Skip to main content

Early survival on maintenance dialysis therapy in South Africa: evaluation of a pre-dialysis education programme

Clinical and Experimental Nephrology volume 20, pages 118–125 (2016)Cite this article

Abstract

Background

Mortality in the first year of maintenance dialysis is higher than in subsequent years and, within this first year, the risk of death is highest in the first 90 days. Some studies have shown that pre-dialysis education reduces early mortality. Limited data have been published from South Africa regarding early mortality after commencement of maintenance dialysis treatment and the effect of pre-dialysis intervention programmes on these outcomes. The aim of this study was to assess the impact of a pre-dialysis intervention programme on 90- and 365-day outcomes and to determine incident mortality in a population of chronic haemo- and peritoneal dialysis patients in South Africa.

Methods

This study used a retrospective cohort of 269 patients who received a pre-dialysis intervention [Healthy Start (HS)] and a matched group of 269 patients who did not receive the intervention. Both groups subsequently commenced maintenance haemo-/peritoneal dialysis with National Renal Care (NRC). A between-group comparative analysis was conducted to determine whether there were any differences in morbidity and mortality at 90 and 365 days of chronic dialysis treatment. Survival curves for the first 365 days of treatment were calculated using the Kaplan–Meier estimation for the entire population and by age group, gender, race, diabetes, dialysis modality and presence of a central venous catheter (CVC) at start of dialysis treatment.

Results

There were no significant differences between the HS and non-HS groups at 90 and 365 days when comparing mortality, cause of death, hospital admission rates and length of stay. Data were then pooled and a Kaplan–Meier analysis showed 90- and 365-day survival of 96.7 and 85.6 %, respectively. The peak mortality occurred at 150 days of dialysis treatment, but this was not significant. Older age and the presence of a CVC were associated with an increased risk of death in the first year of treatment.

Conclusion

The HS Programme made no difference to mortality in the first year of chronic dialysis. Early survival for both HS and non-HS groups was excellent when compared to international data. Increasing age and the presence of a CVC at the start of chronic dialysis were the two factors that impacted significantly on 1-year survival.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Robinson BM, Zhang J, Morgenstern H, Bradbury BD, Ng LJ, McCullough KP, et al. Worldwide, mortality risk is high soon after initiation of haemodialysis. Kidney Int. 2013;85(1):158–65.

    PubMed Central  Article  PubMed  Google Scholar 

  2. Soucie JM, McClellan WM. Early death in dialysis patients: risk factors and impact on incidence and mortality rates. J Am Soc Nephrol. 1996;7(10):2169–75.

    CAS  PubMed  Google Scholar 

  3. Garcia-Garcia G, Deddens JA, D’Achiardi-Rey R, First MR, Samuels SJ, Kant KS, et al. Results of treatment in patients with end-stage renal disease: a multivariate analysis of risk factors and survival in 341 successive patients. Am J Kidney Dis. 1985;5(1):10–8.

    Article  CAS  PubMed  Google Scholar 

  4. Chan KE, Maddux FW, Tolkoff-Rubin N, Karumanchi SA, Thadhani R, Hakim RM. Early outcomes among those initiating chronic dialysis in the United States. Clin J Am Soc Nephrol. 2011;6(11):2642–9.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  5. Wingard RL, Pupim LB, Krishnan M, Shintani A, Ikizler TA, Hakim RM. Early intervention improves mortality and hospitalization rates in incident haemodialysis patients: RightStart program. Clin J Am Soc Nephrol. 2007;2(6):1170–5. doi:10.2215/CJN.04261206.

    Article  PubMed  Google Scholar 

  6. McQuillan R, Trpeski L, Fenton S, Lok CE. Modifiable risk factors for early mortality on haemodialysis. Int J Nephrol. 2012;2012:435736. doi:10.1155/2012/435736.

    PubMed Central  Article  PubMed  Google Scholar 

  7. Lukowsky LR, Kheifets L, Arah OA, Nissenson AR, Kalantar-Zadeh K. Patterns and predictors of early mortality in incident haemodialysis patients: new insights. Am J Nephrol. 2012;35(6):548–58.

    PubMed Central  Article  PubMed  Google Scholar 

  8. SAS Software vfW. Cary, North Carolina, USA: SAS Institute Inc.; 2002–2010.

  9. Goodkin DA, Bragg-Gresham JL, Koenig KG, Wolfe RA, Akiba T, Andreucci VE, et al. Association of comorbid conditions and mortality in haemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003;14(12):3270–7. doi:10.1097/01.asn.0000100127.54107.57.

    Article  PubMed  Google Scholar 

  10. Tsakiris D, Jones EH, Briggs JD, Elinder C-G, Mehls O, Mendel S, et al. Deaths within 90 days from starting renal replacement therapy in the ERA–EDTA Registry between 1990 and 1992. Nephrol Dial Transplant. 1999;14(10):2343–50.

    Article  CAS  PubMed  Google Scholar 

  11. Bradbury BD, Fissell RB, Albert JM, Anthony MS, Critchlow CW, Pisoni RL, et al. Predictors of early mortality among incident US haemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol. 2007;2(1):89–99.

    Article  PubMed  Google Scholar 

  12. Davids M, Marais N, Jacobs J. South African renal registry annual report 2012. Cape Town, South Africa: Apr 2014.

  13. Foley RN, Chen SC, Solid CA, Gilbertson DT, Collins AJ. Early mortality in patients starting dialysis appears to go unregistered. Kidney Int. 2014;86(2):392–8. doi:10.1038/ki.2014.15.

    Article  PubMed  Google Scholar 

  14. Hasegawa T, Bragg-Gresham JL, Yamazaki S, Fukuhara S, Akizawa T, Kleophas W, et al. Greater first-year survival on haemodialysis in facilities in which patients are provided earlier and more frequent pre-nephrology visits. Clin J Am Soc Nephrol. 2009;4(3):595–602.

    PubMed Central  Article  PubMed  Google Scholar 

  15. Singhal R, Hux JE, Alibhai SM, Oliver MJ. Inadequate predialysis care and mortality after initiation of renal replacement therapy. Kidney Int. 2014;86(2):399–406. doi:10.1038/ki.2014.16.

    Article  PubMed  Google Scholar 

  16. Wingard RL, Chan KE, Lazarus JM, Hakim RM. The “right” of passage: surviving the first year of dialysis. Clin J Am Soc Nephrol. 2009;4(Suppl 1):S114–20. doi:10.2215/CJN.04360709.

    Article  CAS  PubMed  Google Scholar 

  17. Arora P, Obrador GT, Ruthazer R, Kausz AT, Meyer KB, Jenuleson CS, et al. Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center. J Am Soc Nephrol. 1999;10(6):1281–6.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The patients who comprised the study sample; the Healthy Start and chronic dialysis staff of National Renal Care.

Conflict of interest

Karlien van Jaarsveld: Employed by National Renal Care (NRC) at the time of completing this study; financial support from NRC to conduct the study.

June Fabian: Grant from NRC for this study.

Heather Maher: Grant from NRC for this study.

Petra Gaylard: No conflict of interest.

Author information

Affiliations

  1. Donald Gordon Medical Centre, Research Office, Max Price Building, 27 Eton Rd, Parktown, Johannesburg, 2193, South Africa

    June Fabian & Heather Ann Maher

  2. Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, York Rd, Parktown, Johannesburg, 2193, South Africa

    June Fabian

  3. National Renal Care, 26 Cedar Avenue, Richmond, Johannesburg, 2092, South Africa

    Karlien Van Jaarsveld

  4. Data Management and Statistical Analysis (DMSA), PO Box 665, Wits, Johannesburg, 2050, South Africa

    Petra Gaylard

Authors
  1. June Fabian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karlien Van Jaarsveld
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heather Ann Maher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Petra Gaylard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to June Fabian.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 541 kb)

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fabian, J., Van Jaarsveld, K., Maher, H.A. et al. Early survival on maintenance dialysis therapy in South Africa: evaluation of a pre-dialysis education programme. Clin Exp Nephrol 20, 118–125 (2016). https://doi.org/10.1007/s10157-015-1125-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-015-1125-z

Keywords

  • Incident mortality
  • Chronic dialysis in South Africa
  • Pre-dialysis programme
  • Survival
  • Central venous catheter