Peritoneal dialysis for acute kidney injury in sub-Saharan Africa: challenges faced and lessons learned at Kilimanjaro Christian Medical Centre

Callegari, John; Kilonzo, Kajiru; Yeates, Karen; Handelman, Garry J.; Finkelstein, Fredric O.; Kotanko, Peter; Levin, Nathan W.; Carter, Mary

doi:10.1038/ki.2011.408

Cited by 33 publications

(21 citation statements)

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“…This observation highlights the importance of appropriate treatment of anemia in children with ESRD and emphasize the role of erythropoiesis stimulating agents in improving prognosis in patients with chronic kidney disease [26]. According to the KDIGO recommendations, in all pediatric CKD patients receiving ESA therapy, Hb concentration should be in the range of 11.0 to 12.0 g/dl (110 to 120 g/l) [27]. …”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes in children with chronic kidney disease stage 5 over the last 40 years

Adamczuk¹,

Roszkowska‐Blaim²

2017

aoms

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IntroductionWe evaluated outcomes in children with chronic kidney disease stage 5 (CKD 5) treated in the first pediatric dialysis unit in Poland during 1973-2012.Material and methodsThe retrospective analysis included 208 children with CKD 5 undergoing renal replacement therapy (RRT), stratified into four decades of treatment: 1973–1982, 1983–1992, 1993–2002, and 2003–2012.ResultsThe most common causes of CKD 5 included glomerulonephritis in 27.4% and pyelonephritis secondary to urinary tract anomalies in 25.5% of children. Among 208 children, 172 (82.7%) survived and 17.3% died. Kidney transplantation (KTx) was performed in 47.6% of children, including pre-emptive KTx in 1.92% of children. Chronic dialysis was continued in 34.1% of children, and RRT was withdrawn in 1%. The overall mortality rate was 6.2 per 100 patient-years, and 3-year survival was 83.9%. The highest mortality rate of 23.4 per 100 patient-years was observed among children in whom RRT was initiated in 1973–1982, with subsequent reduction of the mortality rate to 4.5 and 2.1 per 100 patient-years in 1993–2002 and 1983–1992 respectively. No deaths were noted after 2002. Cardiovascular problems were the most common cause of death, found in 36.1% of patients (p < 0.01). Identified risk factors for mortality included young age, low residual diuresis, anemia at the time of RRT initiation, and hypertriglyceridemia and hypoalbuminemia during RRT.ConclusionsIn years 1973–2012 significant improvement in prognosis among children with CKD 5 was achieved. Identified predictors of mortality included young age at initiation of RRT, low residual diuresis, anemia and hypertriglyceridemia.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes in children with chronic kidney disease stage 5 over the last 40 years

Adamczuk¹,

Roszkowska‐Blaim²

2017

aoms

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“…Most developed countries can provide peritoneal dialysis (PD) at a lesser expense as compared to HD, the evidence from developing countries is more mixed, but in most cases PD can be provided at a similar cost to HD where economies of scale have been achieved, either by local production or by low import duties on PD equipment [9, 10]. These programs can be sustainable only when governments can afford to support them by allocating funds in their national health budgets [11]. Studies conducted in Nigeria showed that challenges encountered were a combination of several factors namely: late presentation, co morbid conditions, location of the renal care centers, and inability to pay for the recommended adequate dialysis owing to high cost [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma, Tanzania

et al. 2017

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BackgroundKidney Diseases contribute a significant proportion to the global burden of non-communicable diseases. Haemodialysis services as the main modality of renal replacement therapy in most resource limited countries is only available in few cities and at higher costs. The aim of this study was to determine the challenges and outcomes of patients who were on haemodialysis at the University of Dodoma (UDOM) haemodialysis unit in Tanzania.MethodsIn this retrospective study; we reviewed haemodialysis registers and charts of 116 patients dialyzed from January 2013 to June 2015 at The UDOM haemodialysis unit. Data were descriptively and inferentially analysed using Stata version 11 software.ResultsOf the 116 patients, 52 (44.9%) were male, and 38(32.8%) were married. Their median age was 45 years. Thirty-two (27.6%) had acute kidney injury, of them 26 (81.3%) patients had recovery of renal function after haemodialysis. Indications for hemodialysis were anuria (18), intoxications (14), electrolyte imbalance (9), uraemia (7) infections (6) and fluid overload (4). Eighty-four (72.4%) patients had End Stage Renal Diseases (ESRD), of which 37 (44.1%) absconded/lost to follow up, 15 (17.9%) died, 22 (26.2%) were referred to Muhimbili National Hospital (MNH), 12 for possible kidney transplant abroad after haemodialysis, and 10 (11.9%) were still attending our unit for haemodialysis. Residing outside Dodoma was predictive for poor outcomes while on haemodialysis (OR 5.2, 95% CI 3.2–8.6, p < 0.001). In addition the odds ratio for poor outcomes was 7.3 times for a patient ESRD (OR7.34, 95% CI 3.26–18.17, p < 0.001). Patients who had no National Health Insurance Fund (NHIF) coverage (OR 6.6, 95% CI 5.4–12.7, p < 0.001) also had higher odds of poor outcomes after starting haemodialysis.ConclusionUnavailability and high costs related to utilization of haemodialysis services among patients needing dialysis are the challenges for better outcomes. Therefore, haemodialysis and renal transplants services should be made easily available in regional referral hospitals at reasonable costs. In addition, members of the public should be educated on joining health insurance schemes and on making healthy life style choices for preventing chronic kidney disease and its progression.

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“…Initiatives to establish PD in resource-limited settings have proved to be successful, as reported by Callegari et al on PD for treatment of acute kidney injury in Kilimanjaro, Tanzania [10]. In our hospital, we had no acute PD catheter or fluids, which necessitated this improvised technique in managing acute kidney injury.…”

Section: Discussionmentioning

confidence: 77%

Improvised peritoneal dialysis in an 18-month-old child with severe acute malnutrition (kwashiorkor) and acute kidney injury: a case report

Fredrick

Valentine

2013

J Med Case Reports

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IntroductionSevere acute malnutrition is common in developing countries. Children with severe acute malnutrition are prone to complications, including electrolyte imbalance and infections. Our patient was an 18-month-old boy who had severe acute malnutrition (kwashiorkor) and developed acute kidney injury, which was managed with peritoneal dialysis using improvised equipment. This case report illustrates the importance of improvisation in resource-limited settings in providing lifesaving treatment. To the best of our knowledge, this is the first case report on peritoneal dialysis in a child with severe acute malnutrition (kwashiorkor).Case presentationWe report a case of an 18-month-old Bantu-African Tanzanian boy who had severe malnutrition and developed anuric acute kidney injury. He had severe renal dysfunction and was managed with peritoneal dialysis using an improvised catheter and bedside constituted fluids (from intravenous fluids) and was diuretic after 7 days of peritoneal dialysis, with complete recovery of renal functions after 2 weeks.ConclusionChildren with severe acute malnutrition who develop acute kidney injury should be offered peritoneal dialysis, which may be provided using improvised equipment in resource-limited settings, as illustrated in this case report.

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Peritoneal dialysis for acute kidney injury in sub-Saharan Africa: challenges faced and lessons learned at Kilimanjaro Christian Medical Centre

Abstract: hold stock in Fresenius Medical Care. Karen E. Yeates has received honoraria from Baxter and Janssen-Ortho. All other authors declared no competing interests.

Cited by 33 publications

References 1 publication

Long-term outcomes in children with chronic kidney disease stage 5 over the last 40 years

Long-term outcomes in children with chronic kidney disease stage 5 over the last 40 years

Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma, Tanzania

Improvised peritoneal dialysis in an 18-month-old child with severe acute malnutrition (kwashiorkor) and acute kidney injury: a case report

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