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标题：Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review
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作者：Gloria Ashuntantang ; Charlotte Osafo ; Wasiu A Olowu 等
期刊名称：The Lancet Global Health
电子版ISSN：2214-109X
出版年度：2017
卷号：5
期号：4
页码：e408-e417
DOI：10.1016/S2214-109X(17)30057-8
出版社：Elsevier B.V.
摘要：SummaryBackground The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for {ESKD} is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received. Methods We searched PubMed, African Journals Online, {WHO} Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with {ESKD} published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis. Findings Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident {ESKD} cohorts, 496 (16%) of 3197 adults in prevalent {ESKD} cohorts, and 107 (36%) of 294 children with {ESKD} died or were presumed to have died. 2508 (84%) of 2990 adults in incident {ESKD} cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent {ESKD} cohorts. 41 (1%) of 4483 adults in incident {ESKD} cohorts, 2280 (19%) of 12 125 adults in prevalent {ESKD} cohorts, and 71 (19%) of 381 children with {ESKD} received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis Interpretation Most patients with {ESKD} starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with {ESKD} in sub-Saharan Africa. Funding None.