Hope in Hardship: AKI in Haiti
November 04, 2023 | 10:00 AM - 12:00 PM
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Hope in Hardship: AKI in Haiti
- AKI: Epidemiology, Risk Factors, Prevention - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
- Vernet, Fritz Verly, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Pawar, Aditya S., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Cleophat, Philip C., Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Remillard, Brian D., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Brown, Robert S., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Fritz Verly Vernet,
Aditya S. Pawar,
Philip C. Cleophat,
Brian D. Remillard,
Robert S. Brown,
AKI is a significant global issue, especially in low-resource areas with limited healthcare. Worldwide estimates suggest 13 million AKI occurrences/year with 1.7 million deaths, 85% in developing nations. In this study, we describe the presentation of AKI to a single healthcare center in Haiti and how collaboration can improve health care delivery for AKI.
The Hôpital Universitaire de Mirebalais (HUM), a 300 bed Partners in Health facility in rural Mirebalais has six residency programs. A partnership was formed between Beth Israel Deaconess Medical Center (BIDMC), Dartmouth Health and HUM focusing on educating internal medicine residents and staff through online presentations and short visits to Boston or Hanover for training in nephrology, urinalysis, HD, kidney biopsy, and bedside renal ultrasound. We planned that trainees would advance the ISN goal of eliminating preventable or treatable deaths from AKI by 2025.
This program has enhanced the knowledge of medical residents and students in AKI diagnosis, management, electrolyte physiology, and HD, improving patient care and clinical outcomes at HUM. Between July 2021 to October 2022, 194 patients presented with AKI (11 cases/wk). Their mean age was 48 and main causes were heart failure (43%), glomerulopathy (26%), sepsis (12%) eclampsia (5%), other infectious diseases (e.g., leptospirosis, COVID, 2%), and volume depletion (2%). Due to lack of dialysis nurses, all HUM medical residents receive training in hemodialysis, and if the patient meets criteria for HD, a resident will initiate the procedure, performed without cost, as the majority of Haitians cannot afford dialysis. Of these 194 AKI patients, 19% had received HD of which 83% survived. The overall survival was 78%.
Despite shortages of HD supplies and other medical equipment and inability to bring visiting professors to teach in Haiti due to multiple lockdowns and unrest, we have found alternative ways to receive shipments and to train our residents online. These residents become our future teachers, as with only 10 nephrologists for 11 million Haitians, the internists and general practitioners provide care for a large proportion of patients with AKI.
HUM, through education and training, in cooperation with BIDMC and Dartmouth, has provided care for patients with AKI, small victories that offer hope in managing hardship in Haiti.