Objective To describe recovery of renal function (RC) in Black South African patients with primary malignant hypertension (MHT) and end-stage renal failure, according to the type of dialysis provided. Design A retrospective analysis of the records of 31 patients with MHT. Setting A university-based, large tertiary-care hospital and its community-based satellite continuous ambulatory peritoneal dialysis (CAPD) clinics. Patients Only patients with renal failure caused by MHT and who were on dialysis between January 1997 and June 2000. There were 11 patients on peritoneal dialysis (PD) that regained renal function; 11 patients on hemodialysis (HD), none of whom recovered renal function; and 9 patients on PD who did not recover renal function during the same time period. Outcome Measures The groups were investigated for variables that might predict RC. Results Peritoneal dialysis compared with HD was highly significant as an indicator of RC ( p < 0.0001), with 60% of patients on PD regaining renal function, versus 0% on HD. Median time to recovery was 300 (150 – 365) days. There was no significant difference in decline of mean arterial pressure (MAP) between the groups; MAP declined significantly in all groups ( p = 0.000 02). All groups received similar drug therapy. In the RC group, initial MAP, kidney size, and urine output tended to be higher and creatinine lower ( p = not significant). Dialysis adequacy was similar in the different groups. Conclusions This retrospective study suggests there may be benefit from PD as the primary form of dialysis when patients have MHT as a cause of their renal failure. Possible predictors of RC include blood pressure control, initial MAP, initial serum creatinine, initial urine output, and kidney size. Time should be allowed for RC before transplantation is undertaken. Prospective studies are needed to confirm the benefit of CAPD in patients with MHT.

The peritonitis rate and aetiology are similar to the developed world. Socioeconomic factors did not appear to play a role in peritonitis rates or CAPD failure.

Cardiac dysfunction is highly prevalent in dialysis patients in the developed world, and is a major cause of morbidity and mortality. The relative impact of pre-existing cardiac disease and dialysis/uremia on cardiovascular morbidity are not clear. We conducted a retrospective, cross-sectional analysis of cardiac function and mortality in 202 incident and prevalent dialysis patients over an 18-month period in a population with a low prevalence of cardiovascular disease at dialysis initiation. Systolic dysfunction was defined as an ejection fraction (EF) of <50%. Left ventricular hypertrophy (LVH) was determined by echocardiography or electrocardiogram. Clinical data was collected by chart review. Ninety-nine percent of patients were black, with a mean age of 41.7 +/- 10.1 years, and median follow up 28 months (range 1-216 months). Echocardiograms were available in 132 patients. Seventy-seven patients received hemodialysis, and 55 received peritoneal dialysis. Mean EF was 63.2 +/- 11.1. EF was not lower in patients with greater duration of dialysis, although LVH tended to increase (not statistically significant). In 39 patients who died during the study period, cardiac function was not different from survivors, and no patient died of ischemic heart disease or heart failure. In conclusion, in a population of patients with a low prevalence of cardiovascular disease at dialysis initiation, cardiac function appears preserved over time, and cardiac morbidity and mortality are low. This finding suggests that dialysis and uremia per se, in the absence of pre-existing cardiac disease, may not be major contributors to cardiovascular morbidity.