Results: One hundred and twenty-eight patients underwent CAPD. The peritonitis rate was 1.45 episodes per year at risk. The prevalence of CAPD patients affected by at least one episode of CAPD-associated peritonitis during 2016 was 56.3%. The majority of episodes (76.7%) (n = 122) were mono-microbial. Gram-positive organisms accounted for 73.0% (n = 116) of the peritonitis episodes, coagulase-negative Staphylococcus being the most common. Gram-negative organisms accounted for 15.7% (n = 25) of the peritonitis episodes, and the common pathogens was Enterobacteriaceae. Conclusion:The peritonitis rate was alarmingly high, with 1.45 episodes per year at risk; this is three times more than the recommended 0.5 episodes per year according to the ISPD guidelines. The culture-negative rate of 8.8% is within ISPD-acceptable limits. There is a need to strengthen preventive measures with regard to peritonitis.

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Background End-stage kidney disease (ESKD) and the required kidney replacement therapy (KRT) are significant public health challenges for low-and-middle-income countries. The South African government adopted a KRT rationing policy to balance the growing need for KRT and scarce resources. We aimed to describe the epidemiology and KRT access in patients with ESKD referred to the main public sector hospital in the Free State Province, South Africa. Methods A retrospective study of adult patients with ESKD admitted to Universitas Academic Hospital for KRT, was conducted between 1 January 2016 and 31 December 2018. A review of the KRT committee decisions to offer or deny KRT based on the KRT rationing policy of the Free State was undertaken. Demographic information, KRT committee outcomes, laboratory test results, and clinical details were collected from assessment tools, KRT committee meeting diaries, and electronic hospital records. Results Of 363 patients with ESKD referred for KRT access, 96 with incomplete records were excluded and 267 were included in the analysis. Median patient age was 40 (interquartile range, 33‒49) years, and male patients accounted for 56.2 % (150/267, p = 0.004) of the cohort. The average annual ESKD incidence was 49.9 (95 % confidence interval [CI], 35.8‒64.0) per-million-population. The most prevalent comorbidities were hypertension (42.3 %; 113/267), human immunodeficiency virus (HIV) (28.5 %; 76/267), and diabetes mellitus (19.1 %; 51/267). The KRT access rate was 30.7 % (82/267), with annual KRT incidence rates of 8.05 (95 % CI, 4.98‒11.1), 11.5 (95 % CI, 7.83‒15.1), and 14.1 (95 % CI, 10.3‒18.0) per-million-population in 2016, 2017, and 2018, respectively. Advanced organ dysfunction was the commonest reason recorded for KRT access denial (58.9 %; 109/185). Age (odds ratio [OR], 1.04; 95 % CI, 1.00‒1.07; p = 0.024) and diabetes (OR, 5.04; CI, 1.69‒15.03; p = 0.004) were independent predictors for exclusion from KRT, while hypertension (OR, 1.80; 1.06‒3.04; p = 0.029) independently predicted advanced organ dysfunction resulting in KRT exclusion. Conclusions Non-communicable and communicable diseases, including hypertension, diabetes, and HIV, contributed to ESKD, highlighting the need for improved early prevention strategies to address a growing incidence rate. Two-thirds of ESKD patients were unable to access KRT, with age, diabetes mellitus, and advanced organ dysfunction being significant factors adversely affecting KRT access.

Prevalence of lupus nephritis and the use of serology in a central South African chronic kidney disease patient cohortTo the Editor: Lupus nephritis (LN) is a frequent kidney manifestation of systemic lupus erythematosus (SLE) and is classified into six histological classes (I -VI), as per the International Society of Nephrology and Renal Pathology Society criteria. [1] Of the six classes, class III, IV and mixed class V are known as the proliferative forms of LN, which have a more aggressive disease course and poorer prognosis. [2] The initial diagnosis of SLE is made based on the Systemic Lupus International Collaborating Clinics criteria and the 2019 European League Against Rheumatism/American College of Rheumatology (ACR) classification criteria. [3][4][5] Accurate statistics regarding the prevalence of LN in sub-Saharan Africa are limited owing to limited availability of kidney histology registries. [6] However, a substantial amount of research has highlighted worse prognostic factors among individuals of African descent, [2,[7][8][9] attributed to multifactorial factors such as apolipoprotein L1 (APOL-1) gene polymorphism, less robust cutaneous manifestations that contribute to delayed diagnosis of SLE and poor access to healthcare. [6][7]10] The delayed identification of LN has become a major underlying cause of chronic kidney disease (CKD) in South Africans. [2] LN research in South Africa (SA) is limited, and although the prevalence is reported as high, [11][12] no representative value has been published for the central SA population. However, the few data that are available indicate that the SA LN population has a consistently poorer prognosis in comparison with other global populations. [11][12][13][14] This therefore necessitates further analysis of this population.It is important to note that our findings form part of the aim of a larger genetic study wherein the human leucocyte antigen (HLA) profiles of patients with biopsy-proven CKD from a single centre in Bloemfontein, Free State Province, were investigated. This was done in order to determine whether specific HLA alleles confer a higher risk for CKD, and therefore, a study population with a welldefined diagnosis was selected. Consequently, as part of the inclusion criteria of the main study, all participants must have undergone a kidney biopsy, and were recruited between January and June 2022. In conducting this research, we were able to determine the distribution of the various chronic kidney diseases in a central SA population, from which we found the prevalence of LN to be noteworthy.Ethics approval was obtained from the Health Sciences Research Ethics Committee of the University of the Free State (ref. no. UFS-HSD2021/1462/2501), as well as permission from the Free State Department of Health (ref. no. FS_202112_005) and the National Health Laboratory Services, in order to conduct the main study.In this study of 100 (n=100) patients diagnosed with biopsyproven CKD from the nephrology clinic at Universitas Academic Hospital, the prevalence ...