Referral of Patients with Kidney Impairment for Specialist Care in a Developing Country of Sub-Saharan Africa

Aim. The aim of this study was to assess the referral pattern of patients with kidney impairment in Cameroon. Methods. Medical files of patients received at the out-patients department of nephrology from January 2001 to December 2003 at the Yaounde General Hospital were reviewed. Individual information recorded included age, sex, and referral sources. Data on etiologic and co-morbidity factors, clinical signs of CRF, anthropometric measurements, blood pressure, and biological variables were recorded. Patients were staged for kidney damage in three groups following an adaptation of the Kidney Disease Outcome Quality Initiative (KDOQI) guide recommendations, using the creatinine clearance derived from the Cockroft-Gault equation. Results. Of the 183 patients received during the study period, 140 (77.8%) fulfilled the entry criteria. Men (70%) were more represented, and mean age was 50.19 +/- 1.07 years. Hypertension (62.1%) and diabetes mellitus (26.4%) were the most frequent risk factors. There was no major difference between men and women for most clinical and biological variables. Patients were referred mostly by cardiologist (31.4%) and general practitioners (29.3%). Late referral (GFR <30 mL/min) encompassed 82.8% of participants. Regardless of the referral source, the overall trend was toward late referral. Clinical and biological profiles worsen with advanced stage of kidney impairment. In general, management of patients prior to referral was poor. Conclusions. This study has revealed the disconcerting high rate of late referral to nephrologists in this context. Many potential factors can account for this observed pattern, and it is worth investigating to improve referral and outcomes of patients with kidney diseases in Cameroon.