title: Outcomes of rationing dialysis therapy in biopsy-proven end-stage renal disease in South Africa.
abstract: BACKGROUND
  Due to poverty, many countries of sub-Saharan Africa suffer a severe burden of end-stage renal disease (ESRD), the cause of which is often unidentified. We sought to identify biopsy-proven causes of ESRD in Cape Town, South Africa, and to determine the outcome of these patients.
  
  
  METHODS
  Records of biopsies reported as ESRD over a 10-year period were selected for analysis. The demographic, clinical and biochemical characteristics of the patients at the time of biopsy were documented. The decision of the committee that assesses the eligibility of patients for long-term renal replacement therapy (RRT) was documented, and if a patient was not accepted the reasons for the rejection were noted.
  
  
  RESULTS
  Chronic glomerulonephritis (CGN) was the most frequent cause of ESRD (31.2%); human immunodeficiency virus-associated nephropathy (HIVAN) accounted for 12.5% of ESRD cases. Sixty-six patients (45.8%) were never reviewed by the assessment committee for placement in the dialysis program. Of the remaining 78 patients (54.2%) reviewed for RRT, only 48/78 (61.5%) were selected. A higher frequency of patients with HIVAN were not accepted for RRT (17.7%) than patients with HIVAN who were accepted (2.1%) (p=0.008). Social factors such as lack of housing, alcohol abuse, illicit drug abuse, lack of transportation and lack of family/social support accounted for 56.7% of patients not being accepted for RRT.
  
  
  CONCLUSIONS
  There needs to be a development of programs amongst Africans to provide effective solutions that tackle the burden of ESRD, especially related to the increasing prevalence of HIVAN.
authors.affiliation: Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa. Ikechi.Okpechi@uct.ac.za
authors.forename: Ikechi G
authors.initials: IG
authors.lastname: Okpechi
authors.forename: Charles R
authors.initials: CR
authors.lastname: Swanepoel
authors.forename: Brian L
authors.initials: BL
authors.lastname: Rayner
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000453:epidemiology / Q000628:therapy; D000328:Adult; D000704:Analysis of Variance; D001706:Biopsy; D016009:Chi-Square Distribution; D003906:Developing Countries; D005260:Female; D005921:Glomerulonephritis / Q000453:epidemiology / Q000628:therapy; D015276:Health Care Rationing; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D015995:Prevalence; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult