Maria Faye

Background: Peritoneal dialysis (PD) was introduced in Senegal in 2003, with the first PD center established at Aristide Le Dantec University Hospital. Our study aims to determine long-term outcomes of the Senegalese PD cohort. Methods: We performed a single-center retrospective cohort study of adults patients treated with chronic PD from 2004 to 2020. Demographics, comorbidities, labs, complications, hemodialysis (HD) transfers, hospitalizations, PD discontinuation and mortality were collected. Survival was assessed using Kaplan–Meier and Cox models. Results: During the study period, 232 patients were treated by PD. The mean age was 47.5 ± 14.9 years, 56.9% were female, 76% lacked health insurance, and 98.3% had hypertension. Median distance to the PD unit was 22 km (IQR: 13–100). Most patients started kidney replacement therapy on HD in private sector and were transferred to PD due to financial constraints (out-of-pocket payment). A total of 351 peritonitis episodes occurred in 174 patients (0.97 episodes per patient-year), including 14.9% experienced more than three episodes. Staphylococcus aureus and Pseudomonas species were the most frequent causative organisms, with 35.9% of culture-negative episodes. Permanent transfer to HD was the leading cause of PD discontinuation (59.6%), followed by death (37.7%). Median patient survival was 31 months. Time on PD therapy had a median of 35 months, with one-, three-, and five-year survival of 86.1%, 49.8%, and 25.3%, respectively, censored for death, kidney transplantation, and recovery of renal function. Conclusions: PD in Senegal is suitable but challenged by infectious, mechanical, metabolic complications and socioeconomic barriers. Improving infection control, monitoring, catheter placement, and insurance coverage is key to expanding equitable dialysis access.

Introduction: Few data are available in the literature regarding patients with end-stage renal disease initially treated with chronic hemodialysis and then transferred to peritoneal dialysis. The aims of this study were to evaluate the reasons for transferring patients from chronic hemodialysis to peritoneal dialysis and monitor their outcome in peritoneal dialysis. Patients and Methods: A retrospective, descriptive and analytical study over 17 years, conducted at the peritoneal dialysis unit of the Aristide Le Dantec University Hospital. Included were patients over 18 years of age in chronic hemodialysis for at least 3 months, then transferred to peritoneal dialysis. Data were collected from medical records. Results: Twenty-six patients were collected. The average age at initiation of peritoneal dialysis was 52.19±15.37 years. The sex ratio was 0.62. The main causal nephropathy was hypertensive nephropathy (46.2%). The reasons for transfer were personal choice (50%), vascular access problems (42.3%), hemodynamic intolerance (3.8%) and cardiovascular instability (3.8%). Concerning the outcome: 52.2% of patients died, 43.5% returned to hemodialysis and 4.3% had a kidney transplant. The average survival was 503,000±108,343 days. Female gender and transient vascular access were risk factors for mortality of transferred patients (OR=0.043 95% CI [1.085; 148.243] p=0.045) and (OR=0.047 95% CI [1.035; 112.840] p=0.048) respectively. Conclusion: The transfer from hemodialysis to peritoneal dialysis must be anticipated in our context to reduce the morbidity and mortality of our patients on chronic dialysis. Résumé Introduction :Peu de données sont disponibles dans la littérature concernant les patients en insuffisance rénale terminale traités initialement par hémodialyse chronique puis transférés en dialyse péritonéale. Le but de cette étude était d’évaluer les motifs de transfert des patients de l’hémodialyse chronique à la dialyse péritonéale et suivre leur devenir en dialyse péritonéale. Patients et Méthodes : Il s’agit d’une étude rétrospective, descriptive et analytique sur 17 ans au niveau de l’unité de dialyse péritonéale du CHU Aristide Le Dantec. Étaient inclus, les patients de plus de 18 ans en hémodialyse chronique pendant au moins 3 mois, puis transférés en dialyse péritonéale. Les données ont été collectées à partir des dossiers médicaux. Résultats : Vingt-six patients ont été colligés. L’âge moyen à l’initiation de la dialyse péritonéale était de 52,19±15,37 ans. Le sex-ratio était de 0,62. La principale néphropathie causale était la néphroangiosclérose (46,2%). Les motifs de transfert étaient le choix personnel (50%), les problèmes d’abords vasculaires (42,3%), l’intolérance hémodynamique (3,8%) et l’instabilité cardiovasculaire (3,8%). Concernant le devenir : 52,2% des patients étaient décédés, 43,5% remis en hémodialyse et 4,3% transplantés rénal. La moyenne de survie était de 503,000±108,343 jours. Le sexe féminin et l’abord vasculaire transitoire étaient des facteurs de risque de mortalité des patients transférés (OR=0,043 IC à 95% [1,085 ; 148,243] p=0,045) et (OR=0,047 IC à 95% [1,035 ; 112,840] p=0,048) respectivement. Conclusion : Le transfert de l’hémodialyse vers la dialyse péritonéale doit être anticipé dans notre contexte pour réduire la morbi-mortalité de nos patients sous dialyse chronique.

Fungal peritoneal infection is a relatively rare but serious complication of peritoneal dialysis. It is associated with a high risk of technical failure and mortality, particularly in the event of late diagnosis. Most of these fungal infections are associated with the Candida genus. However, in recent years, we have observed an emergence of new fungal species with established pathogenicity in peritoneal dialysis. We report the first case of fungal peritoneal infection due to Geotrichum spp that occurred in our peritoneal dialysis unit in Dakar in Senegal.

Introduction: The aim of this study was to evaluate the performance of conventional (CBPM) and sequential (SBPM) blood pressure measurements in peritoneal dialysis (PD) patients using ambulatory blood pressure measurements (ABPM) as a reference. Patients and methods: Through a cross-sectional study including 17 patients followed in the PD unit of the Aristide Le Dantec Hospital, BP was measured by 3 methods: i) an automated measurement (OMRON M3 COMFORT^TM) performed by a health care staff called CBPM; ii) the average of 5 automated measurements in an isolated patient in a cubicle called SBPM; iii) 24-hour ABPM with the CONTEC^TM device (Germany). High blood pressure was considered when the BP was higher than 130/80 mmHg at the 24-hour ABPM. Results: The area under the curve (AUC) for systolic blood pressure (SBP) was similar (p=0.28) between SBPM [AUC, 0.933; 95% CI, 0.813 – 1.000] and CBPM [AUC, 0.900; 95% CI, 0.752 – 1.000]. Regarding diastolic blood pressure (DBP), SBPM [AUC, 0.858; 95% CI, 0.638 – 1.000] was similar (p=1) to CBPM [AUC, 0.917; 95% CI, 0.753 – 1.000]. On Bland-Altman analysis, CBPM overestimated SBP by 11.65 mmHg and DBP by 3.94 mmHg. SBPM overestimated SBP by 6.2 mmHg and DBP by 4.35 mmHg. Conclusion: SBPM and CBPM are efficient in the diagnosis of ambulatory hypertension in PD patients in Dakar.

Objectives: This study aimed to evaluate the efficacy of Rituximab in the management of idiopathic membranous nephropathy (IMN) based on the following criteria: (I) Biological remission at three months (M3) and six months (M6); (II) change in mean proteinuria (24PU), mean serum albumin, and mean serum creatinine at M3 and M6; (III) and side effects. Methods: This retrospective descriptive and analytical study included patients with histologically confirmed IMN with positive plasma anti-PLA2R antibodies who received at least one dose of Rituximab after six months of follow-up without spontaneous remission. Patients with unexplainable records were not included. Results: A total of five patients (P1, P2, P3, P4, and P5), including four males and one female were analyzed. The mean age was 44.20 ± 23.14 years. All patients had IMN type 2. At inclusion, the mean albuminemia, mean creatinine, and mean 24hPU levels were 15.56 ± 5.27 g/L, 17.3 ± 7.6 mg/L, and 6.54 ± 1.13 g/24h, respectively. The median anti-PLA2R antibody titer was 100 IU with extremes of 10 and 800 IU. Partial remission was noted in three patients at M3 (P2, P4, and P5), and it was maintained until M6 in P2. No complete remission was observed. A significant decrease in mean 24hPU at M3 was noted (P < 0.001). Generalized pruritus associated with seizures was noticed in P4 after the first dose of Rituximab. Conclusions: Partial remission was noted in three patients at M3, and one patient maintained this remission at M6. Rituximab significantly reduced 24hPU at M3 after administration. Rituximab administration was well tolerated by the patients.