Is and death occurrences. Peritonitis rates in PD programs are usually a reflection of the standard of care in PD programs. Factors that can be attributed to the possibility of sub-optimal standard of care among our patients are technical manpower shortages and lack of adequate infrastructure in health services systems in rural settings. In rural, underdeveloped regions of china where there are significantly less doctors and trained health staff in PD programs, PD outcomes have been noted to be poor in comparison to PD patients with access to adequately staffed urban units.[21, 22] The Nutlin (3a) site relative lack of nearby standard PD services in our patients’ RDX5791 site locale is brought to bear in the average distance travelled to access care (114.3 ?70.2 km). Cost considerations in making these journeys will most certainly deter early presentation for prompt intervention when peritonitis symptoms develop. Our patients are largely unemployed and those accepted unto the chronic dialysis program are given 1200 Rands (approximately 85) per month in form of a social grant by the provincial government. The lack of an association between infection-related mortality and type of housing mirrors the positive impact of good housing conditions in infection control. A significantly higher proportion of PD patients dwelt in formal houses which are characterized in South Africa by the presence of running water and proper sewage disposal systems. In an attempt not to make invalid associations, we did not further assess the relationship among risk of infection-related death, peritonitis and type of housing because of the small numbers. Cardiovascular causes account for the majority of deaths among chronic dialysis patients. [23] In our cohort of patients however, deaths related to CV causes accounted for only 29.3 of all deaths with body weight at dialysis initiation being the only significantly associated factor for CV mortality. We recognise that this low proportion of CV deaths can be accounted for by selection bias whereby patients who are healthier, younger, and with less comorbidities and CV disease burden are dialysed. This is apparent in the mean age of our patients (36.1 ?11.9 years), mean BMI (23.9 ?5.5 Kg/m2) and the percentage of patients with DM (10.3 ) and hypertension (25.9 ) in a predominantly black population of patients. Due to the current dialysis-rationing policy operational in government-funded dialysis centres in South Africa (ours inclusive), stringent criteria are applied in accepting ESRD patients to the maintenance dialysis program.[24] The exclusion criteria under this policy are factors that are known to be associated with poor CV outcomes. As such patients who are > 60 years, diabetic (if > 50 years),PLOS ONE | DOI:10.1371/journal.pone.0156642 June 14,9 /Baseline Predictors of Mortality in Chronic Dialysis Patients in Limpopo, South Africamorbidly obese (>BMI.35kg/m2) and those with advanced and irreversibly progressive cardiac, CV or peripheral vascular disease are not accepted on to the program. Peritoneal dialysis has the potential of being a preferred RRT option in developing countries as it could serve rural dwelling patients who commonly live far away from in-centre HD units which are usually cited in urban areas. However, poorer patient outcomes in PD patients may prevent its optimal usage among this group of patients in a country like South Africa. Even though this study has described poorer survival among PD patients, this should not d.Is and death occurrences. Peritonitis rates in PD programs are usually a reflection of the standard of care in PD programs. Factors that can be attributed to the possibility of sub-optimal standard of care among our patients are technical manpower shortages and lack of adequate infrastructure in health services systems in rural settings. In rural, underdeveloped regions of china where there are significantly less doctors and trained health staff in PD programs, PD outcomes have been noted to be poor in comparison to PD patients with access to adequately staffed urban units.[21, 22] The relative lack of nearby standard PD services in our patients’ locale is brought to bear in the average distance travelled to access care (114.3 ?70.2 km). Cost considerations in making these journeys will most certainly deter early presentation for prompt intervention when peritonitis symptoms develop. Our patients are largely unemployed and those accepted unto the chronic dialysis program are given 1200 Rands (approximately 85) per month in form of a social grant by the provincial government. The lack of an association between infection-related mortality and type of housing mirrors the positive impact of good housing conditions in infection control. A significantly higher proportion of PD patients dwelt in formal houses which are characterized in South Africa by the presence of running water and proper sewage disposal systems. In an attempt not to make invalid associations, we did not further assess the relationship among risk of infection-related death, peritonitis and type of housing because of the small numbers. Cardiovascular causes account for the majority of deaths among chronic dialysis patients. [23] In our cohort of patients however, deaths related to CV causes accounted for only 29.3 of all deaths with body weight at dialysis initiation being the only significantly associated factor for CV mortality. We recognise that this low proportion of CV deaths can be accounted for by selection bias whereby patients who are healthier, younger, and with less comorbidities and CV disease burden are dialysed. This is apparent in the mean age of our patients (36.1 ?11.9 years), mean BMI (23.9 ?5.5 Kg/m2) and the percentage of patients with DM (10.3 ) and hypertension (25.9 ) in a predominantly black population of patients. Due to the current dialysis-rationing policy operational in government-funded dialysis centres in South Africa (ours inclusive), stringent criteria are applied in accepting ESRD patients to the maintenance dialysis program.[24] The exclusion criteria under this policy are factors that are known to be associated with poor CV outcomes. As such patients who are > 60 years, diabetic (if > 50 years),PLOS ONE | DOI:10.1371/journal.pone.0156642 June 14,9 /Baseline Predictors of Mortality in Chronic Dialysis Patients in Limpopo, South Africamorbidly obese (>BMI.35kg/m2) and those with advanced and irreversibly progressive cardiac, CV or peripheral vascular disease are not accepted on to the program. Peritoneal dialysis has the potential of being a preferred RRT option in developing countries as it could serve rural dwelling patients who commonly live far away from in-centre HD units which are usually cited in urban areas. However, poorer patient outcomes in PD patients may prevent its optimal usage among this group of patients in a country like South Africa. Even though this study has described poorer survival among PD patients, this should not d.
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