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
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i2.16629Keywords:
Peritoneal dialysis outcomes, south africaAbstract
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.
References
Wearne N. Kilonzo K, Effa E, et al. Continuous ambulatory peritoneal dialysis: Perspectives on patient selection in low- to middle-income countries. Int J Nephrol Renovasc Dis 2017;10:1-9. https://doi. org/10.2147/IJNRD.S104208
Makhele L, Matlala M, Sibanda M, et al. A cost analysis of haemodialysis and peritoneal dialysis for the management of end-stage renal failure at an academic hospital in Pretoria, South Africa. Pharmacoeconom Open 2019;3(4):631-641. https://doi.org/10.1007/s41669-019-0124-5
Davids MR, Jardine T, Marias N, et al. South African Renal Registry Annual Report 2017. Afr J Nephrol 2019;22(1):60-71. https://doi.org/10.21804/22-1-3810
Mabaso M, Makola L, Naidoo I, Mlangeni LL, Jooste S, Simbayi L. HIV prevalence in South Africa through gender and racial lenses: Results from the 2012 population-based national household survey. Int J Equity Health 2019;18(1):167. https://doi.org/10.1186/s12939-019-1055-6
Stokes A, Berry KM, Mchiza Z, et al. Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011 - 2012. PLoS ONE 2012;12(1):e0184264. https://doi.org/10.1371/journal.pone.0184264
Davidson B, Crombie K, Manning K, Rayner B, Wearne N. Outcomes and challenges of a PD-first program, a South-African perspective. Perit Dial Int 2018;38(3):179-186. https://doi.org/10.3747/ pdi.2017.00182
Kapembwa KC, Bapoo NA, Tannor EK, Davids MR. Peritoneal dialysis technique survival at Tygerberg Hospital in Cape Town, South Africa. Afr J Nephrol 2017;20(1):25-33. https://doi. org/10.21807/20-1-1917
Ersoy FF. Improving technique survival in peritoneal dialysis: What is modifiable? Perit Dial Int 2009;29(Suppl 2):S74-S77.
Ye H, Zhou Q, Fan L, et al. The impact of peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis patients. BMC Nephrol 2017;18(1):186. https://doi.org/10.1186/s12882-017-0588-4
Zent R, Myers JE, Donald D, Rayner BL. Continuous ambulatory peritoneal dialysis: An option for the developing world? Perit Dial Int 1994;14(1):48-51.
Ndlovu KCZ, Sibanda W, Assounga A. Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: A prospective cohort study. BMC Nephrol 2017;18(1):48. https://doi. org/10.1186/s12882-017-0466-0
Chow KM, Szeto CC, Leung BC, Kwan BC-H, Law MC, Li PK-T. A risk analysis of continuous ambulatory peritoneal dialysis-related peritonitis. Perit Dial Int 2005;25(4):374-379. https://doi. org/10.1177/089686080502500413
Isla RAT, Mapiye D, Swanepoel C, Rozumyk N, Hubahib JE, Okpechi IG. Continuous ambulatory peritoneal dialysis in Limpopo province, South Africa: Predictors of patient and technique survival. Perit Dial Int 2014;34(5):518-525. https://doi.org/10.3747/pdi.2013.00334
Li PK-T, Chow KM, van de Luitgaarden MWM, et al. Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol 2017;13(2):90-103. https://doi.org/10.1038/nrneph.2016.181
United States Renal Data System. 2020 Annual Data Report. Bethesda, MD: National Institute of
Diabetes and Digestive and Kidney Diseases, 2020. https://adr.usrds.org/2020 (accessed 22 April 2022). 16. Canadian Institute for Health Information. Treatment of end-stage organ failure in Canada. Canadian Organ Replacement Register, 2010 - 2019: End-stage kidney disease and kidney transplants. Ottawa,
ON: CIHI, 2020. https://www.cihi.ca (accessed 22 April 2022).
Guo A, Mujais S. Patient and technique survival on peritoneal dialysis in the United States: Evaluation
in large incident cohorts. Kidney Int 2003;64(Suppl 88):S3-S12. https://doi.org/10.1046/j.1523-
2003.08801.x
Yang X, Yi C, Liu X, et al. Clinical outcome and risk factors for mortality in Chinese patients with diabetes on peritoneal dialysis: A 5-year cohort study. Diabetes Res Clin Pract 2013;100(3):354-361. https://doi.org/10.1016/j.diabres.2013.03.030
Bieber SD, Mehrotra R. Patient and technique survival of older adults with ESRD treated with peritoneal dialysis. Perit Dial Int 2015;35(6):612-617. https://doi.org/10.3747/pdi.2015.00050
Katz I, Sofianou L, Hopley M. An African community-based chronic ambulatory peritoneal dialysis programme. Nephrol Dial Transplant 2001;16(12):2395-2400. https://doi.org/10.1093/ndt/16.12.2395 21. Nadeau-Fredette A-C, Bargman JM. Characteristics associated with peritoneal dialysis failure:
Are we asking the right questions? Am J Kidney Dis 2019;74(6):586-588. https://doi.org/10.1053/j.
ajkd.2019.07.002
Li PK-T, Chow KM. Peritoneal dialysis patient selection: Characteristics for success. Adv Chronic Kidney Dis 2009;16(3):160-168. https://doi.org/10.1053/j.ackd.2009.02.001
Parry K, van Eeden A. Measuring racial residential segregation at different geographic scales in Cape Town and Johannesburg. S Afr Geogr J 2015;97(1):31-49. https://doi.org/10.1080/03736245.2014.924868 24. Li PK-T, Szeto CC, Piraino B, et al. ISPD peritonitis recommendations: 2016 update on prevention and
treatment. Perit Dial Int 2016;36(5):481-508. https://doi.org/10.3747/pdi.2016.00078
Marshall MR. A systematic review of peritoneal dialysis-related peritonitis rates over time from national or regional population-based registries and databases. Perit Dial Int 2022;42(1):39-47. https://
doi.org/10.1177/0896860821996096
Musoke J, Bisiwe F, Natverlal A, et al. The prevalence and bacterial distribution of peritonitis amongst adults undergoing continuous ambulatory peritoneal dialysis at Universitas Hospital. S Afr J Infect Dis 2020;35(1):a104. https://doi.org/10.4102/sajid.v35i1.104
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
