Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
Perit Dial Int. 2012 May-Jun;32(3):254-60. doi: 10.3747/pdi.2011.00100.
Chronic kidney disease is a major public health problem in sub-Saharan Africa (SSA), which encompasses 70% of the least-developed countries in the world. Most people in SSA have no access to any form of renal replacement therapy (RRT). Given its ease of performance and patient independence, peritoneal dialysis (PD) should be an ideal form of RRT in SSA, but several complex and interdependent factors make PD a difficult option in SSA. The present review describes the practice of PD in SSA, with emphasis on Cape Town, South Africa.
After a review of the recent PubMed literature on RRT in SSA and an appraisal of nephrology practice in South Africa, factors that make the provision of RRT (especially PD) a challenge in SSA include the low number of qualified health care workers, socio-demographic issues (poor housing, electricity, and water supplies), and the cost of PD fluids in the region. Although South Africa has the largest PD population in all of SSA, the growth of PD in South Africa is specifically impeded by the system of RRT rationing, which favors HD; the methods of funding for dialysis and for remuneration of doctors in private practice; and many other socio-economic factors. The peritonitis rate remains relatively high, and it is a significant contributor to morbidity in PD patients in Cape Town.
In many parts of SSA, PD could be the main dialysis modality. However, African governments must start taking responsibility for their people by providing adequate funds for renal replacement programs. Attempts to produce PD fluids locally and to train and educate health care workers will greatly improve the use of PD as a RRT option in SSA.
慢性肾脏病是撒哈拉以南非洲（SSA）的一个主要公共卫生问题，该地区囊括了全球 70%的最不发达国家。大多数 SSA 地区的人无法获得任何形式的肾脏替代疗法（RRT）。腹膜透析（PD）因其操作简便和患者独立性，应该是 SSA 理想的 RRT 形式，但一些复杂且相互依存的因素使得 PD 在 SSA 地区成为一种困难的选择。本综述描述了 SSA 地区 PD 的实践情况，重点介绍南非开普敦。
在对 SSA 地区 RRT 的近期 PubMed 文献进行回顾，并对南非肾脏病学实践进行评估后，使得 RRT（尤其是 PD）在 SSA 地区难以开展的因素包括合格的卫生保健工作者人数较少、社会人口问题（住房差、电力和供水不足），以及该地区 PD 液的费用。尽管南非拥有 SSA 地区最大的 PD 患者群体，但 PD 在南非的增长受到 RRT 配给制度的阻碍，该制度更倾向于血液透析；透析的资金筹措方法和私人执业医生的薪酬制度；以及许多其他社会经济因素。腹膜炎发生率仍然相对较高，是开普敦 PD 患者发病率的重要因素。
在 SSA 的许多地区，PD 可能是主要的透析方式。然而，非洲政府必须开始为其人民承担责任，为肾脏替代项目提供充足的资金。尝试在当地生产 PD 液，并培训和教育卫生保健工作者，将极大地改善 PD 在 SSA 作为 RRT 选择的应用。
