The effect of HIV infection on short term outcomes among patients undergoing peritoneal dialysis

AUTHORS:  

KCZ. Ndlovu 1,2, A Assounga 1,2

1. Inkosi Albert Luthuli Central Hospital, Durban, South Africa 

2. University of KwaZulu-Natal, Durban, South Africa

INTRODUCTION 

Management of Renal failure in the setting of HIV infection has been scarcely studied particularly in low resource settings where access to renal replacement therapy is not widely available. This study aims to evaluate the short term outcomes of Continuous Ambulatory Peritoneal Dialysis (CAPD) in the management of renal failure associated with HIV infection.

METHODS

This is an ongoing prospective cohort study carried out on dialysis requiring renal failure patients newly inserted a tenckhoff catheter in our unit started on 1 September 2012. Forty HIV positive patients and 59 HIV negative controls were enrolled into groups 1 and 2, respectively, by 31 March 2014. Monthly followed up data over 6 months was used to assess primary outcomes of mortality and catheter patency as well as secondary outcomes of hospital admissions and catheter associated complication rates.

RESULTS

Both groups 1 and 2 had statistically comparable proportion of patients with patent catheters at 6 months (52.5% vs 71.2%, p=0.058) catheter failure rates (0.546 vs 0.367 per-person- years, RR 1.49, 95% CI 0.50 – 4.34, p=0.422), all-cause mortality rates (0.751 vs 0.326 per- person-years, RR 2.30, CI 0.84 – 6.59, P=0.0764), and catheter related re-operation rates (0.864 vs 0.480 per-person-years, RR 1.80, CI 0.67 – 4.82, p=0.197) except for all-cause hospital admissions (3.17 vs 1.74 per-person-years, RR 1.89, CI 1.08 – 3.30, P=0.0193) and catheter related admissions (1.99 vs 1.04 per-person-years, RR 1.92, CI 0.98 – 3.76, p=0.0423) where HIV was associated with statistically significant increased incidence. Furthermore, catheter associated complications (tenckhoff associated infections and blockages) were the predominant cause for the first hospital admission in both groups (67% vs 62%, p=0.778).

CONCLUSION: 

This study suggests that HIV infection in patients on CAPD does not significantly adversely influence short term catheter survival and mortality rates, however, it may be associated with increased morbidity relative risk.