Peritoneal dialysis in Africa.

BACKGROUND: Africa is the world's second-largest and second most populous continent. It is also the poorest and most underdeveloped continent. Struggling to provide the essential health interventions for its occupants, the majority of African countries cannot regard renal replacement therapy a health priority.

REVIEW: In 2007, Africa's dialysis population constituted only 4.5% of the world's dialysis population, with a prevalence of 74 per million population (pmp), compared to a global average of 250 pmp. In almost half the African countries, no dialysis patients are reported. The prevalence of peritoneal dialysis (PD) was 2.2 pmp, compared to a global prevalence of 27 pmp, with the bulk of African PD patients (85%) residing in South Africa. In North African countries, which serve 93% of the African dialysis population, the contribution of PD to dialysis is only 0% - 3%. Cost is a major factor affecting the provision of dialysis treatment and many countries are forced to ration dialysis therapy. Rural setting, difficult transportation, low electrification rates, limited access to improved sanitation and improved water sources, unsuitable living circumstances, and the limited number of nephrologists are obstacles to the provision of PD in many countries.

CONCLUSION: The potential for successful regular PD programs in tropical countries has now been well established. Cost is a major prohibitive factor but the role of domestic manufacture in facilitating widespread use of PD is evidenced by the South African example. Education and training are direly needed and these are areas where international societies can be of great help.