Peritoneal Dialysis in the Sudan

Abstract

Background End-stage renal disease is a significant social and economic burden on the Sudan. Continuous ambulatory peritoneal dialysis (CAPD) was recently introduced as a national service and is provided free of charge by the Federal State. We present here an overview of our experience and outcomes after the first 20 months of operation of the National Program, displaying its organization and patient and technique survival, peritonitis rates, and adequacy parameters of the first patients to undergo CAPD. Methods As a national experiment, the program was sequentially launched in 5 adult and 2 pediatric centers in Khartoum, the capital city of the country. The data include the entire 111 patients who underwent CAPD from June 2005 to January 2007. All data were reported to, and analyzed at, the head office of the Sudan National Peritoneal Dialysis Program. Results CAPD is the modality exclusively utilized thus far. Automated PD will be added to the program this year. By 30 January 2007, the total number of patients enrolled was 111. Their age range was 1 – 75 (median 56) years. 20 patients (18%) were shifted to hemodialysis and 5 patients received living related kidney transplants. Two died of severe septicemia due to peritonitis; 16 (14%) others died of non-PD-related causes. There were 60 cases of peritonitis in 839 patient-months, which equates to an overall peritonitis rate of 1 episode every 14 months (0.87 episodes per year at risk). The individual center rates varied. A critical review of cases at the end of the first year showed a statistically significant age difference, with peritonitis being more common in the younger patients. Mean age of patients that developed peritonitis was 30.53 years, whereas that for peritonitis-free patients was 44.09 years ( p = 0.025). All patients that had peritonitis presented with abdominal pain and had a cloudy effluent; none had exit-site or tunnel infection. The culture-negative peritonitis rate was 53%. Pseudomonas species were responsible for 13.3% and Staphylococcus aureus for 6.7%. Touch contamination was the likely mechanism behind 46.7% of the episodes. There were 3 cases of refractory peritonitis and a single case of relapsing peritonitis. Concerning PD adequacy, average Kt/V urea was 1.74; weekly creatinine clearance was 62.5 L/1.73 m2. Average normalized protein catabolic rate, as a measure of dietary protein intake in patients in a steady state, was 1.17 g/kg. These measures indicate that the overall program adequacy was satisfactory and the values fall within the recommended ranges. Conclusion The first 20 months of operation of the Sudan's National Peritoneal Dialysis Program have proven that it is a promising project with multifaceted success. The adequacy indicators are acceptable but the cumulative peritonitis incidence is above that recommended, indicating several areas for potential improvement. Although CAPD is highly cost-effective, ongoing difficulties, including the cost of medications and laboratory tests, are being sorted out with official support and public involvement.

Peritoneal Dialysis in Austere Environments: An Emergent Approach to Renal Failure Management

“…For example, Sudan initiated a government-sponsored CAPD program for ESRD patients in 2005, and in a mere 20-month span established a treatment network capable of meeting accepted standards for efficacy and peritonitis rates. 64 Such programs demonstrate the feasibility of CAPD in resource-limited regions, and will hopefully promote continued international use of this treatment modality. As a means to manage ESRD or treat acute renal failure in austere settings, PD is an option with demonstrated efficacy in diverse settings throughout the world.…”

Infectious peritonitis profile in peritoneal dialysis at Ibn Sina University Hospital: a 6-year data report

“…In Algeria, 8 this rate is estimated at 14%. In the Sudan, 10 it is at 53%. This could be partially explained by the fact that some of our patients, who live in remote areas, may take antibiotics before coming to the hospital to take the bacteriological tests.…”

“…IP is the primary cause of transfer to HD. According to the RDPLF Registry, 10 IP accounts for 22.2% of all causes of definitive transfer to HD. In our study, six patients (7.89%) were definitively transferred to HD, although other causes (physical intolerance, associated pathologies, etc) were often involved in the transfer decision.…”

Understanding acute kidney injury in low resource settings: a step forward

“…Comprehensive guidelines for the use of PD to treat patients (children and adults) with AKI have recently been published [ 13 ]. The feasibility of using PD to treat patients with AKI in LRS is now well documented with excellent outcomes being reported in recent publications from Tanzania [ 14 ], Sudan [ 15 ], and Nigeria [ 16 ]. The Saving Young Lives Program has been actively helping support and develop PD programs to treat patients with AKI in LRS [ 17 ].…”