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.

Predictors of three-month mortality among patients with kidney failure without access to dialysis in Tanzania

2026-02-10T13:45:43+00:00

Background: Chronic kidney disease (CKD) is a growing public health concern in Africa, including East Africa, where
access to kidney replacement therapy (KRT) remains limited due to economic and infrastructural barriers. As a
result, many patients with kidney failure receive unstructured non-dialysis medical care rather than formal conservative
kidney management (CKM) programmes. This study aimed to evaluate short-term outcomes and identify predictors
of three-month mortality among kidney failure patients on non-dialysis medical management at Muhimbili National
Hospital (MNH), Tanzania. Methods: We conducted a 90-day prospective cohort study of adults (≥18 years) with CKD stage 5 who were eligible for haemodialysis but unable to afford it between October and December 2024. Survival was analysed using Kaplan–Meier methods, and mortality predictors were assessed using Cox regression. Ethical approval was obtained from the MUHAS Research and Publications Committee (Ref: MUHAS-REC-08-2024-2415). Results: A total of 172 kidney failure patients were enrolled, with a median age of 60 years and 90-day mortality rate was 24.3%. In multivariate analysis, predictors of mortality included no monthly income (aHR: 3.68, P = 0.031), difficulty in breathing at baseline (aHR: 2.59, P = 0.020), cancer history (aHR: 4.71, P = 0.002), and hyperkalaemia (aHR: 2.34, P = 0.030). Our study highlighted that lack of income, difficulty in breathing, malignancy, and hyperkalaemia predicted shortterm mortality in kidney failure patients who could not access dialysis, reflecting both clinical and socioeconomic vulnerability. Conclusion: There is an urgent need for context-specific CKM guidance and policy interventions to support this underserved population in resource-limited settings.

Peritoneal dialysis-associated peritonitis: incidence, microbiology and outcomes at a South African hospital

2026-03-19T09:13:17+00:00

Background: Kidney failure is a major health issue in South Africa. The public health sector has adopted a ‘peritoneal dialysis (PD) first’ policy for kidney replacement therapy. PD may be characterized by high failure rates, commonly due to PD-associated peritonitis (PDP), although no data exist for the Eastern Cape (EC) province. Here we describe PDP episodes and their outcomes at a tertiary hospital in Gqeberha, EC.
Methods: A retrospective study was conducted on all adult patients receiving chronic PD at Livingstone Tertiary Hospital from 2022–2024, evaluating microbiological profiles and outcomes of all PDP episodes.
Results: Of 91 patients (mean age 38.8 years; 52% male), 61 (67%) experienced PDP. Overall, 117 episodes of PDP occurred over 126.9 patient-years (0.85 episodes/patient-year). Twelve patients (20%) had ≥3 episodes. The culture negative rate was low (11%); Gram-positive organisms predominated (71%). The medical cure rate was 65%. Relapse (OR 0.21; 95% CI 0.06–0.76) and fungal episodes (OR 0.09; CI 0.02–0.39) were associated with lower odds of cure, whereas Gram-positive cases had higher odds than Gram-negatives (OR 3.19; 1.18–8.64). HIV was not associated with episode profile or outcomes. Catheter removal occurred in 21 (18%) episodes; 16 (14%) episodes required modality switch to haemodialysis. Only four patients successfully resumed PD after interval haemodialysis.
Conclusions: PDP rates in EC exceed international targets and contribute to technique failure. Culture-negative and medical cure rates were acceptable. Gram-positive organisms predominated, suggesting a need for improved patient training. Resource restrictions and socio-economic factors may contribute to the high rate.

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.