title: Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review.
abstract: The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received.
  
  
  
  We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis.
  
  
  
  Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis INTERPRETATION: Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa.
  
  
  
  None.
authors.affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
authors.forename: Gloria
authors.initials: G
authors.lastname: Ashuntantang
authors.affiliation: Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Osafo
authors.affiliation: Paediatric Nephrology and Hypertension Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria.
authors.forename: Wasiu A
authors.initials: WA
authors.lastname: Olowu
authors.affiliation: Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria.
authors.forename: Fatiu
authors.initials: F
authors.lastname: Arogundade
authors.affiliation: Internal Medicine-Nephrology, Cheikh Anta Diop University, Dakar, Senegal.
authors.forename: Abdou
authors.initials: A
authors.lastname: Niang
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Porter
authors.affiliation: Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Saraladevi
authors.initials: S
authors.lastname: Naicker
authors.affiliation: Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland. Electronic address: valerie.luyckx@uzh.ch.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Luyckx
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D002648:Child; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012307:Risk Factors