Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review

Ashuntantang, Gloria; Osafo, Charlotte; Olowu, Wasiu A.; Arogundade, Fatiu A.; Niang, Abdou; Porter, John D.; Naicker, Saraladevi; Luyckx, Valérie A.

doi:10.1016/s2214-109x(17)30057-8

Cited by 169 publications

(165 citation statements)

References 54 publications

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“…A recently published report has found that most patients in sub‐Saharan Africa diagnosed with end‐stage kidney disease (ESKD) ultimately discontinue dialysis treatment . As a result, approximately three million people in this region die each year due to lack of access to dialysis.…”

Section: End‐stage Kidney Disease In Africa: a Growing Crisismentioning

confidence: 99%

Transplantation in Africa

Pullen¹

2017

American Journal of Transplantation

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Section: End‐stage Kidney Disease In Africa: a Growing Crisismentioning

confidence: 99%

Transplantation in Africa

Pullen¹

2017

American Journal of Transplantation

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“…For these children without access to RRT, death is inevitable . A systematic review of the outcomes of patients who reach dialysis and the quality of dialysis received in sub‐Saharan Africa found that 133/140 (95%) of children who could not access dialysis died or were presumed dead; and only 71/381 (19%) of children with ESKD received kidney transplants . In South Africa (SA), despite being an UMIC, access to chronic dialysis in the public sector is geographically restricted with only four of nine national provinces offering this service.…”

Section: Introductionmentioning

confidence: 99%

Contemporary outcomes of the pediatric kidney transplant program in Johannesburg, South Africa, between 2004 and 2017: Better or not—And which way forward?

Mshumpela

Loveland

Botha

et al. 2020

Pediatric Transplantation

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Background Outcomes for the pediatric kidney transplant program in Johannesburg (1984‐2003) were found to be suboptimal. In this study, we compared (a) early (era 1:1984‐2003) to contemporary (era 2:2004‐2017) outcomes and (b) compared contemporary outcomes between the public and private sector hospitals in our program. Methods We conducted a retrospective record review of all pediatric (<18 years) KA transplants performed in our kidney transplant program at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC) from 2004 to 2017. We collected the following data per site: number of recipients, transplants performed, mean follow‐up time, and grafts lost; per recipient: age at time of transplant, sex, self‐reported population group; transplant history; donor type; etiology of ESKD; recipient and graft survival. Outcomes for era 1 were based on data published on our kidney transplant program, based at CMJAH. Results At CMJAH (public sector), there was no improvement in recipient and graft survival over time. In the contemporary analysis, 1‐, 5‐, and 10‐year recipient survival, as % (95% CI) was 93 (84‐97); 76 (64‐84); 59 (44‐70) for CMJAH, and 98 (90‐99); 95 (86‐99); 82 (54‐94) for WDGMC (private sector). Similarly, 1‐, 5‐ and 10‐year graft survival was 75 (63‐84); 55 (42‐66); 36 (24‐49) for CMJAH, and 96 (87‐99); 84 (73‐91); 64 (48‐76) at WDGMC. Conclusion Contemporary outcomes for the pediatric kidney transplant program at WDGMC are comparable to outcomes achieved in middle‐ and high‐income settings. However, outcomes at CMJAH are suboptimal, reflecting numerous health system, infrastructural and human resource challenges.

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“…However, its prescription remains far from being optimal in replacing the function of normal kidneys, and its unphysiologic clearance pattern and inability to remove all types and sizes of uremic toxins resulted in inter-and intradialytic complications, higher hospitalization rate, poor quality of life and an unacceptably high rate of cardiovascular and all-cause mortality [3][4][5]. The major HD-contributing factors to high mortality and morbidity rates are excess fluids (hypervolemia) and retention of middle and larger size uremic toxins.…”

Section: Introductionmentioning

confidence: 99%