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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Peritoneal dialysis in the Sudan
Peritoneal Dialysis International, Volume 27, No. 5, Year 2007
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Description
◆Background: End-stage renal disease is a significant social and economic burden on the Sudan. Continuous ambulatory peritoneal dialysis (CAPD) was recently introduced as a national service and is provided free of charge by the Federal State. We present here an overview of our experience and outcomes after the first 20 months of operation of the National Program, displaying its organization and patient and technique survival, peritonitis rates, and adequacy parameters of the first patients to undergo CAPD. ◆Methods: As a national experiment, the program was sequentially launched in 5 adult and 2 pediatric centers in Khartoum, the capital city of the country. The data include the entire 111 patients who underwent CAPD from June 2005 to January 2007. ALL data were reported to, and analyzed at, the head office of the Sudan National Peritoneal Dialysis Program. ◆Results: CAPD is the modality exclusively utilized thus far. Automated PD will be added to the program this year. By 30 January 2007, the total number of patients enrolled was 111. Their age range was 1-75 (median 56) years. 20 patients (18%) were shifted to hemodialysis and 5 patients received living related kidney transplants. Two died of severe septicemia due to peritonitis; 16 (14%) others died of non-PD-related causes. There were 60 cases of peritonitis in 839 patient-months, which equates to an overall peritonitis rate of 1 episode every 14 months (0.87 episodes per year at risk). The individual center rates varied. A critical, review of cases at the end of the first year showed a statistically significant age difference, with peritonitis being more common in the younger patients. Mean age of patients that developed peritonitis was 30.53 years, whereas that for peritonitis-free patients was 44.09 years (p = 0.025). ALL patients that had peritonitis presented with abdominal pain and had a cloudy effluent; none had exit-site or tunnel. infection. The culture-negative peritonitis rate was 53%. Pseudomonos species were responsible for 13.3% and Staphylococcus oureus for 6.7%. Touch contamination was the Likely mechanism behind 46.7% of the episodes. There were 3 cases of refractory peritonitis and a single case of relapsing peritonitis. Concerning PD adequacy, average Kt/V urea was 1.74; weekly creatinine clearance was 62.5 L/1.73 m2. Average normalized protein catabolic rate, as a measure of dietary protein intake in patients in a steady state, was 1.17 g/kg. These measures indicate that the overall program adequacy was satisfactory and the values fall within the recommended ranges. ◆Conclusion: The first 20 months of operation of the Sudan's National Peritoneal Dialysis Program have proven that it is a promising project with multifaceted success. The adequacy indicators are acceptable but the cumulative peritonitis incidence is above that recommended, indicating several areas for potential improvement. Although CAPD is highly cost-effective, ongoing difficulties, including the cost of medications and Laboratory tests, are being sorted out with official support and public involvement. Copyright © 2007 International Society for Peritoneal Dialysis.
Authors & Co-Authors
Elhassan, Elwaleed A.M.
Sudan, Khartoum
National Ribat University
Sudan, Khartoum
Ribat Center for Regular Peritoneal Dialysis, Khartoum
Kaballo, Babikir Gabir
Sudan, Khartoum
Military Hospital
Fedail, Haleema
Sudan, Khartoum
Khartoum North Renal Center
Abdelraheem, Mohamed Babbikir
Sudan, Khartoum
Soba University Hospital
Ali, Tigani
Sudan, Khartoum
Soba University Hospital
Medani, Safaa A.
Sudan, Khartoum
Jaafar Ibn Auf Pediatric Hospital, Sudan
Tammam, Layla
Sudan, Khartoum
Ibn Sina University
Basheir, Ihsan
Sudan, Khartoum
National Ribat University
Taha, Ahabab
Sudan, Khartoum
Khartoum North Renal Center
Mandour, Mohamed
Sudan, Khartoum
Central Medical Supplies Public Corporation, Sudan
El Awad, Khalifa
Sudan, Khartoum
National Center for Kidney Diseases, Khartoum
Abu-Aisha, Hassan A.
Sudan, Khartoum
National Ribat University
Statistics
Citations: 41
Authors: 12
Affiliations: 9
Identifiers
Doi:
10.1177/089686080702700505
ISSN:
08968608
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study
Case Study
Study Approach
Quantitative
Study Locations
Sudan