Long-term clinical outcomes of peritoneal dialysis patients: analysis of the Senegalese cohort from 2004 to 2020.

BackgroundPeritoneal dialysis (PD) was introduced in Senegal in 2003, with the first PD center established at Aristide Le Dantec University Hospital. Our study aims to determine long-term outcomes of the Senegalese PD cohort.MethodsWe performed a single-center retrospective cohort study of adults patients treated with chronic PD from 2004 to 2020. Demographics, comorbidities, labs, complications, hemodialysis (HD) transfers, hospitalizations, PD discontinuation and mortality were collected. Survival was assessed using Kaplan-Meier and Cox models.ResultsDuring the study period, 232 patients were treated by PD. The mean age was 47.5 ± 14.9 years, 56.9% were female, 76% lacked health insurance, and 98.3% had hypertension. Median distance to the PD unit was 22 km (IQR: 13-100). Most patients started kidney replacement therapy on HD in private sector and were transferred to PD due to financial constraints (out-of-pocket payment). A total of 351 peritonitis episodes occurred in 174 patients (0.97 episodes per patient-year), including 14.9% experienced more than three episodes. Staphylococcus aureus and Pseudomonas species were the most frequent causative organisms, with 35.9% of culture-negative episodes. Permanent transfer to HD was the leading cause of PD discontinuation (59.6%), followed by death (37.7%). Median patient survival was 31 months. Time on PD therapy had a median of 35 months, with one-, three-, and five-year survival of 86.1%, 49.8%, and 25.3%, respectively, censored for death, kidney transplantation, and recovery of renal function.ConclusionsPD in Senegal is suitable but challenged by infectious, mechanical, metabolic complications and socioeconomic barriers. Improving infection control, monitoring, catheter placement, and insurance coverage is key to expanding equitable dialysis access.