Practice of Hemodialysis in a Resource-Poor Setting in Nigeria: A 2-Year Experience

Abstract

Background: Hemodialysis (HD) is the main form of renal replacement therapy available in Nigeria. However, this is still largely unaffordable by individuals with resultant poor outcomes.

Methods: This was a retrospective study of all patients with renal failure who had dialysis in the renal unit of Dalhatu Araf Specialist Hospital over the past 2 years. Information retrieved included sex, age, cause of renal failure, human immunodeficiency virus status, hepatitis B surface antigen status, antibodies to hepatitis C virus status, number of sessions, total duration on dialysis (in weeks), use of erythropoietin (EPO), common problems encountered on the dialysis machine, and the outcome of the patient.

Results: A total of 68 patients (50% males) were enrolled in the study. The mean age was 41 ± 15 years (17-75), and mean weight in kilograms was 64.3 ± 10.9 (42-87). Acute kidney injury was seen in 18 (26.5%), while 50 (73.5%) had end-stage renal disease (ESRD). Chronic glomerulonephritis was the leading cause of ESRD (46%) with autosomal dominant polycystic kidney disease being the least (2%). The mean packed cell volume at the start of dialysis was 25.7% ± 5.9%. Tunneled necklines were in 11 (16.8%) and femoral catheters were in 48 (70.6%). The median total number of sessions was 4.0 (1-136), while the median duration on dialysis was 1 week (1-48) with both sexes having the same duration on dialysis (P = 0.44). The average frequency of dialysis among those with ESRD was twice weekly. Only 15 (30.0%) of those with ESRD continued dialysis after 3 months. The median survival time for females was 5 weeks while that for the males was 20 weeks (P = 0.108). EPO use was in 12 (17.7%) being 4000 IU once weekly. Cramps complicated the first sessions of dialysis in 27 (39.7%) patients.

Conclusion: The survival of patients on HD in our environment is poor due largely to poor affordability despite its availability.

Keywords: Hemodialysis; mortality; outcomes; practice; resource poor.

Figure 1

The survival probability of the male and female participants who had hemodialysis in Dalhatu Araf Specialist Hospital