PMID- 29848598
OWN - NLM
STAT- MEDLINE
DCOM- 20181219
LR  - 20220409
IS  - 1718-4304 (Electronic)
IS  - 0896-8608 (Linking)
VI  - 38
IP  - 3
DP  - 2018 May-Jun
TI  - Outcomes and Challenges of a PD-First Program, a South-African Perspective.
PG  - 179-186
LID - 10.3747/pdi.2017.00182 [doi]
AB  - BACKGROUND: South Africa (SA) currently performs the most peritoneal dialysis 
      (PD) in Africa. Yet outcome data on PD programs on the continent are limited. 
      With the escalating need for renal replacement, PD remains a life-saving modality 
      especially as hemodialysis is limited in the public sector. This study aims to 
      evaluate and report the outcomes of a PD-First program performed in a 
      resource-limited setting and identify factors linked to poor outcomes. METHODS: 
      This observational cohort study was performed at Groote Schuur Hospital, 
      analyzing all PD patients retrospectively from January 2008 to June 2014 and 
      thereafter prospectively until June 2015. Variables included demographics, 
      adequacy, modality, fluid status, cardiovascular disease, and diabetes. The 
      influence of these variables on peritonitis rate, technique survival, and patient 
      survival was assessed. RESULTS: In total, 230 patients were initiated on PD, 31 
      of whom excluded as they were on PD for < 90 days. The mean age was 39.7 +/- 10.4 
      years (standard deviation [SD]), 49.8% were male, 63.8% were mixed ancestry and 
      9.8 % were diabetic at dialysis initiation. The average length of time on PD was 
      17 months (interquartile range [IQR] 8 - 32). The peritonitis rate was 0.87 
      (confidence interval [CI] 7.8 - 9.7) events per patient year. The 1-, 2- and 
      5-year patient and technique survival was 91.3%, 79.6%, 50.2% and 85.0%, 75.2%, 
      45.0%, respectively. Diabetes subdistribution hazard ratio (SHR) 3.16 (95% CI 
      1.34 - 7.45, p = 0.009) strongly predicted an increased cumulative incidence for 
      death when accounting for competing risks. African ethnicity SHR 2.16 (95% CI 
      1.26 - 3.71, p = 0.005) was a strong predictor of increased cumulative incidence 
      for technique failure. CONCLUSIONS: In our PD-First program the results are 
      encouraging, despite the lack of home visits due to safety, resource limitations, 
      and a high disease burden. Technique failure in the African race needs further 
      evaluation. Peritoneal dialysis remains a viable, life-saving alternative in an 
      African setting.
CI  - Copyright (c) 2018 International Society for Peritoneal Dialysis.
FAU - Davidson, Bianca
AU  - Davidson B
AD  - Department of Nephrology and Hypertension, Groote Schuur Hospital, University of 
      Cape Town, Western Cape, South Africa bianca.davidson@gmail.com.
AD  - Kidney and Hypertension Research Unit, University of Cape Town, Western Cape, 
      South Africa.
FAU - Crombie, Kenneth
AU  - Crombie K
AD  - Medical Registrar, Department of Internal Medicine, University of Cape Town, 
      Western Cape, South Africa.
FAU - Manning, Kathryn
AU  - Manning K
AD  - Department of Medicine, Statistical Analyst, University of Cape Town, Western 
      Cape, South Africa.
FAU - Rayner, Brian
AU  - Rayner B
AD  - Department of Nephrology and Hypertension, Groote Schuur Hospital, University of 
      Cape Town, Western Cape, South Africa.
AD  - Kidney and Hypertension Research Unit, University of Cape Town, Western Cape, 
      South Africa.
FAU - Wearne, Nicola
AU  - Wearne N
AD  - Department of Nephrology and Hypertension, Groote Schuur Hospital, University of 
      Cape Town, Western Cape, South Africa.
AD  - Kidney and Hypertension Research Unit, University of Cape Town, Western Cape, 
      South Africa.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Perit Dial Int
JT  - Peritoneal dialysis international : journal of the International Society for 
      Peritoneal Dialysis
JID - 8904033
SB  - IM
CIN - Perit Dial Int. 2018 May-Jun;38(3):159-160. PMID: 29848595
MH  - Adolescent
MH  - Adult
MH  - Cohort Studies
MH  - Female
MH  - *Health Policy
MH  - Humans
MH  - Kidney Failure, Chronic/*mortality/*therapy
MH  - Male
MH  - Middle Aged
MH  - *Peritoneal Dialysis
MH  - South Africa
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Africa
OT  - PD-First
OT  - Peritoneal dialysis
OT  - South Africa
OT  - outcomes
EDAT- 2018/06/01 06:00
MHDA- 2018/12/20 06:00
CRDT- 2018/06/01 06:00
PHST- 2017/08/30 00:00 [received]
PHST- 2017/12/09 00:00 [accepted]
PHST- 2018/06/01 06:00 [entrez]
PHST- 2018/06/01 06:00 [pubmed]
PHST- 2018/12/20 06:00 [medline]
AID - 38/3/179 [pii]
AID - 10.3747/pdi.2017.00182 [doi]
PST - ppublish
SO  - Perit Dial Int. 2018 May-Jun;38(3):179-186. doi: 10.3747/pdi.2017.00182.