Baseline Predictors of Mortality among Predominantly Rural-Dwelling End-Stage Renal Disease Patients on Chronic Dialysis Therapies in Limpopo, South Africa.
BACKGROUND
Dialysis therapy for end-stage renal disease (ESRD) continues to be the readily available renal replacement option in developing countries. While the impact of rural/remote dwelling on mortality among dialysis patients in developed countries is known, it remains to be defined in sub-Saharan Africa.


METHODS
A single-center database of end-stage renal disease patients on chronic dialysis therapies treated between 2007 and 2014 at the Polokwane Kidney and Dialysis Centre (PKDC) of the Pietersburg Provincial Hospital, Limpopo South Africa, was retrospectively reviewed. All-cause, cardiovascular, and infection-related mortalities were assessed and associated baseline predictors determined.


RESULTS
Of the 340 patients reviewed, 52.1% were male, 92.9% were black Africans, 1.8% were positive for the human immunodeficiency virus (HIV), and 87.5% were rural dwellers. The average distance travelled to the dialysis centre was 112.3 ± 73.4 Km while 67.6% of patients lived in formal housing. Estimated glomerular filtration rate (eGFR) at dialysis initiation was 7.1 ± 3.7 mls/min while hemodialysis (HD) was the predominant modality offered (57.1%). Ninety-two (92) deaths were recorded over the duration of follow-up with the majority (34.8%) of deaths arising from infection-related causes. Continuous ambulatory peritoneal dialysis (CAPD) was a significant predictor of all-cause mortality (HR: 1.62, CI: 1.07-2.46) and infection-related mortality (HR: 2.27, CI: 1.13-4.60). On multivariable cox regression, CAPD remained a significant predictor of all-cause mortality (HR: 2.00, CI: 1.29-3.10) while the risk of death among CAPD patients was also significantly modified by diabetes mellitus (DM) status (HR: 4.99, CI: 2.13-11.71).


CONCLUSIONS
CAPD among predominantly rural dwelling patients in the Limpopo province of South Africa is associated with an increased risk of death from all-causes and infection-related causes.
Polokwane Kidney and Dialysis Centre, Pietersburg Provincial Hospital and the University of Limpopo, Polokwane, South Africa.
Ramon A
RA
Tamayo Isla
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
Oluwatoyin I
http://orcid.org/0000-0002-1241-0432
OI
Ameh
South African National Bioinformatics Institute/Medical Research Council of South Africa Bioinformatics Unit, University of the Western Cape, Cape Town, South Africa.
Darlington
D
Mapiye
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
Charles R
CR
Swanepoel
Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.
Aminu K
AK
Bello
Polokwane Kidney and Dialysis Centre, Pietersburg Provincial Hospital and the University of Limpopo, Polokwane, South Africa.
Andrew R
AR
Ratsela
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
Ikechi G
IG
Okpechi
D000328:Adult; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology