African Journal of Nephrology

Burnout in South African dialysis practitioners: a mixed methods study

2025-09-04T10:38:19+00:00

Introduction: Provision of dialysis to patients with kidney failure relies on skilled dialysis practitioners (DPs), about whom little is known of the effect on burnout of workplace stressors, resource limitations, and the COVID-19 pandemic, which have increased the condition in other nursing specialities. We therefore analysed burnout in South African DPs working in the public sector.

Methods: Sixty-four anonymous volunteers were recruited from three public sector treatment centres in Johannesburg. Burnout was assessed using the Maslach Burnout Inventory–Human Services Survey (MBI–HSS); the study population additionally completed surveys recording their workplace and COVID-19 experiences. The effect of respondent demographics, workplace, and pandemic experiences on burnout was determined using regression modelling.

Results: Burnout occurred in 22%. Workplace challenges affected 97% of our sample; staffing shortages (97%), insufficient pay (75%), and perceived lack of management support (70%) were frequently cited. Sixty-four percent reported deteriorated perception of their career following COVID-19. Age (ß –0.29 ± 0.12, P = 0.015), longer time in current position (ß 0.38 ± 0.15, P = 0.012), lack of management support (ß 2.76 ± 0.93, P = 0.003), and lower career perception following COVID-19 (ß 3.68 ± 0.91, P < 0.001) increased emotional exhaustion; inadequate pay reduced personal sense of accomplishment (ß –1.12 ± 0.54, P = 0.036). Impaired career perception following COVID-19 independently increased burnout (OR 2.07, 95% CI 1.06–4.06, P = 0.033).

Conclusions: Burnout rates in South African DPs are high and exceed those of many other regions. Perceived inadequate remuneration and poor management support are important factors underlying the condition. COVID-19 experiences continue to exert a significant effect on career appraisal and burnout.

Prolonged intermittent kidney replacement therapy: overcoming challenges in the critically ill patient in low-resource settings

2025-09-04T09:25:51+00:00

Acute kidney injury is a frequent complication of critical illness in intensive care units and has a negative prognostic impact. Kidney replacement therapy (KRT) is frequently needed and the treatment modalities used in these settings include continuous kidney replacement therapy (CKRT), intermittent haemodialysis (IHD) and peritoneal dialysis (PD). Haemodynamic instability is common in critically ill patients and the different KRT modalities affect haemodynamics in different ways. CKRT is often considered the modality of choice due to its lower dialysate flow, extracorporeal blood flow and ultrafiltration rates, leading to better haemodynamic stability. In poor socio-economic settings, however, the high cost of CKRT is a major barrier limiting its widespread use.

This brief narrative review makes the case for increased use of prolonged intermittent kidney replacement therapy (PIKRT), frequently called sustained low-efficiency dialysis (SLED), a form of KRT that uses standard IHD machines to deliver prolonged dialysis sessions at reduced flow rates, with good haemodynamic stability, and at a lower cost. PIKRT is an effective alternative for treating acute kidney injury in critically ill patients in low-resource settings.

Acknowledgement to reviewers 2025

2026-01-20T05:34:49+00:00

The editors of AJN wish to thank the colleagues who generously gave of their time and expertise to review manuscripts for us during 2025. We greatly appreciate their contribution to the quality of the work that we publish.

Welcome to the year 2026 and volume 29: Time for the “Know thy eGFR and urine protein – and act” campaign

2026-01-29T06:01:25+00:00

On behalf of the Editorial Board of the African Journal of Nephrology (AJN), I wish all AJN contributors and readers a very happy and productive year 2026.

Last year, following AJN accreditation with the CAMES (Conseil Africain et Malgache pour l’enseignement Supérieur), we witnessed a significant increase in the submission of French manuscripts. To the contributors of these French manuscripts, we thank you for your submissions, which make AJN a truly bilingual journal.

This year, we aim to move AJN to a new hosting platform that will enable us to apply for accreditation for Scopus and PubMed. We take this opportunity to thank all contributors for the large number of submitted manuscripts, and reviewers for evaluating these manuscripts and providing valuable feedback.

In volume 28, we noted several highlights: a scoping review by Ngema et al. revealed the extent of depression in dialysis patients and Davidson et al. reported on the stability of the peritonitis rate in Cape Town despite extreme conditions such as a severe drought and the COVID-19 pandemic. Finally, Ndinya et al. reported that unexplained hyperkalaemia is associated with low rates of in-hospital death.

This year, World Kidney Day will take place on 12 March 2026 with the following theme: “Kidney health for all – caring for people, protecting the planet”.

Several nephrology bodies have recommended that serum urea and creatinine results be reported together with estimated glomerular filtration rate (eGFR), estimated using widely accepted equations. We should commend commercial laboratories for routinely providing eGFR results. In HIV medicine, patients are educated to be informed about their CD4 count and viral load. In nephrology, eGFR and proteinuria provide an essential evaluation of kidney function. Each adult should know their eGFR and the status of their proteinuria, with these tests being done at least annually.

We need to democratise this knowledge, empower patients to own it and help them participate in the management of their kidney function, as shown in an algorithm adapted from the International Society of Nephrology [1]. Let us give them the tools to help themselves. With a strategy that includes a healthy diet, inhibition of the renin-angiotensin-aldosterone system and the control of comorbidities, we can delay or avoid dialysis for at least two-thirds of patients.

Therefore, let us start the “Know thy eGFR and urine protein – and act” campaign.