title: Early survival on maintenance dialysis therapy in South Africa: evaluation of a pre-dialysis education programme.
abstract: BACKGROUND
  Mortality in the first year of maintenance dialysis is higher than in subsequent years and, within this first year, the risk of death is highest in the first 90 days. Some studies have shown that pre-dialysis education reduces early mortality. Limited data have been published from South Africa regarding early mortality after commencement of maintenance dialysis treatment and the effect of pre-dialysis intervention programmes on these outcomes. The aim of this study was to assess the impact of a pre-dialysis intervention programme on 90- and 365-day outcomes and to determine incident mortality in a population of chronic haemo- and peritoneal dialysis patients in South Africa.
  
  
  METHODS
  This study used a retrospective cohort of 269 patients who received a pre-dialysis intervention [Healthy Start (HS)] and a matched group of 269 patients who did not receive the intervention. Both groups subsequently commenced maintenance haemo-/peritoneal dialysis with National Renal Care (NRC). A between-group comparative analysis was conducted to determine whether there were any differences in morbidity and mortality at 90 and 365 days of chronic dialysis treatment. Survival curves for the first 365 days of treatment were calculated using the Kaplan-Meier estimation for the entire population and by age group, gender, race, diabetes, dialysis modality and presence of a central venous catheter (CVC) at start of dialysis treatment.
  
  
  RESULTS
  There were no significant differences between the HS and non-HS groups at 90 and 365 days when comparing mortality, cause of death, hospital admission rates and length of stay. Data were then pooled and a Kaplan-Meier analysis showed 90- and 365-day survival of 96.7 and 85.6%, respectively. The peak mortality occurred at 150 days of dialysis treatment, but this was not significant. Older age and the presence of a CVC were associated with an increased risk of death in the first year of treatment.
  
  
  CONCLUSIONS
  The HS Programme made no difference to mortality in the first year of chronic dialysis. Early survival for both HS and non-HS groups was excellent when compared to international data. Increasing age and the presence of a CVC at the start of chronic dialysis were the two factors that impacted significantly on 1-year survival.
authors.affiliation: Donald Gordon Medical Centre, Research Office, Max Price Building, 27 Eton Rd, Parktown, Johannesburg, 2193, South Africa. june.fabian@mweb.co.za.|Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, York Rd, Parktown, Johannesburg, 2193, South Africa. june.fabian@mweb.co.za.
authors.forename: June
authors.initials: J
authors.lastname: Fabian
authors.affiliation: National Renal Care, 26 Cedar Avenue, Richmond, Johannesburg, 2092, South Africa.
authors.forename: Karlien
authors.initials: K
authors.lastname: Van Jaarsveld
authors.affiliation: Donald Gordon Medical Centre, Research Office, Max Price Building, 27 Eton Rd, Parktown, Johannesburg, 2193, South Africa.
authors.forename: Heather Ann
authors.initials: HA
authors.lastname: Maher
authors.affiliation: Data Management and Statistical Analysis (DMSA), PO Box 665, Wits, Johannesburg, 2050, South Africa.
authors.forename: Petra
authors.initials: P
authors.lastname: Gaylard
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality; D015397:Program Evaluation; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa; D013997:Time Factors; D016896:Treatment Outcome
keywords: Central venous catheter; Chronic dialysis in South Africa; Incident mortality; Pre-dialysis programme; Survival