Utilization of Peritoneal Dialysis among End-Stage Renal Disease Patients in Greater Gaborone, Botswana
DOI:
https://doi.org/10.70619/vol6iss4pp15-30767Keywords:
Peritoneal dialysis, End-Stage Renal Disease, Adult, Patients, UtilizationAbstract
Peritoneal dialysis offers better health outcomes and improved quality of life compared to hemodialysis, yet it remains underutilized globally, especially in Asia and Africa, including Botswana. This study identified factors associated with utilization of PD among End-Stage Renal Disease patients, and explored experiences of those who transitioned from PD to HD as well as those who never utilized PD in greater Gaborone, Botswana. A convergent mixed methods design was used. Quantitative strand utilized a cross-sectional analytical approach with semi-structured questionnaires (N=170), while the qualitative strand used a descriptive phenomenological approach with semi-structured embedded open-ended survey questions (n=108) and interviews (n=16). Quantitative data were analyzed using SPSS V26, while qualitative data were analyzed thematically using NVivo. Findings were integrated for deeper insight. Prevalence of PD was 36(22.5%) compared to 124(77.5%) HD. Majority of participants were male 100(63%), aged >35years 144(90%) and had not married 99(61.9%). More than half of the participants had completed secondary school or higher, 112 (70%). The most prevalent comorbidity was hypertension, 135(84.1%). Logistic regression: negative association of hypertension and PD utilization (OR 0.36[(95% CI 0.15, 091), p=0.026]), while awareness strongly predicted PD utilization (aOR 82.1 [(95% CI 20.6, 584.7), p <0.001]). Integrated findings highlighted misconceptions, mistrust, and mixed effects of higher education on PD uptake. Barriers to PD utilization in Botswana include patients’ concerns about PD side effects, complications, and comorbidities, as well as missed PD opportunities due to late presentation to facilities. Addressing these in Botswana requires targeted patient education alongside system-level support.
References
Rafferty, Q., Stafford, L., Vos, T., et al. Global, regional, and national prevalence of kidney failure with replacement therapy and associated aetiologies, 1990–2023: A systematic analysis for the Global Burden of Disease Study 2023. The Lancet Global Health. 2025. Available from https://www.healthdata.org/research-analysis/library/global-regional-and-national-prevalence-kidney-failure-replacement
Okpechi I G, Jha V, Cho Y, Ye F, Ijezie CI, Jindal K, Klarenbach S, Makusidi MA, Okpechi‐Samuel US, Okwuonu C, Shah N, Thompson S, Tonelli M, Johnson DW, & Bello AK. The case for increased peritoneal dialysis utilization in low‐ and lower‐middle‐income countries. Nephrology. 2022; 27. https://doi.org/10.1111/nep.14024
Mathew N, Davies M, Kaldine F, Cassimjee Z. (2023). Comparison of quality of life in patients with advanced chronic kidney disease undergoing haemodialysis, peritoneal dialysis and conservative management in Johannesburg, South Africa: a cross-sectional, descriptive study. BMC Psychology. 2023;11(1). https://doi.org/10.1186/s40359-023-01196-1
Hsu CC, Huang CC., Chang YC, Chen JS, Tsai WC, Wang KY. A comparison of the quality of life between patients treated with different dialysis modalities in Taiwan. PLoS One.2020;15(1), e0227297. https://doi.org/10.1371/journal.pone.0227297
Cho Y, Bello AK, Levin A, Lunney M, Osman MA, Ye F, Ashuntantang GE, Bellorin-Font E, Gharbi MB, Davison SN, Ghnaimat M, etal. (2021). Peritoneal Dialysis Use and Practice Patterns: An International Survey Study. American Journal of Kidney Diseases. 2021;77(3), 315–325. https://doi.org/10.1053/j.ajkd.2020.05.032
Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, Adebayo OM, Afarideh, M, Agarwal SK et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2020;395(10225), 709–733. https://doi.org/10.1016/s0140-6736(20)30045-3
Tang W, Lai KN. Peritoneal dialysis: The ideal bridge from conservative therapy to kidney transplant. Journal of Nephrology. 2020;33(6):1189–1194. https://doi.org/10.1007/s40620-020-00787-0
Ogunseye OO. Analysis of the Health Financing Structure of Botswana. Health Syst Policy Res. 2020; 7(3). https://doi.org/10.21767/2254-9137.100108
Ministry of Health and Wellness. National guidelines on health services integration. Gaborone (Botswana): UNFPA Botswana;2021. Available from https://esaro.unfpa.org/sites/default/files/pub-pdf/botswana_national_guidelines_report_v2_for_printing_18.05.22_1.pdf
Mbenge CC, Phologolo T, Moloi W. Technique survival and the survival of end-stage kidney disease patients on peritoneal dialysis in Botswana: A 6-year retrospective study. Kidney International Reports.2023 8(3), S76. https://doi.org/10.1016/j.ekir.2023.02.798
Sokwala SAK, Odhiambo JO, Sokwala AP. Perceived Barriers to Peritoneal Dialysis Among Kenyan Nephrologists: A Cross-Sectional Descriptive Study. Canadian Journal of Kidney Health Disease. 2022; 9:205435812211077. https://doi.org/10.1177/20543581221107756
Finderup J, Jensen JD, Lomborg K. Shared decision‐making in dialysis choice has potential to improve self‐management in people with kidney disease: A qualitative follow‐up study. Journal of Advanced Nursing,.2020;77(4), 1878–1887. https://doi.org/10.1111/jan.14726
Bello AK, Okpechi I G, Osman MA, Cho Y, Cullis B, Htay H, Jha V, Makusidi MA et al. Epidemiology of peritoneal dialysis outcomes. Nature Reviews. Nephrology.2022;18, 1–15. https://doi.org/10.1038/s41581-022-00623-7
Lambie M, Davies S. An update on absolute and relative indications for dialysis treatment modalities. Ndt Plus, 16(Suppl_1). 2023; i39–i47. https://doi.org/10.1093/ckj/sfad062
Heaf J, Heiro M, Petersons A, Vernere B, Povlsen JV, Sørensen AB, Clyne N et al. Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study. Clinical Kidney Journal.2020. https://doi.org/10.1093/ckj/sfaa260
Davids MR, Chothia MY, Wearne N, Davidson B, McCulloch M. Nephrology in South Africa. Springer EBooks.2021;55–73. https://doi.org/10.1007/978-3-030-56890-0_6
Li PKT, Chow KM, Cho Y, Fan S, Figueiredo AE, Harris T, Kanjanabuch T et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis/.2022; 42(2):110–153. https://doi.org/10.1177/08968608221080586
Kim D, Pollock C. Epidemiology and burden of chronic kidney disease-associated pruritus. Clinica Kidney Journal.2021; 14(3): i1–i7. https://doi.org/10.1093/ckj/sfab142
Zhang M, Cai C. The experiences of patients with peritoneal dialysis: A systematic review of qualitative evidence protocol. PLoS One.2023;18(7):e0288724–e0288724. https://doi.org/10.1371/journal.pone.0288724
Xie W, Qin L, Huang J, Gu A, Fang W, Jiang N, Yuan J. Clinical risk factors for peritoneal dialysis withdrawal at different dialysis duration. Renal Failure.2023;45(2). https://doi.org/10.1080/0886022x.2023.2274965
Lall D. Mixed-methods research: why, when and how to use. Indian Journal of Continuing Nursing Education.2022; 22(2):143–147. https://doi.org/10.4103/ijcn.ijcn_107_21
Stoecker R, Avila E. From mixed methods to strategic research design. International Journal of Social Research Methodology.2020;24(6):1–14. https://doi.org/10.1080/13645579.2020.1799639
Taherdoost H. Data collection methods and tools for research: A step-by-step guide to choose data collection technique for academic and business research projects. International Journal of Academic Research in Management.2021;10(1):10–38. https://www.researchgate.net/publication/359596426
Elias, MA, Van Damme W, Ku GMV, Kadammanavar M, Wouters E. Lived experiences of people with chronic kidney disease on maintenance dialysis: A systematic review and thematic synthesis of qualitative studies. BMC Nephrology.2025; 26: Article 22. https://doi.org/10.1186/s12882-025-03952-4
Coffey SM, Elliot MR. Optimizing Data collection Interventions to Balance Cost and Quality in Sequential Multimode Survey. Journal of Survey Statistics and Methodology. 2023; 12(3): 741–763. https://doi.org/10.1093/jssam/smad007
Ullrich C, Wensing M, Klafke N, Fleischhauer T, Brinkmöller S, Poß-Doering R, Arnold C. Assessing the time required for qualitative analysis: A comparative methodological study of coding interview data in health services research.2025 Gesundheitswesen. https://doi.org/10.1055/a-2512-8004
Buus N, Ong B, Einboden R, Juel A, Perron A. Constructing research quality: On the performativity of the COREQ checklist. Qualitative Health Research. 2025. Advance online publication. https://doi.org/10.1177/10497323251323225
Cresswell JW, Plano Clark VL. Designing and conducting mixed methods research (3rd ed.). Thousand Oaks(CA).SAGE Publications;2018.
Husebø SE, Reierson IÅ, Hansen A, Solli H. Post-simulation debriefing as a stepping stone to self-reflection and increased awareness — A qualitative study. Advances in Simulation. 2024; 9(33). https://doi.org/10.1186/s41077-024-00306-2
Younas A, Fàbregues S, Creswell JW. Generating metainferences in mixed methods research: A worked example in convergent mixed methods designs. Methodological Innovations.2023; 16(3). https://doi.org/10.1177/20597991231188121
Rahman M O, Alam, MR, Khanam A, Alam MR, Hossain MK, Rahman AKMS, Haque F. Cutaneous Abnormalities in Chronic Kidney Disease Patients with and without Dialysis. Journal of Biosciences and Medicines.2020;08(01): 64–76. https://doi.org/10.4236/jbm.2020.81008
Davies S. The future of peritoneal dialysis. Clinical Kidney Journal, 17(Supplement 2). 2024; ii9–ii18. https://doi.org/10.1093/ckj/sfae277
Poinen K, Er L, Copland MA, Singh RS, Canney M. Quantifying missed opportunities for recruitment to home dialysis therapies: A cohort study. Canadian Journal of Kidney Health and Disease.2021; 8: 1–8. https://doi.org/10.1177/2054358121993250
Symonides B, Kwiatkowska-Stawiarczyk M, Lewandowski J, Małyszko JS, Małyszko J. Resistant and Apparently Resistant Hypertension in Peritoneally Dialyzed Patients. Journal of Clinical Medicine. 2025;14(1):218. https://doi.org/10.3390/jcm14010218
Kim DE, Kim DW, Kim HJ, Rhee H, Seong EY, Choi Y, Song SH. Impact of glycemic control on residual kidney function and technique failure associated with volume overload in diabetic patients on peritoneal dialysis. Kidney Research and Clinical Practice. 2024.https://doi.org/10.23876/j.krcp.23.251
Shankar R, Reddy Y, Alobaidi R. Barriers and facilitators for the adoption of peritoneal dialysis: Protocol for a systematic review of qualitative studies. BMJ Open.2024; 14(10): e091928. https://doi.org/10.1136/bmjopen-2024-091928
Piarulli P, Vizzardi V, Alberici F, Riva H, Aramini M, Regusci L, Cippà, P. E, Bellasi, A. Peritoneal dialysis discontinuation: to the root of the problem. Journal of Nephrology. 2023; 36(7):1763–1776. https://doi.org/10.1007/s40620-023-01759-w
Hahn Lundström, Abrahams AC, Allen J, Altabas K, Béchade C, Burkhalter, F, Clause AL et al. Barriers and opportunities to increase PD incidence and prevalence: Lessons from a European Survey. Peritoneal Dialysis International. 2021;41(6):542–551. https://doi.org/10.1177/08968608211034988
Zeng Y, Yin Y, Deng J, Chen D, Deng L, Wang D, Huang Y, Peng J, Ye Z. Effectiveness of a smart management system in improving adherence and clinical outcomes of patients receiving peritoneal dialysis: a retrospective cohort analysis. BMC Nursing.2025; 24(1). https://doi.org/10.1186/s12912-025-03506-x
Aydin Z , Özcan Ş. Effect of structured pre-dialysis education on the clinical outcomes of kidney patients. International Urology and Nephrology. 2025. https://doi.org/10.1007/s11255-025-04554-7
Shukla AM, Cavanaugh KL, Jia H, Hale Gallardo J, Wadhwa A, Fischer MJ, Reule S, Palevsky PM, Fried LF, Crowley ST. Needs and considerations for standardization of kidney disease education in patients with advanced CKD. Kidney Medicine.2022; 4(6); 100526. https://doi.org/10.2215/cjn.0000000000000170
Brown EA, Zhao J, McCullough K, Fuller DS, Figueiredo AE, Bieber B, Finkelstein FO, Shen J et al. Burden of Kidney Disease, Health-Related Quality of Life, and Employment Among Patients Receiving Peritoneal Dialysis and In-Center Hemodialysis: Findings From the DOPPS Program. American Journal of Kidney Diseases.2021;78(4): 489-500.e1. https://doi.org/10.1053/j.ajkd.2021.02.327
Ngaruiya GW, Mwenda C, Okpechi I. Barriers to peritoneal dialysis utilization among end-stage kidney disease patients in Kenya. Nursing & Primary Care. 2023; 7(2): 2174. https://www.scivisionpub.com/pdfs/barriers-to-peritoneal-dialysis-utilization-among-end-stage-kidney-disease-patients-in-kenya-2174.pdf
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Bonny Ratang Lekolori, Grace Guthemo, Sarah Bett
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
