Peritoneal dialysis in a crisis: Navigating a severe drought and pandemic in South Africa

Background: A severe drought, followed by the COVID-19 pandemic, posed significant challenges to a South African peritoneal dialysis (PD) programme in Cape Town. The study reported here assessed the impact of these crises on peritonitis rates, bacterial organisms cultured, and patient and technique survival.Methods: This observational cohort study used data from a peritoneal dialysis registry from 2007 to 2022. The study population was categorized according to three periods: “Baseline” (2007–2014), “Drought” (2015–2019), and “COVID-19” (2020–2022). Baseline characteristics were recorded when PD began. Trends in peritonitis rates, organisms cultured and causes of technique failure were evaluated during each period. A drought-specific questionnaire explored water quality and source.Results: The cohort comprised 405 patients, representing 559 peritonitis events. There was no statistical difference overall in peritonitis rates, nor peritonitis-free survival at one year among the three periods. Despite Gram-positive organisms being the predominant species cultured, there was an increasing trend in Gram-negative peritonitis during the drought (24%, 46/195) compared to baseline (16%, 37/230) and COVID-19 (15%, 20/134) periods. Klebsiella pneumoniae was the predominant Gram-negative organism cultured overall. However, there was a rise in the proportion Escherichia coli cultured in the drought (17%) compared to the pre-drought (3%) periods. The proportion of Gram-negative catheter-related infections increased during the drought and COVID-19 periods (P = 0.001), with a predominance of Pseudomonas aeruginosa. Only 18% of patients boiled their water as instructed.Conclusion: The similarity in overall peritonitis rates for the three periods highlights the adaptability and sustainability of peritoneal dialysis as a treatment option, especially at a time of increasing environmental and public-health crises.