Peritoneal dialysis technique survival at Tygerberg Hospital in Cape Town, South Africa

Background: The use of peritoneal dialysis (PD) as a treatment modality for patients with end-stage renal disease (ESRD) has been declining in many countries over the past few years. One of the reasons is technique failure, which occurs more frequently than is the case with chronic haemodialysis. Identifying and addressing the causes of technique failure is important in order to maintain more patients on PD, especially in settings where there are limited resources for chronic haemodialysis and a “PD first” approach is followed.Methods: In this retrospective study at Tygerberg Hospital in Cape Town, South Africa, we investigated 170 patients who were started on chronic ambulatory PD between January 2008 and July 2014, and determined rates of technique and patient survival. Demographic, clinical and laboratory data were assessed to identify risk factors for these outcomes.Results: The median age of the patients was 36 years and the most common cause of ESRD was glomerulonephritis. Only one patient had diabetes mellitus. Technique survival at 1, 3 and 5 years was 80%, 54% and 39%, respectively, while patient survival was 90%, 82% and 63%. Patients started on PD during the second half of the study period had improved rates of technique survival. Peritonitis was the most common cause of technique failure. Increasing age and Black ethnicity were associated with increased likelihood of technique failure. Other clinical and social factors were not significantly associated with the occurrence of technique failure.Conclusions: In our patients on PD, peritonitis, increased age and Black ethnicity were important factors associated with the development of technique failure. Concerted efforts are required to reduce peritonitis rates at our centre as this is the leading cause of technique failure

Damaged Intestinal Epithelial Integrity Linked to Microbial Translocation in Pathogenic Simian Immunodeficiency Virus Infections

The chronic phase of HIV infection is marked by pathological activation of the immune system, the extent of which better predicts disease progression than either plasma viral load or CD4+ T cell count. Recently, translocation of microbial products from the gastrointestinal tract has been proposed as an underlying cause of this immune activation, based on indirect evidence including the detection of microbial products and specific immune responses in the plasma of chronically HIV-infected humans or SIV-infected Asian macaques. We analyzed tissues from SIV-infected rhesus macaques (RMs) to provide direct in situ evidence for translocation of microbial constituents from the lumen of the intestine into the lamina propria and to draining and peripheral lymph nodes and liver, accompanied by local immune responses in affected tissues. In chronically SIV-infected RMs this translocation is associated with breakdown of the integrity of the epithelial barrier of the gastrointestinal (GI) tract and apparent inability of lamina propria macrophages to effectively phagocytose translocated microbial constituents. By contrast, in the chronic phase of SIV infection in sooty mangabeys, we found no evidence of epithelial barrier breakdown, no increased microbial translocation and no pathological immune activation. Because immune activation is characteristic of the chronic phase of progressive HIV/SIV infections, these findings suggest that increased microbial translocation from the GI tract, in excess of capacity to clear the translocated microbial constituents, helps drive pathological immune activation. Novel therapeutic approaches to inhibit microbial translocation and/or attenuate chronic immune activation in HIV-infected individuals may complement treatments aimed at direct suppression of viral replication

Peritoneal dialysis technique survival at Tygerberg Hospital in Cape Town, South Africa

CITATION: Kapembwa, K., et al. 2017. Peritoneal dialysis technique survival at Tygerberg Hospital in Cape Town, South Africa. African Journal of Nephrology, 20(1):25-33, doi:10.21807/20-1-1917.The original publication is available at http://www.journals.ac.za/index.php/ajn/Background: The use of peritoneal dialysis (PD) as a treatment modality for patients with end-stage renal disease (ESRD) has been declining in many countries over the past few years. One of the reasons is technique failure, which occurs more frequently than is the case with chronic haemodialysis. Identifying and addressing the causes of technique failure is important in order to maintain more patients on PD, especially in settings where there are limited resources for chronic haemodialysis and a “PD first” approach is followed. Methods: In this retrospective study at Tygerberg Hospital in Cape Town, South Africa, we investigated 170 patients who were started on chronic ambulatory PD between January 2008 and July 2014, and determined rates of technique and patient survival. Demographic, clinical and laboratory data were assessed to identify risk factors for these outcomes. Results: The median age of the patients was 36 years and the most common cause of ESRD was glomerulonephritis. Only one patient had diabetes mellitus. Technique survival at 1, 3 and 5 years was 80%, 54% and 39%, respectively, while patient survival was 90%, 82% and 63%. Patients started on PD during the second half of the study period had improved rates of technique survival. Peritonitis was the most common cause of technique failure. Increasing age and Black ethnicity were associated with increased likelihood of technique failure. Other clinical and social factors were not significantly associated with the occurrence of technique failure. Conclusions: In our patients on PD, peritonitis, increased age and Black ethnicity were important factors associated with the development of technique failure. Concerted efforts are required to reduce peritonitis rates at our centre as this is the leading cause of technique failure.http://www.journals.ac.za/index.php/ajn/article/view/1917Publisher's versio

Quality of life in patients on chronic dialysis in South Africa : a comparative mixed methods study

CITATION: Tannor, E. K., et al. 2017. Quality of life in patients on chronic dialysis in South Africa : a comparative mixed methods study. BMC Nephrology, 18:4, doi:10.1186/s12882-016-0425-1.The original publication is available at http://bmcnephrol.biomedcentral.comBackground: The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis. Dialysis should not only be aimed at prolonging lives but also improve quality of life (QOL). Using mixed methods, we investigated the QOL of patients on chronic haemodialysis (HD) and peritoneal dialysis (PD). Methods: We conducted a cross-sectional study at Tygerberg Hospital in Cape Town, South Africa. All the PD patients were being treated with continuous ambulatory peritoneal dialysis. The KDQOL-SF 1.3 questionnaire was used for the quantitative phase of the study. Thereafter, focus-group interviews were conducted by an experienced facilitator in groups of HD and PD patients. Electronic recordings were transcribed verbatim and analysed manually to identify emerging themes. Results: A total of 106 patients completed questionnaires and 36 of them participated in the focus group interviews. There was no difference between PD and HD patients in the overall KDQOL-SF scores. PD patients scored lower with regard to symptoms (P = 0.005), energy/fatigue (P = 0.025) and sleep (P = 0.023) but scored higher for work status (P = 0.005) and dialysis staff encouragement (P = 0.019) than those on HD. Symptoms and complications were verbalised more in the PD patients, with fear of peritonitis keeping some housebound. PD patients were more limited by their treatment modality which impacted on body image, sexual function and social interaction but there were less dietary and occupational limitations. Patients on each modality acknowledged the support received from family and dialysis staff but highlighted the lack of support from government. PD patients had little opportunity for interaction with one another and therefore enjoyed less support from fellow patients. Conclusions: PD patients experienced a heavier symptom burden and greater limitations related to their dialysis modality, especially with regards to social functioning. The mixed-methods approach helped to identify several issues affecting quality of life which are amenable to intervention.http://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0425-1Publisher's versio

HIV, Hepatitis B, and Hepatitis C in Zambia

Objectives : Epidemiologic data of HIV and viral hepatitis coinfection are needed in sub-Saharan Africa to guide health policy for hepatitis screening and optimized antiretroviral therapy (ART). Materials and Methods: We screened 323 HIV-infected, ART-eligible adults for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) at a tertiary hospital in Lusaka, Zambia. We collected basic demographic, medical, and laboratory data to determine predictors for coinfection. Results: Of 323 enrolled patients, 32 (9.9%; 95% CI=6.7-13.2%) were HBsAg positive, while 4 (1.2%; 95% CI=0.03-2.4%) were HCV Ab positive. Patients with hepatitis B coinfection were more likely to be <40 years (84.4% vs. 61.4%; P=0.01) when compared to those who were not coinfected. Patients with active hepatitis B were more likely to have mild to moderately elevated AST/ALT (40-199 IU/L, 15.8% vs. 5.4%; P=0.003). Highly elevated liver enzymes (>200 IU/L) was uncommon and did not differ between the two groups (3.4% vs. 2.3%; P=0.5). We were unable to determine predictors of hepatitis C infection due to the low prevalence of disease. Conclusions: HIV and hepatitis B coinfection was common among patients initiating ART at this tertiary care facility. Routine screening for hepatitis B should be considered for HIV-infected persons in southern Africa