Survival of South African patients on renal replacement therapy

Abstract

Background The majority of South Africans rely on a resource-constrained public healthcare sector, where access to renal replacement therapy (RRT) is strictly rationed. The incidence of RRT in this sector is only 4.4 per million population (pmp), whereas it is 139 pmp in the private sector, which serves mainly the 16% of South Africans who have medical insurance. Data on the outcomes of RRT may influence policies and resource allocation. This study evaluated, for the first time, the survival of South African patients starting RRT based on data from the South African Renal Registry. Methods The cohort included patients with end-stage kidney disease who initiated RRT between January 2013 and September 2016. Data were collected on potential risk factors for mortality. Failure events included stopping treatment without recovery of renal function and death. Patients were censored at 1 year or upon recovery of renal function or loss to follow-up. The 1-year patient survival was estimated using the Kaplan–Meier method and the association of potential risk factors with survival was assessed using multivariable Cox proportional hazards regression. Results The cohort comprised 6187 patients. The median age was 52.5 years, 47.2% had diabetes, 10.2% were human immunodeficiency virus (HIV) positive and 82.2% had haemodialysis as their first RRT modality. A total of 542 patients died within 1 year of initiating RRT, and overall 1-year survival was 90.4% [95% confidence interval (CI) 89.6–91.2]. Survival was similar in patients treated in the private sector as compared with the public healthcare sector [hazard ratio 0.93 (95% CI 0.72–1.21)]. Higher mortality was associated with older age and a primary renal diagnosis of ‘Other’ or ‘Aetiology unknown’. When compared with those residing in the Western Cape, patients residing in the Northern Cape, Eastern Cape, Mpumalanga and Free State provinces had higher mortality. There was no difference in mortality based on ethnicity, diabetes or treatment modality. The 1-year survival was 95.9 and 94.2% in HIV-positive and -negative patients, respectively. One-fifth of the cohort had no data on HIV status and the survival in this group was considerably lower at 77.1% (P < 0.001). Conclusions The survival rates of South African patients accessing RRT are comparable to those in better-resourced countries. It is still unclear what effect, if any, HIV infection has on survival.

Human resources for nephrology in South Africa: A mixed-methods study

“…This discrepancy exists due to the rationing of government supported RRT in the public sector whilst greater access is available for members of medical insurance schemes in the private sector [11]. Apart from the disparity in access to RRT that exists between public and private healthcare sectors, there are also striking disparities between the different provinces of South Africa, with two provinces (Limpopo and Mpumalanga) having no public sector dialysis centres at all [12].…”

Global Dialysis Perspective: South Africa

“…The survival of South African patients on KRT is comparable with that in better resourced countries. Jardine et al 17 recently analysed South African Renal Registry data and reported 1-year survival of 90.4% in incident patients. There was no difference in survival between patients treated in the private and public healthcare sectors, even after using multivariable analysis to adjust for differences in case mix.…”

“…The use of PD as the first KRT modality in the public sector has been reported at 57%. 17 PD catheters are often inserted at the bedside and around half of South African nephrologists report competence at this skill. 18 Continuous ambulatory peritoneal dialysis (CAPD) is the predominant form of PD, with most patients performing four 2-litre exchanges per day.…”

Survival Analysis of Chronic Kidney Disease Patients with Hemodialysis in West Java. Indonesia, Year 2007 - 2018

“…The number of subjects was significant enough when compared to other five-year survival analysis studies based on the registry. [6][7][8][9][10][11] This study analyzed the survival as stratified by age, gender, and underlying kidney disease, which is similar to others . [6][7][8][9][10][11][12][13][14][15][16][17] .…”