#6242 CLINICAL CHARACTERISTICS OF HEMODIALYSIS PATIENTS FROM AFRICAN COUNTRIES OF PORTUGUESE OFFICIAL LANGUAGE: A PORTUGUESE COHORT
Authors: Costa Claudia , Peres Nadiesda , Branco Carolina , Silva Bernardo , Fonseca José Agapito , Outerelo Cristina , Resina Cristina , Lopes José António , Gameiro Joana 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is a leading cause of morbidity and mortality worldwide, with African descendants being at increased risk of occurrence and progression to end-stage renal disease (ESRD). However, the burden of CKD and ESRD in African continent is still largely conjectural and access to treatment of CKD is restricted in those countries. Africa contributes to &lt;10% of the total renal replacement therapy (RRT) patients worldwide, mainly due to the high costs associated. The purpose of this analysis was to describe the clinical characteristics and outcomes of patients from African Countries of Portuguese Official Language (ACPOL) who integrated the HD program of a tertiary hospital in Portugal.

Method
Retrospective analysis of 126 African patients who integrated the HD program of a tertiary hospital in Portugal, between January 2015 and December 2019. Last follow-up was ascertained in January 2021.

Results
Mean age was 49.9 ± 14.1 years, and 53.6% were male (n = 71). Hypertension was a comorbidity in 96.0% (n = 121). Twenty-one patients came from Angola (16.7%), 53 from Cape Verde (42.1%), 23 from Guinea-Bissau (18.3%), 20 from Saint Thomas and Prince (15.9%), and 9 from Mozambique (7.1%). Motive for referral to Portugal was RRT requirement in 93.7% of the cases (n = 118) and vascular access (VA) dysfunction in 6.3% (n = 8); these 8 patients with VA dysfunction were already on hemodialysis program before their evacuation to Portugal and they were mainly from Cape Verde (n = 4), Angola (n = 3), and one patient from Guinea-Bissau. At arrival, patients who initiated HD in our unit had mean serum creatinine 9.4 ± 4.4 mg/dL, urea 182.5 ± 109.1 mg/dL, Hb 9.6 ± 1.7 g/dL, serum albumin 3.6 ± 0.6 g/dL, PTH 491.7 ± 392.6 pg/mL. Patients referred due to VA dysfunction had mean Hb 10.1 ± 1.8 g/dL, serum albumin 3.7 ± 1.0 g/dL, PTH 918.9 ± 541.6 pg/mL. There were no statistically significant differences in both groups concerning country of origin, although hypoalbuminemia was more frequent in patients from Saint Thomas and Prince (50%) and Angola (42.9%). All patients started HD with a central venous catheter (CVC). During follow-up, CVC remained the vascular access in 51.6% (n = 65), arteriovenous fistula in 42.9% (n = 54), and arteriovenous graft in 5.6% patients (n = 7). Nine patients had exhaustion of VA for HD. Mean follow-up time was 70.5 ± 41.3 months, 1.6% of the patients transitioned to peritoneal dialysis (n = 2) and 15.1% were submitted to renal transplantation (n = 18). The mortality rate during follow-up was 14.3% (n = 18).

Conclusion
There are few studies about African patients undergoing HD and this is the first study presenting the clinical characteristics and outcomes of hemodialysis patients from ACPOL. These are young patients, almost all with hypertension, with a high prevalence of anemia, malnutrition, and secondary hyperparathyroidism. All patients started HD with CVC and several presented multiple access dysfunction. These data reinforce the urgent need of improvement and investment in African countries’ healthcare, especially on what concerns the ESRD, as it contributes to serious consequences in these patients’ survival and quality of life. With the cooperation protocol, Portugal provides these patients with RRT, treatment of the CKD complications, VA care, possibility of peritoneal dialysis and renal transplantation, ultimately improving their chance of survival and quality of life.