Peritoneal dialysis technique survival at Tygerberg Hospital in Cape Town, South Africa

Kapembwa, Kenneth; Bapoo, Nabeel A; Tannor, Elliot Koranteng; Davids, Mogamat Razeen

doi:10.21804/20-1-1917

Cited by 4 publications

(8 citation statements)

References 23 publications

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“…High mortality in the first 90 days following the start of RRT has been highlighted in studies conducted in other African countries [ 30–32 ]. The survival rates reported here are in line with the findings of two other South African studies that included the first 90 days following the initiation of treatment [ 19 , 33 ].…”

Section: Discussionsupporting

confidence: 89%

Survival of South African patients on renal replacement therapy

Jardine

Wong

Steenkamp

et al. 2020

Clinical Kidney Journal

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Background The majority of South Africans rely on a resource-constrained public healthcare sector, where access to renal replacement therapy (RRT) is strictly rationed. The incidence of RRT in this sector is only 4.4 per million population (pmp), whereas it is 139 pmp in the private sector, which serves mainly the 16% of South Africans who have medical insurance. Data on the outcomes of RRT may influence policies and resource allocation. This study evaluated, for the first time, the survival of South African patients starting RRT based on data from the South African Renal Registry. Methods The cohort included patients with end-stage kidney disease who initiated RRT between January 2013 and September 2016. Data were collected on potential risk factors for mortality. Failure events included stopping treatment without recovery of renal function and death. Patients were censored at 1 year or upon recovery of renal function or loss to follow-up. The 1-year patient survival was estimated using the Kaplan–Meier method and the association of potential risk factors with survival was assessed using multivariable Cox proportional hazards regression. Results The cohort comprised 6187 patients. The median age was 52.5 years, 47.2% had diabetes, 10.2% were human immunodeficiency virus (HIV) positive and 82.2% had haemodialysis as their first RRT modality. A total of 542 patients died within 1 year of initiating RRT, and overall 1-year survival was 90.4% [95% confidence interval (CI) 89.6–91.2]. Survival was similar in patients treated in the private sector as compared with the public healthcare sector [hazard ratio 0.93 (95% CI 0.72–1.21)]. Higher mortality was associated with older age and a primary renal diagnosis of ‘Other’ or ‘Aetiology unknown’. When compared with those residing in the Western Cape, patients residing in the Northern Cape, Eastern Cape, Mpumalanga and Free State provinces had higher mortality. There was no difference in mortality based on ethnicity, diabetes or treatment modality. The 1-year survival was 95.9 and 94.2% in HIV-positive and -negative patients, respectively. One-fifth of the cohort had no data on HIV status and the survival in this group was considerably lower at 77.1% (P < 0.001). Conclusions The survival rates of South African patients accessing RRT are comparable to those in better-resourced countries. It is still unclear what effect, if any, HIV infection has on survival.

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Section: Discussionsupporting

confidence: 89%

Survival of South African patients on renal replacement therapy

Jardine

Wong

Steenkamp

et al. 2020

Clinical Kidney Journal

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“…Patient survival in this cohort was similar to that reported by contemporaneous international series, but poorer than that reported in the local literature (Table 3). A greater proportion of patients with diabetes in the present cohort (29.2%) compared with previous local studies (Davidson et al [6] 9.8%, Isla et al [13] 9.9%, Kapembwa et al [7] 0.5%) and diverging survival outcomes for these patients, as observed in this study and reported by others, [17,18] may partially account for this discrepancy. Patients in our cohort were on average older (median age at PD initiation 44.3 years) than in contemporaneous local cohorts (Davidson et al [6] 39.7 years, Isla et al [13] 37.5 years, Kapembwa et al [7] 36 years).…”

Section: Discussioncontrasting

confidence: 61%

“…A greater proportion of patients with diabetes in the present cohort (29.2%) compared with previous local studies (Davidson et al [6] 9.8%, Isla et al [13] 9.9%, Kapembwa et al [7] 0.5%) and diverging survival outcomes for these patients, as observed in this study and reported by others, [17,18] may partially account for this discrepancy. Patients in our cohort were on average older (median age at PD initiation 44.3 years) than in contemporaneous local cohorts (Davidson et al [6] 39.7 years, Isla et al [13] 37.5 years, Kapembwa et al [7] 36 years). Older age, particularly in patients with diabetes, has been associated with increasing mortality risk on PD, [19] which may further explain the poorer overall survival in our series.…”

Section: Discussioncontrasting

confidence: 61%

“…[5] Available local literature has raised concern over the universal suitability of PD in this setting, with increased rates of PD modality discontinuation reported in patients of black African ethnicity. [6,7] PD-related peritonitis is the most important modifiable cause of PD discontinuation [8] and an important contributor to mortality. [9] An increased risk of peritonitis in patients of black African ethnicity [10] and in people living with HIV (PLWH) [11] has been reported by local centres; comorbid diabetes has similarly been identified in some series as a risk factor for peritonitis.…”

mentioning

confidence: 99%

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Peritoneal dialysis outcomes in a tertiary-level state hospital in Johannesburg, South Africa: Ethnicity and HIV co-infection do not increase risk of peritonitis or discontinuation

Sunnyraj

Davies²,

Cassimjee³

2023

S Afr Med J

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Background. Peritoneal dialysis (PD) is a valuable means to increase access to kidney replacement therapy in South Africa (SA). An increased rate of modality discontinuation related to an increased risk of peritonitis in patients of black African ethnicity, in those with diabetes and in those living with HIV has previously been suggested, which may lead to hesitancy in adoption of ‘PD first’ programmes. Objectives. To analyse the safety of a PD-first programme in terms of 5-year peritonitis risk and patient and modality survival at the outpatient PD unit at Helen Joseph Hospital, Johannesburg. Methods. After exclusions, clinical data from 120 patients were extracted for analysis. The effects of patient age at PD initiation, ethnicity, gender, diabetes mellitus and HIV infection on patient and modality survival and peritonitis risk were analysed using Cox proportional hazards modelling and logistic regression analysis. Five-year technique and patient Kaplan-Meier survival curves for peritonitis and comorbidity groups were compared using the Cox-Mantel test. The Mann-Whitney U-test and Fisher’s exact test were used to compare continuous and categorical variables where appropriate. Results. Five-year patient survival was 49.9%. Black African ethnicity was associated with reduced mortality hazard (hazard ratio (HR) 0.33; 95% confidence interval (CI) 0.15 - 0.71; p=0.004), and patients with diabetes had poorer 5-year survival (19.1%; p=0.097). Modality survival at 5 years was 48.1%. Neither Black African ethnicity nor HIV infection increased the risk of PD discontinuation. Peritonitis was associated with increased modality failure (HR 2.99; 95% CI 1.31 - 6.87; p=0.009). Black African ethnicity did not increase the risk of peritonitis. HIV was not independently associated with an increased risk of peritonitis. Patient and PD survival were generally similar to other contemporaneous cohorts, and the peritonitis rate in this study was within the International Society for Peritoneal Dialysis acceptable range. Conclusion. PD is a safe and appropriate therapy in a low socioeconomic setting with a high prevalence of HIV infection. Consideration of home circumstances and training in sterile technique reduce peritonitis risk and improve PD modality survival. Patients with diabetes may be at risk of poorer outcomes on PD.

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“…Peritonitis is the leading cause of technique failure in patients on PD. [19][20][21] Peritonitis rates (0.82-0.87 events per patient-year), though still higher than the International Society for Peritoneal Dialysis recommendation of no more than 0.5 events per patient-year, have been declining steadily over the past 15 years. 12…”

Section: Peritoneal Dialysismentioning

confidence: 98%