MORTALITY AMONG CHRONIC HEMODIALYSIS PATIENTS IN THE FIRST REGIONAL HEMODIALYSIS CENTER IN NORTHERN BURKINA FASO: CROSS-SECTIONAL SURVEY

Introduction:

Hemodialysis is the renal replacement treatment available in Burkina Faso. The Ouahigouya Regional Training Hospital Center (CHUR-OHG) in the north of the country, one of the poorest and high security risk region, is were the first peripheral hemodialysis center is implemented. This center started activities on september 2021 in a context of insufficient dialysis stations in existing centers in the country. The objective of this cross-sectional survey was to determine mortality among chronic hemodialysis patients and to identify the probable causes of death. The main goal was to advocate for improving the technical platform.

Methods:

This was a cross-sectional survey including all patients undergoing chronic hemodialysis in the center from September 9, 2021 to December 31, 2023. Data were collected from medical files, hemodialysis prescription and monitoring notebooks. We were interested in average survival on dialysis, and especially the probable causes of death. Socio-demographic characteristics (occupation, usual residence) as well as the mode of entry into chronic dialysis, the time to creation of an arteriovenous fistula (AVF) were also sought. The collection was carried out from February 1 to 28, 2024. Epi-Info software in version 7.0.8.3 was used for the analysis.

Results:

In 28 months, we collected 131 (72.4%) cases of chronic hemodialysis out of 181 dialysis patients. The sex ratio was 2.2 and the average age was 38.1 years ± 14.7 [9-75]. Farmers/breeders (17.7%), housewives (17.7%) and gold miners (13.8%) were the most represented socio-professional categories. 28% of patients resided outside the northern region and 22% came from the city where the center is implemented. All the patients started chronic hemodialysis for emergency indication. The initial vascular access was the short-term central venous catheter (CVC) in 97% of cases. The average time to create an arteriovenous fistula was 3 months [0 -12]. The mean duration on dialysis was 11.6 months [0 -53]. We noted 44 (33.6%) deaths including 32 men and 12 women. 10 patients (7.6%) gave up hemodialysis sessions for financial reasons. Death occurred within 72 hours following the start of the sessions (early) in 5 patients (11.3%), in the first three months in 20 patients (45.5%) and after three months in 19 patients (43, 2%). The probable causes of death were septic shock in 17 patients (38.6%); undetermined in 16 patients (36.4%) including 9 patients who died at home. The other causes of death were pulmonary embolism (3 cases), stroke (2 cases), dengue fever (1 case) and tamponade (1 case).

Conclusions:

Mortality among chronic hemodialysis patients, is very high in our study but remains underestimated due to cases of abandonment. Infection was the main cause of death that can be explained by the prolonged use of central venous catheters. Unsuitable premises, faulty installations of toilets and wastewater treatment system were also noted (image). So it is a need to refurbish the premises and facilities of the center.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.