The Characteristics, Management and Outcome of Patients Receiving Acute Dialysis in Swaziland (Eswatini)

Background: Eswatini, a land-locked country in Southern Africa with a population of about 1.4 million, is one of the few countries in Africa where dialysis is available as part of the country’s health plan. This is the first study of the pattern of kidney disease amongst patients receiving acute dialysis in the country. Methods: This was a retrospective folder review of patients who were dialysed at Eswatini’s three institutions where dialysis is offered. Patients dialysed acutely from the 1st of June 2015 to the 31st of May 2016 were included. A data collection form was used to collect information on patient demographics (de-identified), co-morbidities, reason for referral for dialysis, place of referral, basic investigations, and outcome in terms of renal recovery, need for chronic dialysis and 30 day mortality. The study was approved by the National Health Research Review Board, the Ethics committee of Eswatini. A waiver of consent was granted as patient information was de-identified. Data from the data collection forms was entered into Microsoft Excel and RStudio software for analysis by the principal investigators. Preliminary Results: A total number of 219 patients received acute dialysis over the study period. Ages ranged from 9 months to 84 years. Most underwent acute haemodialysis with only 4 undergoing acute peritoneal dialysis. The majority (131) 59.8% were male. Co-morbidities included HIV in 124 (56.6%), hypertension in 118 (54.1%), diabetes in 48 (21.9%), and urinary tract obstruction in 13 (5.9%). A total of 87 (39.7%) patients had received Tenofovir Disoproxil Fumarate for treatment of HIV. Of the patients with available data, those achieving partial or full renal recovery within 30 days totaled 42 (19.2%), and 88 (40.2%) went onto chronic dialysis. There were 31 deaths (out 189 identified folders) (16.4%) within 30 days. Conclusions: Dialysis requiring patients in Eswatini include the young and old. The most notable risk factors are hypertension and HIV, as well as recent use of Tenofovir Disoproxil Fumarate. A large proportion of patients present with advanced kidney disease that requires ongoing renal replacement therapy. Improved management of the identified risk factors for acute and chronic kidney disease may reduce the number of patients requiring dialysis in Eswatini.