Introduction: Acute kidney injury (AKI) in hospitalized patients infected with COVID-19 is associated with an elevated mortality rate compared to non-infected patients (39% versus 24%). This is despite a lower prevalence of AKI in COVID-19-infected patients (17 vs 22%). The reasons are multifactorial and have been well documented in developed countries, whereas in developing countries there are scant data. Methods: This study aimed to document the mortality in COVID-19-infected South African patients who required dialysis for AKI. Exclusion criteria included any chronic kidney replacement therapy (transplantation or dialysis). A REDCap survey of South African nephrologists and nephrology fellows registered with the South African Nephrology Society was conducted. The primary outcome was all-cause in-hospital mortality, while additional points of interest included comorbidities, dialysis modality and intervention required. Univariate analysis of mortality predictors was performed. Results: The COVID-19-related AKI mortality rate was 58.9%. Significant predictors included continuous veno-venous haemodialysis therapy, invasive ventilation, use of inotropes and the presence of shock. Ischaemic heart disease, heart failure and admission to a private healthcare facility were associated with lower mortality. No significant associations were found with ethnicity, sex, hypertension, diabetes, HIV infection or the use of other modes of dialysis. Conclusions: In South African patients, we report similar outcomes in critically ill patients requiring dialysis for AKI, relative to international data. The predictors of mortality most likely reflect the severity of the illness in our patients. The data suggest that continuous veno-venous haemodiafiltration or slow low efficiency dialysis may be the preferred dialysis modalities in these patients.

The editors of AJN wish to thank the colleagues who generously gave of their time and expertise to review manuscripts for us during 2019. We greatly appreciate their contribution to the quality of the work that we publish.

Background: Cardiovascular disease is the most common cause of morbidity and premature mortality in patients on chronic haemodialysis. There are limited data on cardiac abnormalities among these patients in sub-Saharan Africa, including Uganda. We determined the prevalence and patterns of echocardiographic (echo) abnormalities among patients with end-stage renal disease (ESRD) on haemodialysis at Mulago National Referral Hospital, Kampala, Uganda. Methods: Eighty patients with ESRD on chronic haemodialysis were enrolled in the study over a period of five months from November 2017 to March 2018. We collected data on demographic and baseline clinical characteristics by reviewing charts and conducting patient interviews. Participants had blood pressure measurements performed and blood samples taken for laboratory investigations. We then conducted a cardiac evaluation using standard transthoracic echo protocols. Bivariable and multivariable analysis was performed to study associations with left ventricular hypertrophy and diastolic dysfunction. Results: Fifty-three of the 80 patients (66%) were male, mean age was 49 ± 16 years and the median duration on dialysis was 9.5 months (interquartile range 4–24 months). Twenty-eight (35%) had to travel >50 km to access dialysis. Seventy-four patients (93%) had at least one cardiac echo abnormality and 30% had at least three abnormalities. Left ventricular hypertrophy (68%) and diastolic dysfunction (64%) were the most common abnormalities. There was a high prevalence of factors that have previously been associated with left ventricular hypertrophy and diastolic dysfunction including anaemia (79%), poorly controlled hypertension (79%) and dyslipidaemia (56%) but none of these was statistically significantly associated in this study. Conclusions: Our study confirmed a high prevalence of cardiac abnormalities among a young population of African patients with ESRD on chronic dialysis. We recommend that echocardiography be part of the routine care to help plan early intervention for those at high risk of cardiovascular events.

Background: Hypernatraemia is a common electrolyte problem in hospitalized patients and is associated with a high mortality rate. We aimed to determine the incidence, causes, management, and outcomes of hypernatraemia in adult hospitalized patients at a large South African tertiary hospital. Methods : A retrospective study was conducted at Tygerberg Hospital in Cape Town, South Africa. Adult patients with hypernatraemia (at least one serum sodium concentration ≥150 mmol/L) during a 3-month period in 2014 were identified from our laboratory database for inclusion. Results : There were 204 patients with hypernatraemia, an incidence of 1.5%. Of these patients, 101 (49.5%) were male, and the mean age was 53 years. There were 66 patients (32.4%) who had hypernatraemia on admission, and 138 who developed it during the course of their hospital stay. The overall in-hospital mortality was 38.7%, with higher rates for older patients and those with more severe degrees of hypernatraemia. Contributory causes which were most commonly present included dehydration/hypovolaemia (45%), followed by sepsis (39%). Net sodium gain, rather than water deficit, was identified as the main mechanism in most of the patients who developed hypernatraemia in the intensive care units. We found little evidence of any diagnostic work-up and also found that the details of fluid therapy and intake-output charting were poorly documented. Conclusions : There is a very high mortality rate in our hospitalized patients with hypernatraemia. The diagnostic work-up and therapy was often inadequate or poorly documented. The management of this important condition needs to be improved with the aid of standardized protocols.

Background: Across the world, World Kidney Day (WKD) is marked yearly to increase awareness of kidney diseases. In 2016, its focus was on children for the first time. We report on a WKD screening initiative for kidney disease that was conducted in two public schools in Lagos State, Nigeria. Methods: Participants were recruited after guardians provided signed consent and older children gave assent. Baseline data were obtained which included family history of chronic diseases like sickle cell disease, hypertension, diabetes, renal disease, and the use of herbal medications. Anthropometric parameters such as height, weight and body mass index (BMI) were recorded. Investigations included urinalysis, measurement of serum creatinine and estimation of glomerular filtration rate (eGFR) using the Schwartz formula. Results: A total of 405 children were screened; there were 190 (46.9%) males and 215 females. The children were aged 2 to 17 years with a mean age of 9.1 ± 3.0 years. Over 80% of the children had normal nutritional status. Severe thinness was seen in 22 (6.8%) whereas overweight was present in 10 (3.1%). Only 1 was obese. eGFR was above 90 mL/min/1.73 m2 in 232 (94.3%) of the participants. Hypertension was present in 47 (14.4%), with the highest rate among those 0–8 years old. Proteinuria was detected in 118 (29.2%); none of the children had haematuria. Systolic hypertension, a family history of smoking and the use of herbal medications were associated with proteinuria. Conclusions: The study has highlighted a high rate of proteinuria, associated with the use of herbal medications, hypertension and a family history of smoking. Screening for renal disease in children with appropriate follow-up and timely intervention to avoid progression to end-stage renal disease is imperative.

African Journal of Nephrology (AJN) has completed a full year of operation as a web-based journal. After addressing a few teething problems, the journal is now running smoothly. I wish to thank reviewers, readers and the members of the editorial board for having participated in this endeavour. On behalf of the editorial board, I wish to thank all colleagues who have chosen to submit their valuable work to our journal. A special welcome and thanks to contributors who have submitted their manuscript in French, with an English abstract. They ensure that AJN remains a representative vehicle for nephrology research output in Africa. Volume 20, for the year 2017, has now given way to Volume 21, which will include publications throughout the year 2018. As a tribute, I wish to summarize few highlights of Volume 20. The story of the African Association of Nephrology (AFRAN) by Prof Rashad Barsoum, the founding president of AFRAN, is a very good record of the development of nephrology in Africa. The review of renal physiology in patients with potassium disorders by Prof Mitch Halperin and the review of focal and segmental glomerulosclerosis by Prof John Feehally are excellent updates of the two topics. Original articles and case reports from contributors from various African regions are testament to the active production of nephrology knowledge in Africa. Finally, congress proceedings of the AFRAN Congress in March 2017 in Yaounde (Cameroon) and of the Southern African Transplantation Society Congress in September 2017 in Durban (South Africa) are excellent records of high quality nephrology meetings in Africa. As we are continuing to digitize and preserve our past, I wish to invite everyone to read our archive of publications. I urge everyone who may have copies of old AJN issues or manuscripts that are missing in the archive, to forward them to us to ensure that we make all our past papers available online. In the beginning, AJN started as a newsletter, published by the late Prof Salma Suleiman of Sudan. To complete the AJN archive, we hope to include the past newsletters as a tribute to the late Prof Suleiman. We urge anyone having any copies of the newsletter to forward it to AJN. As in Volume 20 in 2017, Volume 21 will consist of a single issue and include all publications for 2018. They will be added throughout the year as they are accepted for publication. We should expect exciting reviews by experts as in our previous volumes as well as special articles. For our legacy project that was started by Prof Rashad Barsoum, first AFRAN President, we will request the subsequent AFRAN presidents to each submit a review of the period of their tenure. As in the past, we expect to publish original articles as well as interesting case reports, and we encourage regional and national societies to submit the abstracts from their conference proceedings for publication. Finally, I wish to take this opportunity to express my best wishes for the year 2018 to all contributors, reviewers and readers. Alain G Assounga Editor-in-Chief

Background: The use of peritoneal dialysis (PD) as a treatment modality for patients with end-stage renal disease (ESRD) has been declining in many countries over the past few years. One of the reasons is technique failure, which occurs more frequently than is the case with chronic haemodialysis. Identifying and addressing the causes of technique failure is important in order to maintain more patients on PD, especially in settings where there are limited resources for chronic haemodialysis and a “PD first” approach is followed. Methods: In this retrospective study at Tygerberg Hospital in Cape Town, South Africa, we investigated 170 patients who were started on chronic ambulatory PD between January 2008 and July 2014, and determined rates of technique and patient survival. Demographic, clinical and laboratory data were assessed to identify risk factors for these outcomes. Results: The median age of the patients was 36 years and the most common cause of ESRD was glomerulonephritis. Only one patient had diabetes mellitus. Technique survival at 1, 3 and 5 years was 80%, 54% and 39%, respectively, while patient survival was 90%, 82% and 63%. Patients started on PD during the second half of the study period had improved rates of technique survival. Peritonitis was the most common cause of technique failure. Increasing age and Black ethnicity were associated with increased likelihood of technique failure. Other clinical and social factors were not significantly associated with the occurrence of technique failure. Conclusions: In our patients on PD, peritonitis, increased age and Black ethnicity were important factors associated with the development of technique failure. Concerted efforts are required to reduce peritonitis rates at our centre as this is the leading cause of technique failure.

Background: The management of end-stage kidney disease constitutes a heavy burden on communities worldwide due to the high cost of renal replacement therapy (RRT). Data on the cost of RRT are scanty in low-income countries. This study aimed to evaluate the global cost of haemodialysis in Cameroon, an emerging economy in Central Africa. This will provide data to help healthcare planners develop more cost-effective strategies for the care of these patients. Methods: A prospective cost analysis of chronic haemodialysis care in three public-sector facilities was conducted in Cameroon. Both incident and prevalent patients were enrolled and followed up for 6 months. Patient data and costs were collected from patient interviews, medical records, bills, hospital price-lists and the procurement departments of the hospitals. Direct medical costs included outpatient consultation fees, dialysis consumables, dialysis session fees, drugs, laboratory and radiological tests. Non-medical direct costs included the cost of transport, feeding, water and electricity. Indirect costs related to the monthly loss of productivity for patients and their caretakers. The annual costs were calculated as the median costs for 6 months multiplied by 2 and were expressed in the local currency, the Central African franc (XAF), and US dollars ($). Results: A total of 154 patients (62.3% males), mean age of 46.8 ± 15.2 years, were included, with 6 130 dialysis sessions completed during the study period. The annual median cost of haemodialysis per patient was XAF 7 988 800 ($ 13 581). Out-of-pocket payments amounted to XAF 2 420 300 ($ 4 114), accounting for 30% of the total cost. The median direct cost was XAF 7 458 200 ($ 12 679) and indirect cost XAF 530 600 ($ 902). Direct medical costs accounted for 88%, mainly due to dialysis consumables. In the initiation phase, additional costs of $ 754 were incurred. The cost of hospitalization, laboratory and radiology tests, feeding, consultation fees and some drugs varied significantly among facilities. Conclusions: Compared to the national gross domestic product per capita in Cameroon, the cost of care of patients on haemodialysis is high. Out-of-pocket payments are out of the reach of most patients and there is a need for implementing other cost-effective strategies to prevent and manage end-stage kidney disease in our setting. Key words : cost analysis, haemodialysis, peritoneal dialysis, Cameroon.

A 58-year-old patient developed complete anuria following elective abdominal surgery for an ileocaecal mass. Contrast-enhanced computed tomography demonstrated absent intra-renal blood flow and a kidney biopsy confirmed diffuse cortical necrosis. Histology of the ileocaecal mas displayed deep fissuring which was diagnostic of Crohn’s disease. Bilateral renal cortical necrosis (BRCN) is a rare complication of surgery but should be considered in any patient developing complete anuria. Since the disease is often associated with a coagulopathy, conditions predisposing to thrombosis should be sought. Inflammatory Bowel Disease (IBD) with surgical complications, as in this case, should be considered among the conditions which may predispose to BRCN.

This correction serves to update the reported numbers of new kidney transplants performed annually since 2012 in the public sector in the province of KwaZulu-Natal.