The use of chronic dialysis in a resource-poor environment: demographic features and transplant readiness at Helen Joseph Hospital renal unit
Date
2019
Authors
Parbhoo, Dinen
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Abstract
Background
Chronic kidney disease (CKD) places a considerable economic strain on health care systems.
In South Africa resource limitations in the public sector mandate that patients with end stage
renal disease (ESRD) are only offered dialysis if they qualify for renal transplant. Thus, chronic
dialysis serves as a bridge to transplantation.
Objectives
The primary objective of this study was to describe the patients on the chronic dialysis program
with regards to demographic features, aetiology of renal failure, associated chronic comorbidities
and transplant readiness. Secondary objectives included the determination of the
type and duration of dialysis used and the documentation of any possible differences between
the haemodialysis (HD) and peritoneal dialysis (PD) groups and the HIV positive and negative
patients.
Methods
A cross-sectional record review was conducted of all patients receiving chronic dialysis at the
Helen Joseph Hospital’s Renal Unit as at September 2016. Information regarding demographic
features, disease profile, year of initiation of dialysis, year of presentation, Human
Immunodeficiency Virus (HIV) status and transplant readiness was collected. All data was
analysed at a 95% confidence interval and a p value of <0.05 was considered significant.
Results
There were 92 patients on chronic dialysis, 46 each on PD and HD. The mean (SD) age of
patients in this study was 43.8 years (10.8). There was a slight female predominance (51.1%).
The predominant ethnic group was African (64.1%). The leading causes of ESRD were
hypertension (35.9%) followed by diabetes mellitus (10.9%). The most frequent comorbidity
was hypertension (98.9%) followed by HIV infection (36.1%). The median time that patients
spent on dialysis before presentation for transplant listing was 2 years (range 0-9 years). At the
time of analysis, 27 patients (29.4%) were eligible for transplant and 38 patients (41.3%) were
in the process of transplant eligibility evaluation. Twenty-seven patients (29.4%) were
ineligible for transplant. Of those eligible for transplant, 21 were listed for transplant and 6 were
awaiting presentation for listing. There were no differences between the HD and PD groups or
the HIV positive and negative groups with regards to qualification for transplant.
Conclusion
The demographic features and underlying aetiologies of our cohort are similar to national
figures with only the racial composition being different. The proportion of patients listed for
transplantation (22.8%) and median time for work-up (2 years) are both sub-optimal. Improved
efficiency in the evaluation of transplant eligibility is required in order to optimize the
appropriate allocation of dialysis in a resource-limited setting.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of
Masters in Medicine (MMed)
Johannesburg 2019