Management of end-stage kidney failure; a challenge for the countries of sub-Saharan Africa Example of mineral and bone disorders in Burkina Faso

Introduction. Meeting treatment targets for dialysis is a seemingly impossible challenge for most countries of sub-Saharan Africa. To assess this problem, we conducted this study of mineral and bone disorders in subjects undergoing hemodialysis at the Ouagadougou hemodialysis unit, the only such unit in Burkina Faso. Patients and methods. This cross-sectional descriptive study was conducted in January 2010. We included patients on hemodialysis for at least three months who had some minimal predialysis laboratory results available. The KDIGO guidelines served as our reference. Dialysis sessions lasted 5 h and took place once every five days. The statistical analysis of the data was performed with PASW statistical software, version 18 for Windows. Results The study included 32 of the 53 patients in the unit: 19 men and 13 women with a mean age of 43.5 +/- 12.7 years. Their mean serum levels were 2.2 +/- 0.2 mmol/L for calcium, 1.4 +/- 0.5 mmol/L for phosphorus, 934 +/- 887.4 pg/mL for intact parathyroid hormone and 193.4 +/- 125.7 IU/L for total alkaline phosphatases. No patient reached the target for all three of the first three indicators. Patients with parathyroid hormone >= 800 pg/mL (n = 14) had a serum phosphorus (1.6 +/- 0.6 vs 1.2 +/- 0.4; p = 0.044) and alkaline phosphatases (287.5 +/- 100.5 vs 120.2 +/- 90; p < 0.001), significantly higher than those whose parathyroid hormone level was < 800 pg/mL. Conclusions. The bone and mineral status of our hemodialysis patients is worrisome and is due to suboptimal treatment conditions. The risk of deaths is high. Subsidies sufficient to provide adequate care would reduce these problems, which have, we note, an ethical dimension.