Maintenance dialysis in patients from developing countries: the experience of an Italian center

There are few studies concerning the clinical problems of patients from developing countries undergoing dialysis in European countries. This retrospective study aimed to describe the main clinical features of a group of these patients who happened to be on maintenance dialysis in our unit.

Analysis of the clinical features at presentation and at follow-up of a group of patients from developing countries who entered chronic dialysis in our unit over an 8 year period.

From April 1994 to December 2001, 12 patients (eight males and four females, mean age 38.2 +/- 7.9 yrs) from developing countries (the Philippines (n=5); Egypt (n=4); Morocco (n=1); Mauritius (n=1); Sri-Lanka (n=1)) entered maintenance dialysis in our unit (six hemodialysis (HD) patients, six continuous ambulatory peritoneal dialysis (CAPD) patients). The cause of renal failure was severe/very severe hypertension in five patients (four of whom presented with very advanced end-stage renal disease (ESRD)), chronic glomerulonephritis in four patients, amyloidosis, type 2 diabetic nephropathy, and unknown causes in three patients. After a mean follow-up of 45.3 +/- 32.0 months (median 33, range 18-111), five patients continued on HD, two patients were on CAPD, whilst four patients received a renal transplant and one patient a renal and liver transplant. An important feature of our patients was the high infection rate (67%), such as tuberculosis (n=3), B and/or C viral hepatitis (n=4) and schistosomiasis (n=1). Of note were the clinical problems that developed after visits to the patients' native countries, during which the patients were dialyzed locally. After 5/20 visits (25%), three patients experienced a worsening of anemia (four incidences) and active hepatitis C development (one incidence).

Our study demonstrates that patients from developing countries on maintenance dialysis differ from our local Italian dialysis population in several respects. These are young age, causes of renal failure, frequently late referral, high infection rates, and the clinical complications due to patients' visits to their native countries.