Does Timing of Nephrology Referral Influence Outcome among Patients on Maintenance Hemodialysis in Cameroon

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ABSTRACT Objective. To assess the influence of the timing of nephrology referral on adverse outcomes in patients undergoing chronic haemodialysis (HD) and to identified associated factors to mortality in a referral hospital of Cameroon. Methods. A retrospective study including patients with ESKD who started HD in Douala general hospital from January 2008 to December 2011. Socio demographic and relevant clinical data including date of first nephrologists’ consultation, stage of CKD at presentation, presumed aetiology of CKD and starting date of HD were reviewed. Early referral (ER) was defined as first nephrologists’ consultation at least four months before initiation of HD, and LR as less than four months prior to dialysis. Study outcomes were morbidities, type of vascular access, withdrawal and mortality at one, three, six and twelve months on dialysis. Results. We recruited 188 participants. 66.5% of them were males, and the mean age was 46.8±14.7 years. ERs accounted for 29.8% of the population. Emergency dialysis on a temporary catheter was more frequent for LRs (p=0.000). During the period of dialysis, hospitalization and withdrawal rates were similar between both group (p= 0.76 and p=0.25). From zero to six months, the cumulative survival of ER patients was better (p=0.02) but at one year the difference was no longer significant (p=0.62). Factors associated to high mortality were male sex (p=0.007), diabetes mellitus (p= 0,006) hospitalization (p=0,002) and pulmonary oedema at initiation (p=0,004). Conclusion. One year outcome of HD patients is little modified by the timing of referral; it is more affected by co morbidity and initial morbidity. RESUME Objectif. Decrire l’influence du moment du transfert en nephrologie sur le devenir des patients hemodialyses et identifier les facteurs associes a la mortalite de ces patients. Methodologie. Il s’agit d’une etude retrospective transversale analytique incluant les dossiers medicaux des patients ayant commence l’hemodialyse chronique a l’Hopital General de Douala de Janvier 2008 a Decembre 2011. Les donnees sociodemographiques et cliniques (date de premiere consultation nephrologique, stade IRC au transfert, nephropathie de base, date initiation de dialyse). Le transfert etait precoce (TP) si la premiere consultation nephrologique etait superieure a 4 mois avant l’initiation de la dialyse et tardif (TT) si inferieur a 4 mois. Le devenir etait evalue a un, trois, six et douze mois. Le seuil de significativite etait fixe a p < 0.05. Resultats. 188 patients ont ete inclus dont 66.5% d’hommes. L’âge moyen etait de 46,8±14,7 ans. Le TP concernait 29.8% des patients. Le taux d’abandon et d’hospitalisation etait similaire dans les deux groups (p= 0.76 and p=0.25). Entre zero et six mois, la survie cumulee etait meilleure dans le groupe des TP par rapport au TT (p=0.02) ; mais a 12 mois, il n’y avait plus de difference significative entre les deux groupes (p=0.62). Les facteurs associes a la mortalite etaient le sexe masculin (p=0.007), le diabete sucre (p= 0,006), l’hospitalisation (p=0,002) et l’œdeme pulmonaire a l’initiation de la dialyse (p=0,004). Conclusion. Le devenir a un an des patients hemodialyses chroniques est plus influence par les comorbidites et la morbidite a l’initiation de la dialyse que par le moment du transfert du malade en nephrologie.

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