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Disparities in dialysis allocation: An audit from the new South Africa.

Abstract End Stage Kidney Disease (ESKD) is a public health problem with an enormous economic burden. In resource limited settings management of ESKD is often rationed. Racial and socio-economic inequalities in selecting candidates have been previously documented in South Africa. New guidelines for dialysis developed in the Western Cape have focused on prioritizing treatment. With this in mind we aimed at exploring whether the new guidelines would improve inequalities previously documented. A retrospective study of patients presented to the selection committee was conducted at Groote Schuur Hospital. A total of 564 ESKD patients presented between 1 January 2008 and 31 December 2012 were assessed. Half of the patients came from low socioeconomic areas, and presentation was late with either overt uremia (n = 181, 44·4%) or fluid overload (n = 179, 43·9%). More than half (53·9%) of the patients were not selected for the program. Predictors of non-acceptance onto the program included age above 50 years (OR 0·3, p = 0·001), unemployment (OR 0·3, p<0·001), substance abuse (OR 0·2, p<0·001), diabetes (OR 0·4, p = 0·016) and a poor psychosocial assessment (OR 0·13, p<0·001). Race, gender and marital status were not predictors. The use of new guidelines has not led to an increase in inequalities. In view of the advanced nature of presentation greater efforts need to be made to prevent early kidney disease, to allocate more resources to renal replacement therapy in view of the loss of young and potentially productive life.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 28419150
OWN - NLM
STAT- In-Process
DA  - 20170418
LR  - 20170418
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 4
DP  - 2017
TI  - Disparities in dialysis allocation: An audit from the new South Africa.
PG  - e0176041
LID - 10.1371/journal.pone.0176041 [doi]
AB  - End Stage Kidney Disease (ESKD) is a public health problem with an enormous
      economic burden. In resource limited settings management of ESKD is often
      rationed. Racial and socio-economic inequalities in selecting candidates have
      been previously documented in South Africa. New guidelines for dialysis developed
      in the Western Cape have focused on prioritizing treatment. With this in mind we 
      aimed at exploring whether the new guidelines would improve inequalities
      previously documented. A retrospective study of patients presented to the
      selection committee was conducted at Groote Schuur Hospital. A total of 564 ESKD 
      patients presented between 1 January 2008 and 31 December 2012 were assessed.
      Half of the patients came from low socioeconomic areas, and presentation was late
      with either overt uremia (n = 181, 44.4%) or fluid overload (n = 179, 43.9%).
      More than half (53.9%) of the patients were not selected for the program.
      Predictors of non-acceptance onto the program included age above 50 years (OR
      0.3, p = 0.001), unemployment (OR 0.3, p&lt;0.001), substance abuse (OR 0.2,
      p&lt;0.001), diabetes (OR 0.4, p = 0.016) and a poor psychosocial assessment (OR
      0.13, p&lt;0.001). Race, gender and marital status were not predictors. The use of
      new guidelines has not led to an increase in inequalities. In view of the
      advanced nature of presentation greater efforts need to be made to prevent early 
      kidney disease, to allocate more resources to renal replacement therapy in view
      of the loss of young and potentially productive life.
FAU - Kilonzo, Kajiru G
AU  - Kilonzo KG
AD  - Division of Nephrology and Hypertension, Department of Medicine, Faculty of
      Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.
AD  - Internal Medicine Department, Kilimanjaro Christian Medical University College,
      Kilimanjaro, Moshi, Tanzania.
FAU - Jones, Erika S W
AU  - Jones ESW
AD  - Division of Nephrology and Hypertension, Department of Medicine, Faculty of
      Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.
FAU - Okpechi, Ikechi G
AU  - Okpechi IG
AD  - Division of Nephrology and Hypertension, Department of Medicine, Faculty of
      Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.
FAU - Wearne, Nicola
AU  - Wearne N
AD  - Division of Nephrology and Hypertension, Department of Medicine, Faculty of
      Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.
FAU - Barday, Zunaid
AU  - Barday Z
AD  - Division of Nephrology and Hypertension, Department of Medicine, Faculty of
      Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.
FAU - Swanepoel, Charles R
AU  - Swanepoel CR
AD  - Division of Nephrology and Hypertension, Department of Medicine, Faculty of
      Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.
FAU - Yeates, Karen
AU  - Yeates K
AD  - Department of Nephrology, Queen's University, Kingston, Ontario, Canada.
FAU - Rayner, Brian L
AU  - Rayner BL
AD  - Division of Nephrology and Hypertension, Department of Medicine, Faculty of
      Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.
LA  - eng
PT  - Journal Article
DEP - 20170418
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
EDAT- 2017/04/19 06:00
MHDA- 2017/04/19 06:00
CRDT- 2017/04/19 06:00
PHST- 2016/08/24 [received]
PHST- 2017/04/04 [accepted]
AID - 10.1371/journal.pone.0176041 [doi]
AID - PONE-D-16-33880 [pii]
PST - epublish
SO  - PLoS One. 2017 Apr 18;12(4):e0176041. doi: 10.1371/journal.pone.0176041.
      eCollection 2017.

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