The state of renal replacement therapy for children in South Africa: Data from the first report of the re‐established National Renal Registry

• Published in: Nephrology (Carlton, Vic.) Vic.), 2017-08, Vol.22 (8), p.583-588
• Main Authors: Biljon, Gertruida, Karusseit, Victor O.L.
• Format: Article
• Language: English
• Subjects: Adolescent; Age; Age Factors; Cerebrovascular system; Child; Child, Preschool; Children; Cross-Sectional Studies; Delivery of Health Care - trends; Demography; developing countries; Dialysis; Female; Health Care Surveys; Hemodialysis; Humans; Kidney transplantation; Male; Nephrology - trends; Prevalence; Private Sector - trends; Public Sector - trends; Registries; Renal failure; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - therapy; renal registry; Renal replacement therapy; Renal Replacement Therapy - adverse effects; Renal Replacement Therapy - mortality; Renal Replacement Therapy - trends; South Africa - epidemiology; Time Factors; Treatment Outcome
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.12949

Background The South African Renal Registry (SARR) was re‐established in 2010. The first report was produced in 2014. It revealed that only 3182 patients out of 43.6 million people who were dependent on the state for medical care, received renal replacement therapy (RRT) in 2012 (73 per million population). Aim To describe the state of RRT for children in South Africa in 2012. Methods From the SARR report and 2012 dataset, a cross‐sectional study was performed of children under 14 years of age who received chronic dialysis, and incident renal transplants in 2012. Patient demographics, treatment modalities and outcome were recorded and RRT rates computed. Results Fifty‐nine children received dialysis in South Africa in 2012, a rate of 3.8 per million age‐related population (pmarp). The mean age was 9 years 11 months. The most common cause of end stage renal failure (ESRF) was acquired glomerular disorders (83%). Ninety percent of the children received treatment in two of the nine provinces. Six children (10%) were treated in the only private dialysis unit. Eleven patients received kidney transplants (19%): six private and five public sector patients. Sixteen patients (27.1%) died: seven due to cardiovascular and three due to cerebrovascular events. Conclusion There was a low RRT rate of 3.8 pmarp for children in South Africa in 2012. Private sector patients were likely to receive more optimal treatment. The poor performance of the state health sector can largely be ascribed to a deficiency of funding for RRT facilities and trained personnel. Summary at a Glance This report is from the South African Registry. Although limited in depth, national‐level data such as that presented herein are unusual in a developing country. The data they present are crucial in summarizing the variability in access to dialysis and treatment patents in different areas.