The Principles And Practice Of Haehodialysis : The Experience At The Kenyatta National Hospital

Abstract

Haemodialysis as a form of renal failure treatment was started at

Kenyatta National Hospital in December 1972 w i t h the opening of the Intensive Care Unit. Between that time and June 1982, the machines used were part of a commodity aid from Japan given to the Kenya Government. In that period haemodialysis was carried out irregularly, a total of 57

I patients "ere di.aLy sed, Of these 25 were females and 32 were males. 31 had acute renal failure, 18 had chronic renal failure and 8 had acute on chronic renal failure. The age range was' 9 years to 50 years. w i t.ha mean age of 29.6 ± 3.6 (± 2SD), the commonest cause of acute renal failure was sepsis with disseminated intravascular coagulation and haemorrhage (32.3%) in various clin settings. Chronic glomerulonephritis was the COlPIDOnest cause of chronic renal failure (46.2%). At this time haemodialysis was geared main towards patients wi t.h acute renal failure who were expected to regain their renal function. 61.3% of the patients with acute

renal failure started on haemodialysis died. The commonest cause of death was continuing uraemia (31.6%) due to irregular and inadequate dialysis.

The patients started on dialysis in this period were severely ill and had adverse biochemical parameters.

In the one year period, begi.nn i.ng August 1981~ in the renal Unit at

Kenyatta National Hospital, intermittent .h.aernod i.a Ly si s has been carried

out regularly. This followed the installation of Gambro type haemodialysis machines in the Unit early in 198/1. The machines were part of a commodity aid from West Germany given to the Kenya Government and the renal Unit where haernodi aLy si s is being carried out was built by the Kenya Government.

In the one year period, Lf2 patients have been haemodialysed. These include

20 with acute renal failure and 22 with chronic renal failure, deliberately started on maintenance haemodialysis. Haemorrhage in various clinical settings was the commouest cause of acute renal failure (50%)., The commonest cause of chronic renal failure was chronic glomerulonephritis (59.1%). 30% of the patients with acute renal failure started on haemodialysis died. None of the deaths was related to the dialysis procedure. In the patients with chronic renal failure started on haemodialysis, 72.7% died. The commonest cause of death was inteldialytic pulmonary oedema (31.3%). The concept of "prophylactic" dialysis was used in the patients with acute renal failure in the prospective period. Thus they were in a better clinical state and had less adverse biochemical parameters than the patients di aly sed between December 1972 and June 1982. The outcome of the dialytic treatment was favourable.

The management of 22 patients with chronic renal fa{lure on maintenance haemodialysis for periods of upto 36,weeks (170 patient-weeks) ~s described.

The clinical and biochemical states of the patients at the start of treatment were poor. The initial control of blood pressure and biochemical response to dialytic treatment were encouraging. The conmmnest recurring problem in the short term has been related to vascular access.