Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review
Summary: Background: The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a system...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2017-04-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X17300578 |
| _version_ | 1818964624766140416 |
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| author | Gloria Ashuntantang, ProfMD Charlotte Osafo, MBChB Wasiu A Olowu, ProfMBBS Fatiu Arogundade, ProfMBBS Abdou Niang, ProfMD John Porter, ProfMD Saraladevi Naicker, ProfMBChB Valerie A Luyckx, DrMBBCh |
| author_facet | Gloria Ashuntantang, ProfMD Charlotte Osafo, MBChB Wasiu A Olowu, ProfMBBS Fatiu Arogundade, ProfMBBS Abdou Niang, ProfMD John Porter, ProfMD Saraladevi Naicker, ProfMBChB Valerie A Luyckx, DrMBBCh |
| author_sort | Gloria Ashuntantang, ProfMD |
| collection | DOAJ |
| description | Summary: Background: The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received. Methods: We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis. Findings: Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis Interpretation: Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa. Funding: None. |
| first_indexed | 2024-12-20T13:04:05Z |
| format | Article |
| id | doaj.art-cff2e0afc1714655a8816814938dc325 |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-20T13:04:05Z |
| publishDate | 2017-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-cff2e0afc1714655a8816814938dc3252022-12-21T19:39:49ZengElsevierThe Lancet Global Health2214-109X2017-04-0154e408e417Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic reviewGloria Ashuntantang, ProfMD0Charlotte Osafo, MBChB1Wasiu A Olowu, ProfMBBS2Fatiu Arogundade, ProfMBBS3Abdou Niang, ProfMD4John Porter, ProfMD5Saraladevi Naicker, ProfMBChB6Valerie A Luyckx, DrMBBCh7Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, CameroonDepartment of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, GhanaPaediatric Nephrology and Hypertension Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, NigeriaRenal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, NigeriaInternal Medicine-Nephrology, Cheikh Anta Diop University, Dakar, SenegalDepartment of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UKDepartment of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaInstitute of Biomedical Ethics, University of Zurich, Zurich, Switzerland; Correspondence to: Dr Valerie A Luyckx, Institute of Biomedical Ethics, University of Zurich, Zurich 8006, SwitzerlandSummary: Background: The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received. Methods: We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis. Findings: Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis Interpretation: Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa. Funding: None.http://www.sciencedirect.com/science/article/pii/S2214109X17300578 |
| spellingShingle | Gloria Ashuntantang, ProfMD Charlotte Osafo, MBChB Wasiu A Olowu, ProfMBBS Fatiu Arogundade, ProfMBBS Abdou Niang, ProfMD John Porter, ProfMD Saraladevi Naicker, ProfMBChB Valerie A Luyckx, DrMBBCh Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review The Lancet Global Health |
| title | Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review |
| title_full | Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review |
| title_fullStr | Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review |
| title_full_unstemmed | Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review |
| title_short | Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review |
| title_sort | outcomes in adults and children with end stage kidney disease requiring dialysis in sub saharan africa a systematic review |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X17300578 |
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