal.

Erectile dysfunction (ED) is very common in dialysis patients because of organic and psychological risk factors. It has a negative impact on patients' quality of life. In Senegal, ED is assumed to be frequent in the general adult population but its prevalence in dialysis patients is unknown. This cross-sectional study aimed to assess the prevalence and risk factors associated with ED in Senegalese dialysis patients. Seventy dialyzed men >18 years old were included. Erectile dysfunction was assessed using the abridged version of International Index of Erectile Function already validated in dialysis patients. Multivariate analysis was performed to identify the factors associated with ED in patients. The mean age of the patients was 52 ± 11.3 years (21-70 years) and the median dialysis vintage was 39.4 months (interquartile range 9-51 months). The prevalence of ED was 81.5% for all patients (80% in hemodialysis and 81.75% in peritoneal dialysis). Severe ED was found in 11.5% of patients. The prevalence of ED was 74.5% in patients younger than 50 years and 86.6% in those 50 years or older. Marital status, comorbidity, hemoglobin level, and use of antihypertensive drugs were not different between patients with and without ED. Libido was conserved in 77% of patients and 44.7% were not satisfied during sexual intercourse. Multivariate analysis identified age and dialysis vintage as risk factors of ED in our patients. Only 7 patients received treatment for ED and 22% sought a consultation with a specialist (urologist and psychologist).