BackgroundIntradialytic hypertension (IDH) increases morbidity and mortality. The prevalence in South Africa is unknown. The pathogenesis is unclear, but it has been suggested that IDH may be due to subclinical fluid overload. The objective of this study was to determine the prevalence of IDH and to evaluate its association with fluid overload using bioimpedance spectroscopy (BIS).MethodsA cross-sectional study involving 190 chronic haemodialysis patients in the Western Cape province of South Africa was conducted between January 2013 and May 2014. IDH was defined as a >10 mmHg increase in systolic blood pressure in at least four of six prior consecutive haemodialysis sessions.ResultsThe prevalence of IDH was 28.4% (n = 54). There was a trend towards pre-dialysis overhydration in the IDH group when compared with controls {2.6 L [95% confidence interval (CI) 1.7–3.4] versus 1.8 L [95% CI 1.4–2.1], respectively; P = 0.06} as measured by BIS, but no difference in mean ultrafiltration (UF) volume (2.4 versus 2.6 L; P = 0.30). A trend towards greater use of antihypertensive drugs was noted in the IDH group [2.5 drugs (95% CI 2.15–2.87) versus 2.1 (95% CI 1.82–2.30); P = 0.05]. More participants in the IDH group received calcium channel blockers (54 versus 36; P = 0.03).ConclusionsThe prevalence of IDH in our treatment centres is much higher than previously reported. Subclinical fluid overload may be a major contributing factor to the mechanism of this condition. The use of BIS identifies patients who may benefit from additional UF.

The sixth annual report of the South African Renal Registry summarises the 2017 data on renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) in South Africa. In December 2017, the number of patients with ESRD who were treated with chronic dialysis or transplantation stood at 10 744, a prevalence of 190 per million population (pmp). The growing prevalence observed since the registry was established is due mainly to the increasing numbers of patients accessing haemodialysis in the private sector, where the prevalence was 855 pmp. In the public sector, which serves 84% of the South African population, the prevalence of RRT (66 pmp) remained below the level reported for 1994, so that the disparity in access continued to increase. The disparities between provinces remained, with Limpopo and Mpumalanga the most under-served, as did the disparities between ethnic groups, with Blacks being the most under-served group. The Western Cape was the province with the highest public sector treatment rates and was also where most of the country’s public sector kidney transplants were performed.

The ninth annual report of the South African Renal Registry summarises the December 2020 data on kidney replacement therapy (KRT) for patients with kidney failure in South Africa. The numbers of patients reported here are substantially lower than those recorded in the previous report. This is likely the result of several factors, including larger numbers of deaths from COVID-19 and other causes, delayed initiation of KRT due to the pandemic, and challenges with data submission to the registry during a period when personnel were overwhelmed with clinical responsibilities related to the pandemic. In December 2020, the number of patients who were being treated with chronic dialysis or transplantation stood at 8 734, a prevalence of 146 per million population (pmp). The prevalence of South Africans accessing treatment in the private healthcare sector was 729 pmp, whereas it was 44 pmp in the chronically under-resourced public sector, well below the rate reported for 1994.

The seventh annual report of the South African Renal Registry summarises the 2018 data on kidney replacement therapy (KRT) for patients with kidney failure in South Africa. In December 2018, the number of patients who were being treated with chronic dialysis or transplantation stood at 10 730, a prevalence of 186 per million population (pmp). Most patients are treated with haemodialysis in the private healthcare sector, where the prevalence was 839 pmp. In the public sector, which serves 85% of the South African population, the prevalence of KRT (67 pmp) remained below the level reported for 1994. Limpopo and Mpumalanga remain the most under-served provinces and Blacks the most under-served population group. The Western Cape province had the highest public sector treatment rates by a large margin and was also where most of the country’s public sector kidney transplants were performed.

The eighth annual report of the South African Renal Registry summarises the 2019 data on kidney replacement therapy (KRT) for patients with kidney failure in South Africa. This round of data collection has been adversely affected by the COVID-19 pandemic, which has impacted on the completeness of the data. In December 2019, the number of patients who were being treated with chronic dialysis or transplantation stood at 9 937, a prevalence of 169 per million population (pmp). The prevalence in South Africans accessing the private healthcare sector was 788 pmp, whereas it was 57 pmp in the chronically under-resourced public sector, still below the rate reported for 1994.