Epidemiology of chronic kidney diseases in the Republic of Guinea; future dialysis needs

BACKGROUND Chronic kidney disease (CKD) is increasing worldwide and can lead to end-stage renal disease (ESRD). OBJECTIVES Because few patients with ESRD in the Republic of Guinea have access to haemodialysis, we retrospectively evaluated the prevalence of CKD, ESRD and access to supportive therapies. PATIENTS AND METHODS 579 CKD patients (304 males; mean age: 44 ± 16 years) were admitted into Conakry nephrology department, the only centre in the Republic of Guinea, between 2009 and 2013. Most patients (63%) resided within Conakry (the capital), 12.5% came from lower Guinea, 11.7% from middle Guinea, 7.9% from upper Guinea and 4.8% from forest Guinea. RESULTS Reasons for referral were increased serum creatinine (49.5%), hypertension (27%) and diffuse edema (17%). Also, 11% were diabetic, 12.5% were smokers, 17% were HIV-positive, 8.3% were HBV-positive and 15% were HCV-positive. The most frequent symptom at admission was nausea/vomiting (56%). Upon admission, 70.5% of patients already had ESRD. Although no kidney biopsies were performed it was assumed that 34% and 27% of patients had vascular nephropathy and chronic glomerulonephritis, respectively. Of the 385 ESRD patients, only 140 (36.3%) had access to haemodialysis (two sessions/week, 4 hours each). Most patients that received haemodialysis resided within the Conakry region (P < 0.0001). There were significant associations between mortality and (i) terminal stage of CKD (P = 0.0005), (ii) vascular nephropathy (P = 0.002), and (iii) nephropathies of unknown origin (P = 0.0001). CONCLUSIONS A fourfold increase in haemodialysis machines is needed in Conakry, plus four new nephrology/haemodialysis centres within the Republic of Guinea, each holding ≥30 haemodialysis machines.