“The development of a peritoneal dialysis (PD) program, as compared with a hemodialysis (HD) program, avoids the cost of machines, HD supplies, and water treatment, making it a much less expensive program to set up and maintain. These programs can be sustainable only when governments can afford to make them a part of the national health care budget. Many lives can be saved by the establishment of a program such as this that allows the treatment of AKI with PD.”
Kilimanjaro Christian Medical Centre (KCMC), in Moshi, Tanzania, is a referral hospital of approximately 450 beds that employs more than 1000 and serves more than 11 million people in northern Tanzania. Before July 2009, KCMC was without treatment for acute kidney injury (AKI), as efforts many years prior to establish such a program had been unsuccessful. Because of the lack of functioning registries, the incidence and prevalence of AKI and chronic kidney disease (CKD) in sub-Saharan Africa cannot be reliably quantified; however, the prevalence of CKD is estimated to be three to four times higher than in developed countries, primarily due to hypertension and glomerular diseases.
The focus of this program at KCMC is AKI treatment for women of childbearing age and children, but men with AKI have also been treated. Gravity-driven peritoneal dialysis (PD) was chosen because of the ability to deliver dialysis without the need for additional equipment beyond consumables, thus reducing cost and complexity when used in an acute low-resource setting as compared with automated PD or hemodialysis (HD). The development of chronic maintenance HD programs in developing countries such as Tanzania presents complex financial and logistical problems. The development of a treatment program using PD for AKI can be viewed as a short-term and relatively affordable service that is urgently required for a segment of the population. The establishment of sustainable acute PD programs is not without its own challenges, but its practicality in a low-resource setting makes it the best treatment option for AKI until recovery of kidney function has been achieved.