Anemia management in hemodialysis patients in a low-resource setting: blood transfusion and unmet blood needs in Burkina Faso.

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Résumé

Introduction: Anemia is a common complication in the advanced stages of Chronic Kidney Disease (CKD) and is associated with high morbidity and mortality. In sub-Saharan Africa, the inaccessibility of Erythropoiesis Stimulating Agents (ESAs) leads to frequent use of Red Blood Cell Transfusions (RBCT). Our study aimed to determine the prevalence of anemia and assess the RBCT needs of hemodialysis patients at Tengandogo University Hospital, Burkina Faso. Patients and methods: This retrospective study conducted from January 1, 2021, to December 31, 2023. All patients undergoing maintenance hemodialysis for at least 3 months were included. Results: Seventy-three patients, with a mean age of 44.48 ÷ 14.57 years were included. The sex ratio was 2.04. All patients were anemic, with a mean hemoglobin level of 7.29 ≤ 1.41 g/dL. Anemia was severe in 72.6% of them. Only 13 patients (17.81%) regularly received ESAs. Forty-eight patients (65.75%) had been transfused and received an average of 8.81 + 8.89 units of Packed Red Blood Cells (PRBC) per patient (range: 1-42). Patients who received transfusions had a significantly lower hemoglobin level (p<0.001) and a shorter dialysis vintage (p = 0.003). Over three years, an average of 13.7 units of PRBC were prescribed per patient, totaling 658 units, but only 422 (64.2%) of these were transfused. The non-availability rate was 34%, representing an average of 4.7 unmet PRBC units per patient. Patients with hemoglobin level below 7 g/dL had significantly more unmet PRBC requests (p = 0.015). Conclusion: The high prevalence of severe anemia and reliance on transfusions is due to the financial inaccessibility of ESAs and intravenous iron. Subsidizing these medications would therefore improve anemia management in hemodialysis patients, reduce morbidity and mortality and preserve RBCT resources for life-threatening emergencies.

Mots-clés

Anemia, Hemodialysis, Blood transfusion, Burkina Faso, Sub-saharan Africa