HEMODIALYSIS MIGHT IMPROVE OUTCOMES IN SEVERE RIFT VALLEY FEVER-RELATED ACUTE KIDNEY INJURY: A CASE SERIES FROM SOUTHWESTERN UGANDA

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Abstract Title *

HEMODIALYSIS MIGHT IMPROVE OUTCOMES IN SEVERE RIFT VALLEY FEVER-RELATED ACUTE KIDNEY INJURY: A CASE SERIES FROM SOUTHWESTERN UGANDA

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Co-author 1

Rose Muhindo rosie@must.ac.ug Mbarara University of Science and Technology Internal Medicine Mbarara Uganda -

Co-author 2

Grace Kansiime gkansiime@must.ac.ug Mbarara University of Science and Technology Internal Medicine Mbarara Uganda -

Co-author 3

Badru Kayongo kayongobad@yahoo.com Mbarara University of Science and Technology Psychiatry Mbarara Uganda -

Co-author 4

Abel Mwine abelmwinek@gmail.com Mbarara Regional Referral Hospital Nursing Mbarara Uganda -

Co-author 5

Gerald Atukwase geraldatukwatse@gmail.com Mbarara Regional Referral Hospital Nursing Mbarara Uganda -

Co-author 6

Simon Ahimbisibwe simonahimbisi@gmail.com Mbarara Regional Referral Hospital Nursing Mbarara Uganda -

Co-author 7

Musa Kitandwe kitandwemusa7@gmail.com Mbarara Regional Referral Hospital Nursing Mbarara Uganda -

Co-author 8

Christopher Mugabo mugabochristopher93@gmail.com Mbarara University of Science and Technology Internal Medicine Mbarara Uganda -

Co-author 9

Ernest Ssewanyana ssewanyanaernest@gmail.com Mbarara University of Science and Technology Department of Internal Medicine Mbarara Uganda *

Co-author 10

Silver Atuzarirwe atuzasilver@gmail.com Mbarara Regional Referral Hospital Nursing Mbarara Uganda -

Co-author 11

Oswald Katsigire oswaldkats@gmail.com Mbarara Regional Referral Hospital Nursing Mbarara Uganda -

Co-author 12

Nicholas Nuwashaba nicholasnuwashaba@gmail.com Mbarara Regional Referral Hospital Laboratory Mbarara Uganda -

Co-author 13

Nelson Wandera dennisnelson000@gmail.com Mbarara Regional Referral Hospital Medicine Mbarara Uganda -

Co-author 14

Co-author 15

Introduction

Rift Valley Fever (RVF) is a zoonotic viral hemorrhagic fever (VHF) with increasing frequency of outbreaks in parts of Africa, the Arabian Peninsula and some parts of Europe. Most patients with RVF succumb to kidney failure and acute liver injury. Despite kidney failure being a wellknown complication of RVF, there are no studies exploring the role of renal replacement therapy (RRT) in improving outcomes among patients with RVF. We present a case series to examine the impact of hemodialysis on the outcomes of patients with RVF in southwestern Uganda.

Methods

We did a retrospective medical records review of all four patients who were admitted at the Mbarara Regional Referral Hospital (MRRH) Special Pathogens Unit with a RT-PCR positive diagnosis of RVF during the June-July 2023 outbreak.

Results

All 4 patients presented with severe Acute Kidney Injury (AKI) requiring RRT and liver injury; mean serum creatinine 9.66 mg/dl, urea 224.53 mg/dl, median AST 1636 IU/L, median ALT 1598 IU/L. Other complications in these patients included; hyperkalemia, thrombocytopenia and anemia. Hemodialysis (HD) being a paid-for service at our center, only 2/4 (50%) of the patients could afford it. One of them underwent 5 sessions while the other underwent 4 sessions of intermittent HD, in addition to supportive treatment. The other 2 patients only got supportive treatment with IV fluids, calcium gluconate, IV insulin, anti-emetics and blood transfusion. Both patients who underwent HD survived and were discharged with significant improvement in serum creatinine and urine output after 11 and 9 days of admission respectively. On the other hand, both patients who did not undergo HD died in hospital on day 2 and day 5 of admission (Fig. 1).

Conclusion

Hemodialysis was associated with better outcomes in this small case series of four patients with Rift Valley Fever despite presence of other complications such as liver injury, hyperkalemia, thrombocytopenia and anemia. Therefore, we recommend efforts to promote equitable access to HD services in regions where outbreaks of RVF are likely to occur. Nonetheless, we acknowledge that the sample size and methodology of this study are inadequate to accurately predict a generalizable survival benefit. We therefore recommend larger, adequately powered studies to establish the survival benefit of different RRT modalities in people with RVF.

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