Characteristics and allocation outcomes of patients assessed for the renal replacement therapy at Groote Schuur Hospital (2008-2012)
Master Thesis
2014
Permanent link to this Item
Authors
Supervisors
Journal Title
Link to Journal
Journal ISSN
Volume Title
Publisher
Publisher
University of Cape Town
Department
Faculty
License
Series
Abstract
End Stage Kidney Disease (ESKD) is a global public health problem with an enormous economic burden. In resource limited settings like South Africa management of End Stage Kidney Diseases is rationed to the most transplantable candidates. Racial and socio-economic inequalities in selecting candidates have been documented in a South Africa despite the availability of guidelines. No data is available on selection outcomes using the current 2010 prioritization guidelines of Western Cape. We audited the outcome of patients assessed for the renal replacement therapy at Groote Schuur hospital. A retrospective analytic study of patients presented to the renal replacement therapy committee was conducted in the renal unit of Groote Schuur Hospital. Outcome letters, proceedings from the committee meetings and the hospital database were sources of data used. All new patients presented between 2008 and 2012 were included in the study. Data entry and statistical analysis was done using SPSS v.22. A total of 734 ESKD patients were assessed for renal replacement therapy between January, 2008 and December, 2012. During that period, there were 564 new patients, of which more than half (53.9%) were not selected for the program. Following the introduction of the new prioritization criteria a trend towards increasing number of patients presented and accepted was noted. More males were presented (M: F = 1.3) and most patients were below the age of 50yrs (n=478, 84.8%). Half of the patients came from low socioeconomic areas. There were no significant differences in socio-demographic factors before and after introduction of the new guidelines. Clinically they had advanced disease with either uremic (n=181, 44.4%) or fluid overload (n=179, 43.9%) symptoms as their major presentation. The underlying causes were Hypertension (40.6%), Diabetes (14.4%) and chronic Glomerulonephritis (15.8%). Predictors of rejection from the program included age above 50 years, unemployment and a poor psychosocial assessment. Substance abuse and Diabetes also showed a statistical significant association with the likelihood of being rejected. Race and marital status were not predictors. Efforts to allocate more resources should continue in view of the loss of young and potential productive life. Advanced presentation of patients with ESRD represents challenges in early diagnosis and referral in the current system. Community screening programs and improved access to knowledgeable clinicians at the primary level is advocated. The use of new selection guidelines have not led to an increase in selection inequalities.
Description
Includes bibliographical references.
Keywords
Reference:
Kilonzo, K. 2014. Characteristics and allocation outcomes of patients assessed for the renal replacement therapy at Groote Schuur Hospital (2008-2012). University of Cape Town.