PERITONEAL DIALYSIS IN THE SUDAN

National Ribat University Hospital 1 ; Military Hospital 2 ; Khartoum Renal Center 3 ; Soba University Hospital 4 ; Jaafar Ibn Auf Pediatric Hospital 5 ; Ibn Sina Specialized Hospital 6 ; Khartoum North Renal Center 7 ; Central Medical Supplies Corp. 8 ; and National Center for Kidney Diseases, 9 Khartoum, Sudan Correspondence to: E.A.M. Elhassan, Ribat Center for Regular Peritoneal Dialysis, P.O. Box 363, Khartoum, Sudan. waleedali{at}yahoo.com Background: End-stage renal disease is a significant social and economic burden on the Sudan. Continuous ambulatory peritoneal dialysis (CAPD) was recently introduced as a national service and is provided free of charge by the Federal State. We present here an overview of our experience and outcomes after the first 20 months of operation of the National Program, displaying its organization and patient and technique survival, peritonitis rates, and adequacy parameters of the first patients to undergo CAPD. Methods: As a national experiment, the program was sequentially launched in 5 adult and 2 pediatric centers in Khartoum, the capital city of the country. The data include the entire 111 patients who underwent CAPD from June 2005 to January 2007. All data were reported to, and analyzed at, the head office of the Sudan National Peritoneal Dialysis Program. Results: CAPD is the modality exclusively utilized thus far. Automated PD will be added to the program this year. By 30 January 2007, the total number of patients enrolled was 111. Their age range was 1 – 75 (median 56) years. 20 patients (18%) were shifted to hemodialysis and 5 patients received living related kidney transplants. Two died of severe septicemia due to peritonitis; 16 (14%) others died of non-PD-related causes. There were 60 cases of peritonitis in 839 patient-months, which equates to an overall peritonitis rate of 1 episode every 14 months (0.87 episodes per year at risk). The individual center rates varied. A critical review of cases at the end of the first year showed a statistically significant age difference, with peritonitis being more common in the younger patients. Mean age of patients that developed peritonitis was 30.53 years, whereas that for peritonitis-free patients was 44.09 years (p = 0.025). All patients that had peritonitis presented with abdominal pain and had a cloudy effluent; none had exit-site or tunnel infection. The culture-negative peritonitis rate was 53%. Pseudomonas species were responsible for 13.3% and Staphylococcus au