title: Report of the first peritoneal dialysis program in Guyana, South America.
abstract: BACKGROUND
  In 2008, we initiated the first Guyanese comprehensive kidney replacement program, comprising hemodialysis (HD), peritoneal dialysis (PD), vascular access procedures, and living-donor kidney transplantation. The government of Guyana, US-based philanthropists, US-based physicians, and Guyanese caregivers teamed up to form a public-private partnership. This pilot program was free of cost to the patients.
  
  
  METHODS
  From July 2010 to the time of writing, we placed 17 patients with end-stage kidney disease on PD, which was used as a bridge to living-donor kidney transplantation. During the same period, we placed 12 primary arteriovenous fistulae.
  
  
  RESULTS
  The 17 patients who received a PD catheter had a mean age of 43.6 years and a mean follow-up of 5.3 months. In that group, 2 deaths occurred (from multi-organ failure) within 2 weeks of catheter placement, and 2 patients were switched to HD because of inadequate clearance. Technical issues were noted in 2 patients, and 3 patients developed peritonitis (treated with intravenous antibiotics). An exit-site abscess in 1 patient was drained under local anesthesia. The peritonitis rate was 0.36 episodes per patient-year. Of the 17 patients who received PD, 4 underwent living-donor kidney transplantation.
  
  
  CONCLUSIONS
  In Guyana, PD is a safe and cost-effective option; it may be equally suitable for similar developing countries. In Guyana, PD was used as a bridge to living-donor kidney transplantation. We have been able to sustain this program since 2008 by making incremental gains and nurturing the ongoing public-private partnership.
authors.affiliation: Surgery, Stony Brook University Hospital, Long Island, New York, NY, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Altieri
authors.forename: Tarun R
authors.initials: TR
authors.lastname: Jindal
authors.forename: Mayur
authors.initials: M
authors.lastname: Patel
authors.forename: David K
authors.initials: DK
authors.lastname: Oliver
authors.forename: Edward M
authors.initials: EM
authors.lastname: Falta
authors.forename: Eric A
authors.initials: EA
authors.lastname: Elster
authors.forename: Alden
authors.initials: A
authors.lastname: Doyle
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Guy
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Womble
authors.forename: Rahul M
authors.initials: RM
authors.lastname: Jindal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006172:Guyana / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D016730:Program Development; D055818:Public-Private Sector Partnerships / Q000458:organization & administration*; D055815:Young Adult