Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, Nigeria.
BMJ Open. 2020 Dec 24;10(12):e039970. doi: 10.1136/bmjopen-2020-039970.
The aim of this study was to report the prevalence of peritonitis and mortality in patients with end-stage kidney disease (ESKD) treated with chronic peritoneal dialysis (PD) in Africa.
Systematic review.
Africa.
Patients with ESKD in Africa.
PD in its varied forms.
PD-related peritonitis rate (primary outcome), time-to-discontinuation of PD, mortality.
Four databases, including PubMed, Embase, Web of Science and Africa Journal Online were systematically searched from 1 January 1980 to 31 December 2019.
Studies conducted in Africa reporting peritonitis rate and mortality in patients treated with PD.
Two reviewers extracted and synthesised the data using Microsoft Excel. The quality of included data was also assessed.
We included 17 studies from seven African countries representing 1894 patients treated with PD. The overall median age was 41.4 years (IQR: 38.2-44.7) with a median time on PD of 18.0 months (17.0-22.6). An overall median peritonitis rate of 0.75 (0.56-2.20) episodes per patient-year (PPY) was observed and had declined with time; peritonitis rate was higher in paediatric studies than adult studies (1.78 (1.26-2.25) vs 0.63 (0.55-1.87) episodes PPY). The overall median proportion of deaths was 21.1% (16.2-25.8). Culture negative peritonitis was common in paediatric studies and studies that reported combined outcomes of continuous ambulatory PD and automated PD. Both 1-year and 2-year technique survival were low in all studies (83.6% and 53.0%, respectively) and were responsible for a high proportion of modality switch.
Our study identifies that there is still high but declining peritonitis rates as well as low technique and patient survival in PD studies conducted in Africa. Sustained efforts should continue to mitigate factors associated with peritonitis in patients with ESKD treated with PD in Africa.
CRD42017072966.
本研究旨在报告在非洲接受慢性腹膜透析（PD）治疗的终末期肾病（ESKD）患者中腹膜炎和死亡率的流行情况。
系统评价。
非洲。
非洲的 ESKD 患者。
各种形式的 PD。
PD 相关腹膜炎发生率（主要结局）、PD 终止时间、死亡率。
从 1980 年 1 月 1 日至 2019 年 12 月 31 日，系统地检索了四个数据库，包括 PubMed、Embase、Web of Science 和 Africa Journal Online。
在非洲进行的报告 PD 治疗患者腹膜炎发生率和死亡率的研究。
两名审查员使用 Microsoft Excel 提取和综合数据。还评估了纳入数据的质量。
我们纳入了来自七个非洲国家的 17 项研究，这些研究共纳入了 1894 名接受 PD 治疗的患者。总体中位年龄为 41.4 岁（IQR：38.2-44.7），PD 中位时间为 18.0 个月（17.0-22.6）。观察到总体中位数为 0.75（0.56-2.20）例患者年（PPY）的腹膜炎发生率，且随着时间的推移呈下降趋势；儿科研究中的腹膜炎发生率高于成人研究（1.78（1.26-2.25）vs 0.63（0.55-1.87）PPY）。总体中位数死亡率为 21.1%（16.2-25.8）。在儿科研究和报告连续流动 PD 和自动 PD 综合结果的研究中，培养阴性腹膜炎很常见。所有研究的 1 年和 2 年技术生存率均较低（分别为 83.6%和 53.0%），且均导致治疗方式转换比例较高。
我们的研究表明，在非洲进行的 PD 研究中，腹膜炎发生率仍然较高但呈下降趋势，技术和患者生存率较低。应继续持续努力减轻与非洲接受 PD 治疗的 ESKD 患者腹膜炎相关的因素。
PROSPERO 注册号：CRD42017072966。
