Abstract

Introduction: The phalanus involvement in advanced chronic kidney disease is highly variable. The objective was to study the phalanus involvement of patients at the stage of renal failure under conservative treatment followed at the National University Hospital of Cotonou (Benin) in 2024.

Methods: This was a cross-sectional study with analytical aims, carried out from March 1 to August 31, 2024. All patients aged at least 18 years with a GFR < 15 ml/min/1.73m² for at least three months. The identification of associated factors was possible thanks to a multiple logistic regression model at the 5% threshold.

Result: Of the 201 patients included, 29 had nail involvement, representing a frequency of 12.9%. The average age of the affected subjects was 48.36 ± 12.65 years with a sex ratio of 2.22. The nail involvements found were equisegmented nails (9.3%), leukonychia (3.1%) and alopecia (1.3%). Associated factors were high body mass index (p=0.023 ORa =0.31; 95% CI=0.08-1.92), hyperphosphatemia (p=0.0201, ORa=14.01; 95% CI=1.17- 43.49) and regular use of erythropoietin (p=0.0032, ORa =8.33; 95% CI=2.13-9.02).

Conclusion: The complications of chronic renal failure are frequent, variable and multifactorial. Their prevention would require early detection and good monitoring.

Keywords

Phanereal damage; Associated factors; Renal failure; Benin

Introduction

Patients with advanced Chronic Kidney Disease (CKD) frequently present phanereal manifestations as complications [1]. Phanera are keratinized structures found on the skin surface of animals, including humans, and play a variety of roles, mainly protective, but also aesthetic and sensory. Most phanerial manifestations in CKD occur in patients at the stage of renal failure and affect the patient’s quality of life [1-3]. Nail and hair changes were found in 60% and 50% of cases respectively, according to a study carried out by Pune in India in patients with renal failure [4]. In North-East India, Bijayanti Devi, et al. [5] found in 2020 that all renal failure patients had hair and nail changes in 68% and 119% of cases respectively.

In Nigeria, Falodun, et al. showed that in patients with renal failure, nail lesions occurred in 40% of cases [6].

Normally, patients with kidney failure should receive replacement therapy [7]. However, in Benin, due to inadequate technical facilities, some patients are treated with conservative care, with the aim of managing symptoms and improving quality of life without dialysis or kidney transplantation [7]. Sometimes, some patients decline replacement therapy due to the constraints and complications associated with dialysis and prefer conservative treatment that meets their physical, emotional and social needs.

In black Africa, few studies have been carried out on the phanerial manifestations of advanced Chronic Kidney Disease. The aim of this study is to identify the factors associated with kidney damage in patients with renal failure undergoing conservative treatment at the National teaching hospital of Cotonou (Benin) in 2024.

Study Methods

Type of study

This was a cross-sectional study, conducted over a six-month period from March1 to August 31, 2024.

Target population

The study focused on patients suffering from chronic kidney disease at the stage of renal failure, followed at the National teaching hospital Hubert Koutoukou Maga in Cotonou (Benin)

Inclusion criteria

All patients aged at least 18, with a Glomerular Filtration Rate (GFR) of less than 15ml/min/1.73m² for at least three months and undergoing conservative treatment were included.

Exclusion criteria

Subjects unable to express themselves were excluded.

Sampling was exhaustive

The dependent variable was the presence of phanereal involvement in a patient with renal failure not put on hemodialysis.

The independent variables were socio-demographic, clinical and paraclinical data.

Judging criteria

Phanerotic disorders include alopecia, equi-segmented nails and leukonychia.

Alopecia: This is the loss of hair from any part of the body for any reason [8].

Equisegmented nails: Characterized by a discoloration of the nail with a white proximal part and a reddish-pink to brown distal part, which fades over time [9].

Leuconychia: This is a whitening of the nail plate [10].

Data collection techniques and tools

Data were collected during a personal interview. Clinical data were obtained from a complete physical examination, with particular emphasis on skin and skin appendages. They were collected during the consultation. Patients were interviewed individually. Hospitalized patients were seen in bed after obtaining their consent, and anthropometric parameters were also taken.

Data processing and analysis

The data were entered and analyzed. To facilitate analysis, the injuries found were classified into groups.

The data were analyzed in several ways:

- a descriptive section, which consisted of calculating frequencies and averages for qualitative and quantitative variables.

- an analytical component which measuring the association between the dependent variable and the independent variables.

The measure of association used was Relative Risk (RR). Chi-square or Fischer’s statistical tests were used as appropriate to determine the p-value. A multivariate analysis was performed to eliminate confounding factors between measures association, logistic regression with SPSS version 20 software. The significance level was set at 0.05.

Ethical considerations

This was a research project initiated at the Faculty of Medicine, University of Parakou. The subjects included were those who had given their free and informed consent. Anonymity and confidentiality were respected.

Results

Overall incidence of kidney damage in patients with renal failure undergoing conservative treatment

In all, we included 225 patients, 29 of who had phanerial involvement, a frequency of were found in 12.9% of cases.

Specific frequency of phanereal damage

Of the 225 patients, 21 (9.3%) presented with equi-segmented nails, seven (3.1%) with leukonychia and three cases (1.3%) with allopecia.

Socio-demographic characteristics

The mean age of subjects with renal failure and at least one phanereal involvement was 48.36 ± 12.65 years, with extremes of 20 and 70 years. Of the 29 patients, 20 were male, with a sex ratio of 2.22.

Of these 29 subjects, 18 lived in urban areas, 13 secondary educations, 11 were self-employed and five were retired

Clinical features

Of the 29 patients, 27 suffered from hypertension, six from diabetes mellitus and two from heart disease. Of the 29 subjects surveyed, four were malnourished and two were obese.

Biological data

All 29 patients had hyperuremia and hypercreatininemia. Hyperphosphatemia was present in one subject; hypocalcemia in nine, hypokalemia in one patient, hyperkalemia in 16 and 10 subjects had a hemoglobin level below 10 g/dL.

Therapeutic data

Among the 29 subjects, 11 were on central antihypertensives, 17 on peripheral antihypertensives, 12 on injectable iron and 14 on erythropoietins.

Identification of factors associated with phanereal damage

In univariate analysis, body mass index (p= 0.007), phosphoremia (p= 0.01) and erythropoietin use (p= 0.01) were significantly associated with the occurrence of phanereal damage in patients renal failure (Table 1).

		Univariate						Multivariate
	Phanereal damage				RP	IC 95%	p	aOR	IC 95%	p
	95%
		N	n	%
Body mass index (kg/m2)							0.0077			0.0023
	<18.5	14	4	28.57	1
	18.5-24.9	174	23	13.22	0.46	0.18-1.15		0.22	0.18-1.15
	25-29.9	20	0	0	-	-		-	-
	≥30	17	2	11.76	0.41	0.08-1.92		0.31	0.08-1.92
Phosphoremia							0.013			0.0201
	Normal	146	21	14.38	11.32	1.01-52.12		14.01	1.17-43.49
	Increased	79	1	1.27	1			1	-
						-
Erythropoietin intake							0.0138			0.0032
	Yes	167	27	16.16	4.69	1.13-18.76		7.88	2.13-9.02
	No	58	2	3.44		-		1	-

Table 1: Factors associated with kidney damage in patients with renal failure in univariate and multivariate analysis.

In multivariate analysis, body mass index (p= 0.023 ORa= 0.31; CI95%= 0.08-1.92), phosphoremia (p=0.0201, ORa=14.01; CI95%= 1.17-43.49) and erythropoietin intake (p=0.0032, ORa= 8.33; CI95%= 2.13-9.02) were significantly associated with phanereal damage in these patients (Table 1).

Discussion

Our study was the first to be carried out in patients with renal failure who were not receiving renal replacement therapy, focusing exclusively on phanereal damage in our hospital. It constituted a baseline.

Limits and biases

The study was monocentric and of short duration, which made it impossible to obtain several cases. Similarly, the results of paraclinical examinations were not available for all patients, to facilitate interpretation. In parallel, patients do not benefit from holistic conservative treatment.

Comparison of results with those of other authors

Overall frequency of phanereal damage

A frequency of 12.9% was found. This is lower than the 40-60% found by Falodun, et al. [6] in Nigeria and Bijayanti Devi, et al. [5] in India.

This may be justified by the small sample size and short duration of the study. In fact, chronic kidney disease leads to bone mineral disorders.

Specific frequency of phaneric damage

Equi-segmented nails: Equi-segmented nails were found in 9.3% of cases, close to the 10.7% found in 2014 by Kaze, et al. [11] in Cameroon. This frequency remains higher than those ranging from 1.1% to 8% found in the African literature [6,12,13]. It is also lower than the variations of 20 to 40% estimated by some other authors [8- 12]. This may be justified by the small sample size and short duration of the study.

Alopecia: Patients with alopecia represented a frequency of 3.1%. This is higher than the 0.9% found by Bouraima et al. [14] in 2022 in Mali. This frequency could be justified by the fact that the study was monocentric and of short duration, which did not favor a large recruitment of patients.

Leuconychia: Our study found a frequency of 1.3% for leukonychia. This frequency is lower than the 5% found in Lebanon by Elsayed, et al. [15]. The patients were undergoing conservative treatment and not yet undergoing suppletive therapy, which will increase life expectancy but accentuate the complications of advanced chronic kidney disease.

Factors associated with phanereal damage

Phanereal damage was significantly associated with obesity, hyperphosphatemia and erythropoietin use. According to the literature, obesity with hypoprotein disorders and iron deficiency anemia leads to skin disorders [16].

Hyperphosphatemia, for its part, reflects a bone mineral disorder responsible for phanerotic damage. According to the literature, the more advanced the chronic kidney disease, the more these complications appear [1,3,4].

One of the side-effects of erythropoietin use may be iron deficiency [17]. Iron deficiency is thought to be responsible for skin disorders [16].

Conclusion

The prevalence of kidney damage is relatively high in people suffering from chronic kidney disease, especially at the stage of renal failure. They are multifactorial. Early management of these disorders cans patients’ quality of life.

References

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Article Information

Article Type: RESEARCH ARTICLE

Citation: Ahoui s, Akpadjan F, Finkpon A, Aikobinou SC , Vinasse A, et al. (2025) Factors associated with Phanereal Damage in Patients Suffering from Renal Failure under Conservative Treatment at the National Teaching Hospital of Cotonou (Benin). Int J Nephrol Kidney Fail 11(3): dx.doi. org/10.16966/2380-5498.257

Copyright: ©2025 Ahoui S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

Received date: 13 May, 2025

Accepted date: 11 Aug, 2025

Published date: 20 Aug, 2025