Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Nephrology, Helen Joseph Hospital, Johannesburg, South Africa.
S Afr Med J. 2023 Feb 1;113(2):98-103. doi: 10.7196/SAMJ.2023.v113i2.16629.
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.
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.
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.
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.
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.
腹膜透析（PD）是增加南非（SA）肾脏替代治疗机会的宝贵手段。先前有人提出，与黑非洲裔患者、糖尿病患者和 HIV 感染者相关的腹膜炎风险增加，导致模式转换的犹豫，从而导致模式转换率增加。
分析海伦·约瑟夫医院门诊 PD 病房 PD 优先方案的安全性，即 5 年腹膜炎风险和患者及模式存活率。
排除后，对 120 名患者的临床数据进行了分析。使用 Cox 比例风险模型和逻辑回归分析，分析患者 PD 起始时的年龄、种族、性别、糖尿病和 HIV 感染对患者和模式存活率以及腹膜炎风险的影响。使用 Cox-Mantel 检验比较 5 年技术和患者腹膜炎和合并症组的 Kaplan-Meier 生存曲线。使用 Mann-Whitney U 检验和 Fisher 确切检验比较适当的连续和分类变量。
5 年患者存活率为 49.9%。黑非洲裔与降低死亡率风险相关（风险比（HR）0.33；95%置信区间（CI）0.15-0.71；p=0.004），糖尿病患者 5 年生存率较差（19.1%；p=0.097）。5 年模式存活率为 48.1%。黑非洲裔和 HIV 感染均未增加 PD 停止的风险。腹膜炎与模式失败相关（HR 2.99；95%CI 1.31-6.87；p=0.009）。黑非洲裔未增加腹膜炎的风险。HIV 与腹膜炎的风险增加无关。患者和 PD 生存率通常与其他同期队列相似，本研究中的腹膜炎发生率在国际腹膜透析协会可接受范围内。
在 HIV 感染高发的低社会经济环境中，PD 是一种安全且合适的治疗方法。考虑家庭情况和无菌技术培训可降低腹膜炎风险，提高 PD 模式存活率。糖尿病患者 PD 预后可能较差。
