Suivi post-greffe rénale à Kinshasa : analyse de survie et des facteurs associés à la perte de la fonction rénale du greffon

Contexte et objectifs. La greffe rénale n?est pas encore pratiquée en RDC, ce qui oblige les patients à se faire opérer à l?étranger. Le suivi post-greffe est fait localement par des médecins congolais, mais n?a pas encore été évalué. Nos objectifs étaient de déterminer la survie des greffons et d?identifier les facteurs associés à la perte de la fonction rénale du greffon chez les patients suivis à Kinshasa.Méthodes. Nous avons colligé les dossiers des patients qui ont bénéficié d?une greffe rénale à l?étranger (86% en Inde) et dont le suivi post-greffe a été effectué dans les hôpitaux de Kinshasa entre 2000 et 2017. Les paramètres d?intérêt étaient : l?âge au moment de la greffe, le type de greffe, la spécialité du médecin qui avait sélectionné le donneur et qui a fait le suivi post-greffe à Kinshasa, la régularité de prise des immunosuppresseurs et l?issue de la greffe (complications, rejet ou non, reprise ou non en dialyse). Les facteurs associés à la perte de la fonction rénale du greffon (défini par le rejet, une néphropathie chronique du greffon ou la reprise en dialyse) étaient recherchés en analyse univariée. La survie des greffons a été décrite par la méthode de Kaplan-Meier.Résultats. Au total, 29 sujets (moyenne d?âge à la greffe : 48±15 ans ; 83% d?hommes) ont été ou sont suivis en post-greffe rénale à Kinshasa. La greffe avec donneur vivant a été majoritaire (97%), avec 7% de donation ABO différent.Le rejet a été diagnostiqué dans 24% des cas. Les autres complications rapportées étaient : la néphropathie chronique du greffon (24%), les complications urologiques ou vasculaires per-opératoires (3%), la nécrose tubulaire aiguë transitoire (7%), les cancers (10%), le diabète cortisonique (7%) et la réactivation d?une infection par le VHC (3%). 0nze patients (38%) ont été repris en dialyse. La prise irrégulière des immunosuppresseurs (0R :3,33 ; IC 95% : 1,71-6,49 ; p=0,002) et le suivi par un médecin non néphrologue (OR: 2,88 ; IC 95% : 1,64-5,03 ; p=0,004) étaient les deux facteurs associés à la perte de la fonction rénale du greffon. La survie moyenne des greffons était de 61 mois dans le groupe entier, meilleure lorsque la préparation/le suivi était fait par un néphrologue (83 mois vs 41 mois ; p=0,026).Conclusion. Nonobstant un faible échantillonnage, ces donnent révèlent une moins bonne survie des greffons après la transplantation rénale chez les patients suivis à Kinshasa, notamment lorsque la prise en charge n?est pas faite en milieu spécialisé. Une prise de conscience collective et la nécessité d?établir des normes et de bien préparer les patients s?imposent

Uncontrolled hypertension among patients managed in primary healthcare facilities in Kinshasa, Democratic Republic of the Congo.

BACKGROUND: Uncontrolled hypertension remains an important issue in daily clinical practice worldwide. Although the majority of patients are treated in primary care, most of the data on blood pressure control originate from population-based studies or secondary healthcare. OBJECTIVE: The aim of this study was to evaluate the frequency of uncontrolled hypertension and associated risk factors among hypertensive patients followed at primary care facilities in Kinshasa, the capital city of Democratic Republic of the Congo. METHODS: A sample of 298 hypertensive patients seen at primary healthcare facilities, 90 men and 208 women, aged ≥ 18 years, were consecutively included in this cross-sectional study. The majority (66%) was receiving monotherapy, and diuretics (43%) were the most used drugs. According to 2007 European Society of Hypertension/European Society of Cardiology hypertension guidelines, uncontrolled hypertension was defined as blood pressure ≥ 140/90 or ≥ 130/80 mmHg (diabetes or chronic kidney disease). Logistic regression analysis was used to identify the determinants of uncontrolled hypertension. RESULTS: Uncontrolled hypertension was observed in 231 patients (77.5%), 72 men and 159 women. Uncontrolled systolic blood pressure (SBP) was more frequent than uncontrolled diastolic blood pressure (DBP) and increased significantly with advancing age (p = 0.002). The proportion of uncontrolled SBP and DBP was significantly higher in patients with renal failure (p = 0.01) and those with high (p = 0.03) to very high (p = 0.02) absolute cardiovascular risk. The metabolic syndrome (OR 2.40; 95% CI 1.01-5.74; p = 0.04) emerged as the main risk factor associated with uncontrolled hypertension. CONCLUSION: Uncontrolled hypertension was common in this case series and was associated with factors related to lifestyle and diet, which interact with blood pressure control.

Prevalence and risk factors of pre-hypertension in Congolese pre and post menopausal women.

OBJECTIVES: We aimed to assess the prevalence of prehypertension and its associated factors in a population of Congolese pre and postmenopausal women. METHODS: We had consecutively recruited 200 women (100 premenopausal and 100 postmenopausal) aged 40 - 60 years at the department of Gynecology and Obstetrics, University of Kinshasa Hospital, and AKRAM Medical Center in Kinshasa, DRC. An interview was carried out using a questionnaire that comprised questions related to lifestyle, menses characteristics, medical history of diabetes, CVD, hypertension, current antihypertensive medication and use of traditional medicine. In addition, physical examination and biological measurements were performed. Multivariate logistic regression analysis was used to assess associated factors with prehypertension. RESULTS: Of the participants, 34% were normotensive, 38.5 % prehypertensive and 27.5% hypertensive. Compared to normal blood pressure, prehypertension was common in the older (age>50 years of age) women. Menopause, the use of traditional medicine and older age were associated with prehypertension. However, only menopause (aOR: 2.71; 95%CI: 1.10-3.52) and the use of traditional medicine (aOR: 2.24; 95% CI: 1.07-4.7) remained associated with prehypertension in a multivariate logistic regression analysis. CONCLUSION: This study showed that prehypertension is common among Congolese menopausal women, and that menopause and the use of traditional medicine were the main factors associated with prehypertension.

Sickle cell trait is not associated with chronic kidney disease in adult Congolese patients: a clinic-based, cross-sectional study.

OBJECTIVE: The aim of this study was to evaluate the determinants of chronic kidney disease (CKD) with special emphasis on sickle cell trait (SCT). METHODS: Three hundred and fifty-nine patients (171 men and 188 women), aged 18 years or older, with reduced kidney function (eGFR < 90 ml/min/1.73 m(2)) and seen at secondary and tertiary healthcare in Kinshasa were consecutively recruited in this cross-sectional study. Serum creatinine and haemoglobin electrophoresis were performed in each patient. CKD was defined as < 60 ml/min/1.73 m(2). Logistic regression analysis was used to assess determinants of CKD with a special emphasis on SCT. A p-value < 0.05 defined the level of statistical significance. RESULTS: SCT was present in 19% of the study population; its frequency was 21 and 18% (p > 0.05) in patients with and without CKD, respectively. In multivariate analysis, sickle cell trait was not significantly (OR: 0.38; 95% CI: 0.559-1.839; p = 0.235) associated with CKD; the main determinants were dipstick proteinuria (OR: 1.86; 95% CI: 1.094-3.168; p = 0.02), the metabolic syndrome (OR: 1.69; 95% CI: 1.033-2.965; p = 0.03), haemoblobin ≥ 12 g/dl (OR: 0.36; 95% CI: 0.210-0.625; p = 0.001), and personal history of hypertension (OR: 2.16; 95% CI: 1.202-3.892; p = 0.01) and of diabetes mellitus (OR: 2.35; 95% CI: 1.150-4.454; p = 0.001). CONCLUSION: SCT was not an independent determinant of CKD in the present case series. Traditional risk factors emerged as the main determinants of CKD.

Prevalence and predictors of metabolic syndrome among Congolese pre- and postmenopausal women.

OBJECTIVES: This study aimed to determine the prevalence and predictors of metabolic syndrome (MetS) among Congolese pre- and postmenopausal women. METHODS: In total, 200 women (100 premenopausal and 100 postmenopausal) were interviewed and underwent clinical and biological investigations searching for lipid and non-lipid cardiovascular risk factors. National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) criteria were used to define MetS. Multivariate logistic regression analysis was used to evaluate predictors of MetS. RESULTS: There were significant differences between the two groups in terms of age, plasma cholesterol, high density lipoprotein cholesterol and triglyceride levels. MetS was present in 20% and 10% of postmenopausal and premenopausal women (p = 0.07), respectively. The MetS components hypertension, elevated plasma glucose and triglycerides were more frequently observed in post- vs. premenopausal women with MetS. Menopause (adjusted odds ratio (aOR) 2.49; 95% confidence interval (CI) 1.05-5.95), overweight (aOR 6.35; 95% CI 1.66-24.23) and obesity (aOR 14.29; 95% CI: 3.84-53.06) emerged as the main independent predictors of MetS. CONCLUSION: This study showed that MetS is common among Congolese postmenopausal women; menopause and weight gain emerged as its main predictors. This suggests that an integrated therapeutic approach combining hormone replacement therapy and lifestyle change in postmenopausal women should be considered.

Left ventricular hypertrophy and geometry in type 2 diabetes patients with chronic kidney disease. An echocardiographic study.

OBJECTIVE: We assessed left ventricular structural alterations associated with chronic kidney disease (CKD) in Congolese patients with type 2 diabetes. METHODS: This was a cross-sectional study of a case series. We obtained anthropometric, clinical, biological and echocardiographic measurements in 60 consecutive type 2 diabetes patients (37 females, 62% ) aged 20 years or older from the diabetes outpatient clinic, University of Kinshasa Hospital, DRC. We computed creatinine clearance rate according to the MDRD equation and categorised patients into mild (CrCl > 60 ml/min per 1.73 m(2)), moderate (CrCl 30-60 ml/min per 1.73 m(2)) and severe CKD (< 30 ml/min per 1.73 m(2)). Left ventricular hypertrophy (LVH) was indicated by a LV mass index (LVMI) > 51 g/m(2.7) and LV geometry was defined as normal, or with concentric remodelling, eccentric or concentric hypertrophy, using relative wall thickness (RWT) and LVMI. RESULTS: Compared to patients with normal kidney function, CKD patients had higher uric acid levels (450 ± 166 vs 306 ± 107 µmol/l; p ≤ 0.001), a greater proportion of LVH (37 vs 14%; p ≤ 0.05) and longstanding diabetes (13 ± 8 vs 8 ± 6 years; p ≤ 0.001). Their left ventricular internal diameter, diastolic (LVIDD) was (47.00 ± 6.00 vs 43.00 ± 7.00 mm; p ≤ 0.001), LVMI was (47 ± 19 vs 36.00 ± 15 g/m2.7; p ≤ 0.05) and proportions of concentric (22 vs 11%; p ≤ 0.05) or eccentric (15 vs 3%; p ≤ 0.05) LVH were also greater. Severe CKD was associated with increased interventricular septum, diastolic (IVSD) (12.30 ± 3.08 vs 9.45 ± 1.94 mm; p ≤ 0.05), posterior wall thickness, diastolic (PWTD) (11.61 ± 2.78 vs 9.52 ± 1.77 mm; p ≤ 0.01), relative wall thickness (RWT) (0.52 ± 0.17 vs 0.40 ± 0.07; p ≤ 0.01) rate of LVH (50 vs 30%; p ≤ 0.05), and elevated proportions of concentric remodelling (25 vs 15%; p ≤ 0.05) and concentric LVH (42 vs 10%; p ≤ 0.05) in comparison with patients with moderate CKD. In multivariable adjusted analysis, hyperuricaemia emerged as the only predictor of the presence of LVH in patients with CKD (adjusted OR 9.10; 95% CI: 2.40-33.73). CONCLUSION: In keeping with a higher rate of cardiovascular events usually reported in patients with impaired renal function, CKD patients exhibited LVH and abnormal LV geometry.

Influence of Carotid Intima Media Thickness on Cardiovascular Risk Stratification in Black Hypertensive Patients. A Cross-Sectional Study

Objective: to assess the influence of carotid intima-media thickness in addition to traditional risk factors on cardiovascular risk assessment in hypertensive patients. Methods: 60 hypertensive patients ( 45 years) seen at the outpatient hypertension Clinic were included in the present study. They underwent the followings procedures: (i) medical history; physical examination and clinic blood pressure measurement; (ii) routine blood chemistry; (iii) carotid B mode ultrasound. Increased carotid IMT was defined as values 0.9 mm and 1.3 mm. 2007 ESH/ESC guidelines were used to assess cardiovascular risk. Chi square and Student t tests were used as appropriate. P value 0.05 defined the level ofstatistical significance. Results: according to 2007 ESH/ESC guidelines 5 (8); 16 (27); 25 (42) and 14 patients (23) were at low; moderate; high and very high risk; respectively. With the integration of cIMT; 5 (31) and 2 patients (8) initially at moderate and high risk; respectively; shifted from these categories to high and very high risk ones. The net reclassification improvement was 12for all the population. No changes were observed in initially low and very high risk patients. Conclusion: Carotid intima-media thickeness may improve cardiovascular risk stratification; mainly in moderate or intermediate risk hypertensive patients

Increased Carotid Intima-Media Thickness and Associated Risk Factors among Congolese Hypertensive Patients in Kinshasa. A Cross-Sectional Study

Objective. To assess the prevalence of increase carotid Intima-media thickness and associated risk factors in hypertensive patients. Methods. 60 consecutive hypertensive patients ( 45 years) seen at the outpatient hypertension Clinic were included in the present study. They underwent the following procedures: (i) medical history; physical examination and clinic blood pressure measurement; (ii) routine blood chemistry; (iii) carotid B mode ultrasound. Increased carotid IMT was defined as values 0.9 mm and 1.3 mm or values 75th percentile. 2007 ESH/ESC guidelines were used to assess cardiovascular risk. Univariate logistic regression analysis was used to evaluate risk factors associated with increased cIMT. P value 0.05 defined the level of statistical significance. Results. Increased IMT was present in 12and 32of patients using values 0.9 mm and 0.8 (75th percentile); respectively. Age 60 years (OR: 7.5; 95CI: 1.9-30; p = 0.003); diabetes 5 years (OR: 2.0; 95CI: 1.1-3.7; p = 0.016); hypertension 7 years (OR: 3.6; 95CI: 1.1-13; p = 0.029) and uric acid 7 mg/dl (OR: 4.6; 95CI: 1.4-15; p = 0.012) emerged as the main predictors of the risk of having increased cIMT. Conclusion. Increased IMT was common among the present case series; diabetes; hypertension and hyperuricemia; all components of the MetS; emerged as the main modifiable risk factors associated with increased cIMT. Therapeutic lifestyle changes should be encouraged in addition to antihypertensive therapy in these patients

[Correlation between capillary fasting glucose and HbA1c: study on 181 type 2 diabetics patients in Democratic Republic of the Congo]. / Correlation entre la glycémie à jeun capillaire et l'HbA1c: 181 diabétiques de type 2 à Kinshasa (République démocratique du Congo).

OBJECTIVES: Due to lack of equipment, diabetic patients in Congolese hospitals are monitored only by capillary (CFG) or plasmatic fasting glucose. The purpose of this study was to estimate the correlation between the HbA1c and CFG in type 2 diabetic patients. METHODS: From July 1st to October 30th, 2007, four CFG tests (one every two weeks) and one HbA1c test (immunoassay method) were performed in 181 type 2 diabetics managed at the University Hospital of Kinshasa. Correlation between the HbAlc test and each CFG test was determined by Pearson coefficient (r). Variation of HbA1c according to the average CFG was determined by simple linear regression. RESULTS: Duration of diabetes varied between 1 and 32 years (median: 4 years). Patients had an average age of 56.4 +/- 11.2 years of age; a mean CFG of 9.38 +/- 3.62 mmol/L and HbA1c of 9.4 +/- 2.7%. HbA1c correlated better with average CFG (r = 0.753, p < 0.001) than with CFG performed 4 weeks earlier (r = 0.714, p < 0.001), 6 weeks earlier (r= 0.649, p < 0.001), 2 weeks earlier (r = 0.646, p < 0.001) and concomitantly (r = 0.636, p < 0.001). Extrapolation based on the linear regression equation showed that a delta of 1.925 mmol/L in average CFG = D 1% HbA1c. CONCLUSION: In the type 2 diabetic patients in this study, average CFG of 4 tests carried out at 2-week intervals was well correlated to the HbAlc. Average CFG seems a good alternative for monitoring type 2 diabetes in environments not equipped for HbAlc testing.

Facteurs pronostiques de l'insuffisance renale aigue aux Cliniques Universitaires de Kinshasa

Cette etude a recherche les facteurs pronostiques de l'insuffisance renale aigue (IRA) en vue d'ameliorer la survie des patients. Methode : Ont ete collectees sur base d'une fiche ad hoc; les caracteristiques demographiques (age; sexe); cliniques (delai d'admission et au cours de l'hospitalisation; differents facteurs etiologiques; types de traitement applique) et biologiques (creatinemie; clairance de la creatinine; uree sanguine; ionogramme sanguin; hemogramme) des patients admis au Service de Nephrologie des Cliniques Universitaires de Kinshasa pour IRA; entre 1996et 2003. L'analyse multivariee a utilise le modele de regression logistique par la methode de trainage avant (pas a pas) pour identifier les facteurs pronostiques de cette affection. L'etude de la survie a recouru a la courbe de Kaplan Meier et a la regression de COX. Resultats : Trois cents vingt cas d'IRA ont ete enregistres (5des admissions en Medecine Interne); avec un sex-ration H/F de 2 et l'age moyen de 33 ans. Seuls 18des patients ont pu beneficier de la dialyse. Le taux de mortalite etait de 29;4. Les facteurs de mauvais pronostic ont ete : le coma (p0;01); l'anemie (p0;01); la kaliemie (p0;01); le sepsis (p0;05); le delai d'admission a l'hopital (p0;05) et l'age (p

Clinical correlates of left ventricular hypertrophy in black patients with arterial hypertension.

OBJECTIVE: To assess the relationship between the lipid profile, other cardiovascular risk factors and left ventricular hypertrophy (LVH) in black hypertensive patients. MATERIALS AND METHODS: We undertook a cross-sectional study of a case series at the hypertension clinic, University of Kinshasa Hospital. Lipids, lipoproteins and other cardiovascular risk factors were analysed in 100 consecutive hypertensive patients. Left ventricular hypertrophy was assessed by 12-lead electrocardiography (ECG) using Cornell voltage index. RESULTS: Forty-eight hypertensive patients, 26 men and 22 women, had LVH. With univariate analysis, the patients with LVH were older (age 52 +/- 9 vs 45 +/- 9 years; p /= 1.03 mmol/l (adjusted OR 0.19; 95% CI: 0.057-0.651), plasma glucose >/= 6.11 mmol/l (adjusted OR 0.19; 95% CI: 0.046- 0.828), or on treatment for hypertension (adjusted OR 0.23; 95% CI: 0.082-0.645) had a lower risk for cardiac damage compared to their respective control groups. CONCLUSION: LVH is a common complication in Congolese hypertensives. Dyslipidaemia, high plasma glucose levels, the duration of hypertension and being on antihypertensive therapy appear to be the main predictors of hypertensive cardiac damage.

Correlates of serum lipids and lipoproteins in Congolese patients with arterial hypertension.

OBJECTIVE: The purpose of this study was to assess the prevalence of dyslipidaemia and the correlates of serum lipids and lipoproteins among Congolese subjects with and without arterial hypertension. METHODS: One hundred hypertensive patients attending the outpatient clinics at the University of Kinshasa Hospital, and 100 age- and sex-matched controls recruited among hospital personnel or blood donors entered the case-control study. Their blood pressure (BP), heart rate (HR), body mass index (BMI), waist-to-hip ratio (WHR), serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), plasma fibrinogen (only in patients) and fasting glucose, serum uric acid, creatinine and creatinine clearance (CrCl) were compared using the Student's t-test or Chi-square test as appropriate. Associations between continuous variables were assessed with Pearson correlation coefficients, and correlates of lipids and lipoproteins were determined using multiple linear-regression analysis. RESULTS: Compared to healthy controls, hypertensive patients had greater BMI (p or= 6.20 mmol/l. In hypertensive patients, TC (r = 0.24; p < 0.01) and LDL-C (r = 0.20; p < 0.05) were positively correlated to plasma fibrinogen. A positive correlation was also observed between TC and LDL-C (r = 0.91; p < 0.001), HDL-C and CrCl (r = 0.28; p < 0.001), and TG and glucose (r = 0.24; p < 0.01), whereas TG were negatively correlated to HDL-C (r = -0.38; p < 0.001). In multiple linear-regression analysis, LDL-C, HDL-C, TG and age accounted for 87% (R2) of variation in TC levels; plasma glucose and HDL-C for 19% (R2) of variation in TG levels; and TG and CrCl for only 17% (R2) of variation in HDL-C levels. CONCLUSIONS: The present data indicate that dyslipidaemia affects a substantial proportion of healthy and hypertensive Congolese subjects. Furthermore, hypertension is associated with a cluster of risk factors characteristic of the metabolic syndrome, of which overweight/central obesity could be the cornerstone. Management of arterial hypertension should therefore focus both on lowering high blood pressure and correcting associated lipid disorders.

Examen microscopique urinaire normal de l'adulte zairois aux Cliniques Universitaires de Kinshasa

Les objectifs ont ete de proposer une methode standardisee de l'examen microscopique de l'urine et de determiner les valeurs de reference. Cent dix-neuf echantillons recoltes lors de la premiere et/ou de la seconde miction matinale provenant de 100 sujets sains. Les urines etaient d'aspect limpide chez tous les sujets et de coloration jaune clair (58;80 pour cent); jaune fonce (27;7 pour cent) (jaune paille (13;4 pour cent). L'urine de la premiere et de la seconde miction constitue l'echantillon ideal pour l'examen microscopique urinaire. Les valeurs de reference obtenues sont comparables a celles rapportees dans la litterature. Ces resultats suscitent l'interet de la vulgarisation de la methode standardisee

Nephropathie diabetique : caracteristiques anatomo-cliniques des cas observes aux Cliniques universitaires de Kinshasa

La nephropathie diabetique complication majeure du diabete sucre est associee a une forte mortalite liee a l'insuffisance renale terminale et aux complications cardiovasculaires. Environ 30-40 pour cent des diabetiques insulinodependants et 10-20 pour cent des non insulinodependants developperont au cours de leur diabete