Yannick Mayamba Nlandu

Sickle cell disease (SCD) is one of the most common haemoglobinopathies worldwide, with nearly 300,000 newborns affected each year, of which about 80% are born in sub-Saharan Africa [1,2]. In the D...

Introduction: Sickle cell disease (SCD) carries a high risk of chronic kidney disease, necessitating accurate glomerular filtration rate (GFR) monitoring. This study evaluated the performance of creatinine-based (eGFRcrea), cystatin C-based (eGFRcys), and combined (eGFRcrea+cys) equations against directly measured GFR (mGFR). Methods: Clinically stable Congolese adults with SCD were recruited in 13 medical centers from Kinshasa. GFR was measured using iohexol plasma clearance. We compared the bias, precision, and accuracy of Chronic Kidney Disease Epidemiology (CKD-EPI) and European Kidney Function Consortium (EKFC) equations. Results: Among 207 patients included (24 [20;31] years and 58% of women), mean mGFR was 129 ± 38 ml/min/1.73 m2 with 41% of patients hyperfiltrating (mGFR >135 ml/min/1.73 m2). Among eGFRcrea equations, CKD-EPI was superior in hyperfiltrating patients, while EKFC performed better in normofiltrating patients. However, all eGFRcrea equations were suboptimal with only around 80% of estimated GFR (eGFR) results within 30% of mGFR. eGFRcys equations showed severe underestimation and poor accuracy. eGFRcrea+cys equations offered no clear added value. Conclusion: All eGFR equations were suboptimal in this young SCD population, with cystatin C performing particularly poorly. Given the limitations of current biomarkers, measuring GFR by a reference method remains the recommended standard. However, given the cost and logistical challenges of mGFR in low-income settings, relying on creatinine-based EKFC equation for normofiltrating patients and on creatinine based Chronic Kidney Disease Epidemiology Equation (CKD-EPIcrea) for hyperfiltrants appears to be a more feasible and pragmatic approach.

Background and Objectives: On-line hemodiafiltration (OL-HDF) has been proposed as an alternative to conventional hemodialysis (HD) for patients with end-stage chronic kidney disease (CKD). Randomized controlled trials suggest that OL-HDF may reduce mortality, particularly when the convection volume (CV) exceeds 23 L/1.73 m² per session. However, achieving this target depends on local practices and may be limited to selected populations. The CONVINCE trial reported a 97% success rate using a structured optimization protocol, but its applicability to unselected real-world populations remains uncertain. This study aimed to evaluate the incidence of high CV in OL-HDF among unselected patients managed under routine conditions with a standardized optimization protocol. Methods and Materials: This prospective cohort study (May–October 2024) included 67 unselected incident and prevalent patients undergoing HD or HDF in a hospital-based dialysis center. All patients were switched to post-dilution OL-HDF following the CONVINCE optimization protocol, which involved stepwise increases in blood flow, adjustment of filtration fraction, and optimization of session duration. Results: The mean age was 68.8 ± 14.9 years; 56.7% were male. Blood flow increased from 283 to 338 mL/min (p < 0.001), and the use of dialyzers > 2 m² increased from 36% to 68% (p < 0.003). Kt/V improved from 1.22 to 1.6 (p < 0.01). CV increased by ~2 L from M1 onward and was sustained through M6, correlating positively with blood flow, session duration, and Kt/V (all p < 0.01). Conclusions: Stepwise optimization protocol enabled sustained achievement of high CV (23.5 L/session) in 62.3% of patients, improving dialysis adequacy.

Background: Kidney transplantation activity at the University Hospital of Guadeloupe was briefly interrupted at the onset of the COVID-19 pandemic, reflecting the global impact of this health crisis on organ transplantation. This study assessed patient and graft recovery in 335 recipients transplanted between 2013 and 2023, comparing those transplanted before 2020 and after the resumption of activity. The objective was to evaluate changes in recipient profiles, surgical parameters, and post-transplant outcomes following this disruption. Methods: This retrospective cohort included all kidney transplants performed at the University Hospital of Guadeloupe over a ten-year period. Most patients (70%) received transplants before 2020, with 30% afterward. All grafts were ABO-compatible, and 98.2% were from deceased donors. Trends in transplant activity were analyzed to identify variations over time, with a peak observed in 2018, followed by a decline until 2021 and a progressive recovery from 2022. Comparative analyses were performed to examine disparities in donor and recipient characteristics, ischemia durations, and outcomes between the two periods. Results: After 2020, recipients were more likely to be elderly (≥70 years), immunized, obese, have heterozygous sickle cell disease, or have polycystic kidney disease (p < 0.05). Mean cold ischemia time decreased (p = 0.009), while warm ischemia time increased (p < 0.001), reflecting procedural and logistical adaptations. Graft survival remained stable, with 97.5% at 6 months and 89.8% at 4 years for transplants before 2020, versus 100% and 96.9%, respectively, after 2020 (p = 0.160). Patient survival did not differ significantly between periods (p = 0.199). Independent factors associated with mortality included recipient age ≥ 60 years, diabetes, graft failure, transplantation before 2020, cold ischemia time ≥ 1200 min, and graft pyelonephritis. Conclusions: Despite the temporary suspension of activity and an increased proportion of transplants with expanded criteria after 2020, graft recovery and patient survival were not adversely affected. These findings suggest that kidney transplantation in Guadeloupe demonstrated strong resilience and capacity for adaptation during and after the COVID-19 crisis, maintaining outcomes comparable to the pre-pandemic period.

Kidney transplantation activity at the University Hospital of Guadeloupe was briefly interrupted at the onset of the COVID-19 pandemic. This study assessed patient and graft survival in 335 recipients transplanted between 2013 and 2023, comparing those transplanted before 2020 and after the resumption of activity. Most patients (70%) received transplants before 2020, with 30% after-ward. ABO compatibility was observed in 98.2% of grafts from brain-dead do-nors. Peak transplant activity occurred in 2018, followed by a decline until 2021 and recovery from 2022. After 2020, recipients were more likely to be el-derly (≥70 years), immunized, obese, have heterozygous sickle cell disease, or polycystic kidney disease (p < 0.05). Mean cold ischemia time decreased (p = 0.009), while warm ischemia time increased (p < 0.001). Graft survival re-mained stable, with 97.5% at 6 months and 89.8% at 4 years for transplants before 2020, versus 100% and 96.9%, respectively, after 2020 (p = 0.160). Patient survival did not differ between periods (p = 0.199). Independent factors associ-ated with mortality included recipient age ≥ 60 years, diabetes, graft failure, transplantation before 2020, cold ischemia time ≥ 1200 minutes, and graft py-elonephritis. Despite an increased proportion of transplants with expanded criteria after 2020, graft and patient survival were not adversely affected.

The aim of this study was to determine kidney outcomes and associated factors in COVID-19 patients discharged from intensive care unit (ICU) in an African setting. In a prospective observational single-center cohort study, we compared the rate of decline in eGFRcr and the incidence of CKD between COVID-19 patients with and without AKI after discharge from ICU. Kidney function decline (KFD) and chronic kidney disease (CKD) during 2 years of follow-up were defined as eGFR decline ≥ 30% and eGFR less than 60 mL/min/1.73 m² and/or the presence of proteinuria, respectively. The association between COVID-19-associated AKI (COVID-AKI) and eGFR decline after hospital discharge was assessed using mixed-effects models. Logistic regression and Cox regression were used to define factors associated with KFD and CKD. The incidence of KFD and CKD at two years of follow-up was 23% and 0.73 per 100 patient months (P-M), respectively. Patients with COVID-AKI had a greater decline in eGFR (-11.09 mL/min/1.73 m²/year [95% CI, −3.65 to-1.02]; p ˂0.001) and CKD incidence (3.11 per 100 P-M vs 0.18 per 100 P-M, p = 0.003) in the fully adjusted model controlling for comorbidities and peak creatinine level. AKI was associated with KFD (aOR: 3.46 [2.40-5.24], p = 0.001) and CKD (aHR: 3.37 [2.35-5.41], p = 0.003). KFD and CKD are common in COVID-19 survivors. AKI was associated with both KFD and CKD after ICU discharge. Kidney care after COVID-19 needs to be organized in the context of AKI.

Acute kidney injury (AKI) is a significant cause of morbidity and mortality, especially in low and lower-middle income countries. Data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) were used to evaluate the organization of structures and services for the provision of AKI care in world countries and ISN regions. An international survey of key stakeholders (clinicians, policymakers, and patient advocates) from countries affiliated with the ISN was conducted from July to September 2022 to assess structures and services for AKI care across countries. Main findings of the study show that overall, 167 countries or jurisdictions participated in the survey, representing 97.4% of the world’s population. Only 4% of countries had an AKI detection program based on national policy or guideline, and 50% of these countries used a reactive approach for AKI identification (i.e., cases managed as identified through clinical practice). Only 19% of national governments recognized AKI as a healthcare priority. Almost all countries (98% of the countries surveyed) reported capacity to provide acute hemodialysis (HD) for AKI, but in 31% of countries, peritoneal dialysis (PD) was unavailable for AKI. About half of all countries (44% of countries surveyed) provided acute dialysis (HD or PD) via public funding, but funding availability varied across ISN regions, including less than a quarter of countries in Oceania and South East Asia (17%) and Africa (24%) and highest availability in Western Europe (91%). Availability increased with the increasing country income level. Initiatives have been developed to propose and promote optimal care for AKI (including the ISN 0-by-25 initiative), but capacity for optimal AKI care remains low, particularly in low- and lower-middle-income countries. Concerted efforts by the global community are required to close these gaps, to improve AKI outcomes across the world.

Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) infection is well established as a systemic disease including kidney damage. The entry point into the renal cell remains the angiotensin-converting enzyme 2 (ACE-2) receptor and the spectrum of renal lesions is broad, with a clear predominance of structural and functional tubular lesions. The most common form of glomerular injury is collapsing glomerulopathy (CG), which is strongly associated with apolipoprotein L1(APOL-1) risk variants. These acute lesions, which are secondary to the direct or indirect effects of SARS-CoV-2, can progress to chronicity and are specific to long COVID-19 in the absence of any other cause. Residual inflammation associated with SARS-CoV-2 infection, in addition to acute kidney injury (AKI) as a transitional state with or without severe histological lesions, may be responsible for greater kidney function decline in mild-to-moderate COVID-19. This review discusses the evidence for renal histological markers of chronicity in COVID-19 patients and triggers of low-grade inflammation that may explain the decline in kidney function in the post-COVID-19 period.