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Risk of death and the economic accessibility at the dialysis therapy for the renal insufficient patients in Lubumbashi city, Democratic Republic of Congo

The last five years, Lubumbashi records the emergence centers of dialysis. We achieved this study to evaluate the risk factors of death for the renal insufficient patients and the economic accessibility to this peak therapy. A cross sectional study based on a random sample of 53 patients has been completed in 2012. The data is analyzed using the SPSS 19.0 software. A significance level of p < 0.05 and Confidence interval fixed to 95%. The Fischer exact test and the odds ratio have been used. The participation rate was 65.4%. The mean age was 49.49 ± 13.30 years old and 60.4% were aged > 50 years old. The sex ratio 0.3 women by men was noted. 83% of patients was private versus other category (p<0.05). 66% are renal insufficient chronic patients versus 34% of recent renal insufficient patients. 90% of patients were diabetic hypertensive. The patients’ monthly income declared was US$ 205 for 52.8% of patients, US $ 525 for 34% patients and US $ 750 for 13.2% of patients versus US $ 1, 270 monthly mean care cost. The deaths are associated statistically with an interruption of the treatment (χ2=9.30, p=0.0022, OR= 8.5) and with the irregularity of treatment (χ2=8.65, p=0.0032, OR=6). Africa in comparison with countries of other continents, to invest in advanced medical equipment is a salutary measure, but the majority of patients are not able to pay the costs of health care. Our results shown that, the dialysis became an ultimate recourse for the renal insufficient patients at Lubumbashi city but the economic accessibility remains a major obstacle. Consequently, it's important to subsidize the health care of these patients.


Introduction
It's observed that the health consequence of chronic kidney disease is the renal failure. When renal function has deteriorated to a point when it is not possible to sustain life, the process is irreversible and the patient is considered to be in the end-stage renal disease [1].
Two methods of treatment are available for these patients: dialysis and renal transplantation. The development of these two methods has been an important advance of modern medicine, which has an impact on many renal patients [1].
In United States since 1996, around 335,014 patients in the depended on either dialysis or a kidney transplant to perform the function of their own failed kidneys [1,2]. As well has, the health care is expensive and many life are saved. The study carried out by.'. indicate that, the morbidity and mortality experienced by the treated end-stage renal disease population is substantially higher than for the all population [2]. Concerning the age of renal insufficient patients in the world, especially in the United States of America, some studies observed that the African-Americans people have develop end-stage renal failure at an earlier age than whites.
For theses patients, their mean age at end-stage renal disease incidence was 55.8 years old compared with 62.2 for whites [2].
African-Americans people constitute almost 30 percent of prevalent end-stage renal disease patients, in spite they represent only 12.6 percent of the U.S. population [2]. The incidence of chronic kidney disease is enormous and its prevalence keeps increase [3]. It is highly important to highlight the burden of renal insufficient patients in developing countries in this century because the prevalence of kidney failure is increasing and their costs very high.  [4].
For example, recent studies oriented on patients with type 1 of diabetes mellitus have established that tight control of the level of blood sugar can reduce the development of proteinuria [3], and the use of angiotensin converting enzyme inhibitors can slow the progression of kidney disease [4]. There is substantial evidence that optimum blood pressure control is an important goal in the followup for all patients with proteinuria or chronic renal insufficiency [5,6], and in patients with type 2 diabetes mellitus [7,8]  In Nigeria, the situation is such that chronic kidney disease represents 8 to 10% of hospital admission [9][10][11]. The couple Hypertension and renal insufficiency is designated by the unromantic name "deadly duo". For Menno T.et al. in 2008, Hypertension is present in 80% of chronic renal insufficient patients.
In these patients, hypertension accelerates the deterioration of renal function and is the direct cause of renal insufficiency in a third of patients on dialysis [12].
Worldwide, the WHO estimates that one in three adults has high blood pressure and 40 to 50% of African adults are hypertensive. In developing countries where renal replacement therapy is available, but it is unaffordable by most patients. In Nigeria as in most other developing countries, there is not social security system or health insurance scheme to assist the patient and the burden is borne solely by the patient and relatives [3]. Health systems are   (Figure 1).

Discussion
This study based of the risk of death and affordability for renal insufficient patients is an approach to public health and health economics in a discussion around the world. It shown that renal failure is largely a result of poor management of diabetes mellitus and hypertension or comorbidity hypertension and diabetes mellitus.
Although it is useful to quantify the high costs of diabetes, it is also important to understand the underlying causes.
Our results indicate a rather alarming lethality around 62.2% of renal insufficient patients in a dialysis center at Lubumbashi city. It must indeed recognize that despite significant progress in therapy, the mortality in patients with acute renal failure remains high, estimated at around 50% [1,2]. Several authors agree to highlight, using different fitting techniques, that there is a mortality directly related to acute renal failure [3,4]. In a large study published, including more than 17,000 patients [15], using the technique of control cases had observed an increase in mortality from 38.5 to 62.8% when the acute renal failure was present.
These observations do not necessarily imply that acute renal failure is the cause of all of this difference in mortality as death and renal disease can both result from one or more third factors. But it's not so symmetrical, more conceivable that acute renal failure is quite independent of the high mortality [6]. Various pathophysiological hypotheses are possible to identify a common explanatory factor.
The most obvious is probably the decrease in tissue perfusion due to a reduction in cardiac output that could explain both an important part of early mortality and renal impairment, since the kidney is physiologically very sensitive to reduction of blood flow. This hypothesis is also supported by the increased mortality accompanying the presence of acute renal failure in populations of patients with cardiovascular disease mortality shifts from less than 10% to over 65% when failure acute kidney was present [7]. About

Conclusion
The results of this study indicate the need for further investigations on the slopes of successful dialysis, the risk factors for death for renal insufficient patients and the procedures for grant expenditures that support. The irregularity of dialysis therapy was significant risk factor of death. The hospital costs are very high compared to the monthly income. Our results shown that, the dialysis became an ultimate recourse for the renal insufficient patients at Lubumbashi city but the economic accessibility remains a major obstacle.
Consequently, it's important to subsidize the health care of these patients.

Acknowledgments
We gratefully thank the hospital staff of Centre Medical du Centre Ville of Lubumbashi city as well as the patients who have voluntarily collaborated to this survey. Table 1: baseline characteristics of 53 renal insufficient patients   Agent of private enterprise 0 3 3