Content area
Full text
Introduction
End-stage renal disease (ESRD) is at least 3-4 times more common in Africa than in developed countries.1 In Africa, ESRD affects mainly adults aged 20 - 50 years, and predominantly results from hypertension and/or glomerular disease. In developed countries, ESRD occurs more commonly in the older age group, where it mainly stems from hypertension and/or diabetes. The burden of managing this condition places additional financial and economic pressure on an already impoverished continent.1
Renal transplantation as a treatment modality requires medical and surgical expertise, financial resources and a donor system. According to the South African Renal Registry Annual Report 2012, less than 20% of patients on renal replacement therapy for ESRD receive renal transplantation. This figure includes public and private sector patients.2
Renal dialysis is therefore the mainstay of ESRD treatment, but is underutilised, mainly owing to financial constraints. Two well-established methods of dialysis are haemodialysis (HD) and peritoneal dialysis (PD).
PD is a most effective renal replacement therapy that offers several advantages over HD.
These include:
* better patient mobility and quality of life
* more flexible scheduling
* encourages employment and independence
* ease of use
* lower cost if the dialysate fluid is produced locally
* preferable in certain comorbidities, such as cardiovascular disease, liver disease, diabetes and patients with electrolyte disturbances
* preservation of residual renal function
* lower mortality during the first year after initiating therapy.3,4,5
The advantages of PD make it a viable treatment option for ESRD in resource-limited developing countries where a chronic dialysis programme can be sustained.
The major disadvantages of PD compared with HD include:
* risk of infection, especially peritonitis
* the requirement for daily dialysis. In comparison, HD patients are usually dialysed three times per week.
* PD patients have less contact with medical personnel and other patients than HD patients
* PD patients need to store all of their dialysate fluid at home.3,4,5
The major disadvantages of HD include:
* need for vascular access, with infection risk
* more stringent diet, including strict fluid restrictions
* post dialysis physical symptoms, such as headache and lethargy.3,4,5
PD catheters (Tenckhoff catheters) are usually placed using open surgical, laparoscopic and percutaneous (Seldinger) techniques.3,4 Various international studies have...