The problem of pulmonary arterial hypertension in end-stage renal disease: can peritoneal dialysis be the solution.

BACKGROUND: Pulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study. METHODS: This is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson's and Bird's calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH. RESULTS: The mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p <  0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD. CONCLUSIONS: Long term APD (> 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD.

Meropenem at recommended dose is a potential risk for seizure in hemodialysis patient.

Dosage adjustment of meropenem is usually recommended in hemodialysis (HD) patients and about 30% of meropenem is cleared during regular HD sessions. However, most of the published trials excluded patients on regular HD. Little is known about the accurate dosage of meropenem needed to avoid central nervous system toxicity. Herein, we report a 65-year-old Saudi female, a known case of end-stage renal disease on regular HD, who was admitted because of pyelonephritis and started on meropenem in the recommended dose according to cultures and sensitivity. She developed tonic-clonic convulsions after the 7th dose. Seizures were completely aborted after discontinuation of the offending drug. The recommended dosage of 500 mg daily in HD patients may still be too high particularly in Asian patients owing to their relatively small body mass index.

The use of Quantiferon-TB gold in-tube test in screening latent tuberculosis among Saudi Arabia dialysis patients.

BACKGROUND AND AIM: Screening for tuberculosis (TB) is a key strategy for controlling infection. This study aimed to detect latent TB among dialysis patients. METHODS: This is a prospective study conducted in King Saud University, Riyadh involving hemodialysis (HD) and peritoneal dialysis (PD) patients aged ≥18 years. Patients were screened for latent TB infection (LTBI) using both TBskin test (TST) and QuantiFERONTB Gold In-Tube test (QFT-GIT). All participants were followed-up clinically and radiologically every 3 months for 2 years. RESULTS: A total of 243 (181 HD and 62 PD) patients were included and 112(46.1%) were males. 45.3% showed positive QFT in HD patients with sensitivity of 91.7%, specificity of 71.4%, positive predictive value (PPV) of 19.5%, and negative predictive value (NPV) of 91.1%. TST results in HD showed that positive TST was 17.4%, sensitivity was 63.2%, specificity was 95.5%, PPV was 51.5%, and NPV was 91.1%. Five (8.1%) showed positive QFT in PD patients with sensitivity of 7.7%, specificity of 91.8%, PPV of 6.6%, and NPV of 92.3%. TST results in PD showed that positive TST was 9.8%, sensitivity was 35.7%, specificity was 97.9%, PPV was 55.8%, and NPV was 93.3%. Previous TB infection was significantly correlated with QFT only in HD patients, but significantly associated with TST in both HD and PD patients. Also in HD, QFT was significantly associated with TST (P = 0.043). CONCLUSIONS: Due to high variability of QFT-GIT sensitivity, we recommend its use for its NPV and to use either TST or QFT in screening latent TB.

Prevalence of vitamin D deficiency in Saudi adults.

OBJECTIVE: To determine the prevalence of vitamin D deficiency in healthy Saudi adults. METHODS: A cross-sectional study carried out as part of the screening and early evaluation of kidney disease project. Vitamin D was measured in subjects recruited at 2 screening camps in Riyadh, Saudi Arabia, between March to May 2008. Subjects from the 2 large commercial centers in Riyadh aged ≥18 years and Saudi nationals were invited. RESULTS: The study sample comprised of 488 subjects. The mean age of the subjects was 37.43 (11.32) years, of which 50.2% (n=245) were males. Twenty-nine percent of subjects were in the vitamin D deficiency group, 22.7% were in the relative insufficiency group, and 47.5% had normal levels of 25-hydroxy vitamin D. We observed that female gender was an independent predictor of vitamin D deficiency or insufficiency (odds ratio [OR]: 2.992; 95% confidence intervals [CI] 2.069-4.327). Anemia was also a predictor for vitamin D deficiency or insufficiency (OR: 3.16; 95% CI 2.02-4.92). Age was positively correlated with vitamin D levels (Pearson correlation=0.183, p<0.000). CONCLUSION: Vitamin D deficiency is common in healthy Saudi adults. This is more pronounced in females and in the younger age groups. Wearing of traditional clothes, deliberate avoidance of the sun, and inadequate dietary intake are likely to be the principal causes of low vitamin D levels.

Predictors of quality of life in hemodialysis patients.

Quality of Life (QoL) is a consistent and powerful predictor that affects the out-come in end-stage renal disease (ESRD) patients on dialysis. This study was undertaken to identify the factors that might predict QoL scores among ESRD patients on hemodialysis (HD). The study was conducted at three HD units in Saudi Arabia from January 2007 to January 2008. We studied 100 HD patients (53 males and 47 females) and used the SF-36 and KDQoL-SF forms covering six domains of QoL, namely physical, emotional, social, illness impact, medical and financial satisfaction, and overall general health. The mean age of the study patients was 47.5 ± 13.8 years and the mean duration of dialysis was 77.2 ± 75.5 months. The QoL scores were 45.8 ± 17.1 for general health, 53.1 ± 32.0 for physical QoL, 50.5 ± 14.8 for emotional QoL, 54.9 ± 18.1 for social QoL, 46.5 ± 13.7 for illness impact, and 45.9 ± 12.2 for the medical and financial domain. The total QoL score was 49.5 ± 13.7. The male patients had statistically significantly reduced QoL and younger patients had better QoL scores. The QoL scores revealed a decreasing trend with decreasing level of education; they were elevated among employed patients. Multiple linear regression analysis demonstrated that age, dialysis duration, and male sex were negative predictors of QoL score. We conclude from our study that QoL is reduced in all the health domains of HD patients. Older age, male gender, unemployment, and duration of dialysis adversely affected the QoL scores. Adequate management of some of these factors could influence patient outcomes.

Quality of life in hemodialysis and peritoneal dialysis patients in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Quality of life (QoL) in end-stage renal disease (ESRD) patients is an important outcome for both physicians and patients in selecting dialysis modality. We conducted a comparison between regular maintenance hemodiaylsis and regular peritoneal dialysis patients in two tertiary referral hospitals in King Saud University in Saudi Arabia. We hypothesize that there might be cultural and socioeconomic factors modifying QoL in dialysis patients. DESIGN AND SETTING: Cross-sectional study on hemodialysis and peritoneal dialysis patients. PATIENTS AND METHODS: Two hundred dialysis patients participated in the study, one hundred in each group of dialysis modality, from July 2007 to July 2008. We used a cross-sectional design and collected the date using the Kidney Disease Quality of Life (KDQoL SF) questionnaire. RESULTS: Patients in both groups had similar sociodemographic characteristics (age, marital status, and education). Mean age (SD) in the hemodialysis group was 47.5 (13.8) years and 51.0 (13.5) years in the peritoneal dialysis group. Males represented 53% and 43%, respectively. Mean duration of dialysis was 77.2 (75.5) months in the hemodialysis group and 34.1 (26.9) months in the peritoneal dialysis group. The mean (SD) score was 49.5 (13.7) in the hemodialysis group and 61.3 (12.4) in the peritoneal dialysis group. QoL mean scores were significantly higher among peritoneal dialysis in all domains and in the total QoL, with the exception of the score of physical QoL, which was higher in the hemodialysis patients, compared to peritoneal dialysis patients, although the difference was not statistically significant. Multiple regression analysis indicated that hemodialysis was a negative predictor of QoL score, compared to peritoneal dialysis. Also, age, male gender, and dialysis duration were negative predictors of QoL score. CONCLUSION: In the unique culture of Saudi Arabia, peritoneal dialysis patients have better QoL, compared to hemodialysis patients, validating the findings of research reports from other countries.

Impact of early chronic kidney disease on maternal and fetal outcomes of pregnancy.

BACKGROUND: Elevated serum creatinine is associated with higher maternal and fetal risks; however, the influence of milder degree of renal impairment diagnosed on basis on estimated glomerular filtration rate (eGFR) is less well defined. This study assesses the impact of early chronic kidney disease (CKD) utilizing eGFR in predicting adverse outcomes in women with CKD. METHODS: We analyzed outcomes of 98 pregnant women with CKD. Women with CKD stage 1 were used as control. RESULTS: Women with eGFR of 60?89 ml/min were at an increased risk for deterioration of renal function, preeclampsia, and cesarean section. The odd ratios for composite maternal complication of worsening of renal function or preeclampsia were 6.75 (95% confidence interval (CI), 1.84-24.80) in women with eGFR of 60?89. Similarly, women with an eGFR of 60?89 had a significantly increased risk for intrauterine growth restriction (38.5%), preterm birth (31.2%), and intrauterine fetal death (15.8%). The odds for composite fetal adverse outcomes were 2.91 (95% CI, 1.19-7.09) in women with eGFR of 60?89. CONCLUSIONS: Early CKD increases the risk of adverse outcomes in pregnancy. Estimated GFR ranging between 60?89 ml/min/1.73 m(2) is associated with significant maternal and fetal complications. The risk of adverse outcomes in pregnant women with early CKD can be more accurately stratified by using estimated GFR than the serum creatinine alone.

Epidemiology of chronic kidney disease in the Kingdom of Saudi Arabia (SEEK-Saudi investigators) - a pilot study.

There are no available data about the prevalence of chronic kidney disease (CKD) and its risk factors in the general population of the kingdom of Saudi Arabia. To estimate the prevalence of CKD and its associated risk factors in the Saudi population, we conducted a pilot community-based screening program in commercial centers in Riyadh, Saudi Arabia. Candidates were interviewed and blood and urine samples were collected. Participants were categorized to their CKD stage according to their estimated Modification of Diet in Renal Disease (MDRD3)-based, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the presence of albuminuria. The sample comprised 491 (49.9% were males) adult Saudi nationals. The mean age was 37.4 ± 11.3 years. The over-all prevalence of CKD was 5.7% and 5.3% using the MDRD-3 and CKD-EPI glomerular filtration equations, respectively. Gender, age, smoking status, body mass index, hypertension and diabetes mel-litus were not significant predictors of CKD in our cohort. However, CKD was significantly higher in the older age groups, higher serum glucose, waist/hip ratio and blood pressure. Only 7.1% of the CKD patients were aware of their CKD status, while 32.1% were told that they had protein or blood in their urine and 10.7% had known kidney stones in the past. We conclude that prevalence of CKD in the young Saudi population is around 5.7%. Our pilot study demonstrated the feasibility of screening for CKD. Screening of high-risk individuals is likely to be the most cost-effective strategy to detect CKD patients.

Concomitant macro and microvascular complications in diabetic nephropathy.

To determine the prevalence of concomitant microvascular and macrovascular complications of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 diabetic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 +/- 11.4 years, mean duration of diabetes was 15.4 +/- 7.5 years, mean age at the onset of nephropathy was 61.5 +/- 12.4 years, and mean duration of nephropathy was 3.9 +/- 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Deterioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing complications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggressive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression into ESRD.

Culture-related service expectations: a comparative study using the Kano model.

OBJECTIVE: To compare service expectations between Arab and Austrian patients. METHODS: We used a Kano model-based questionnaire with 20 service attributes of relevance to the dialysis patient. We analyzed 530, 172, 60, and 68 responses from Saudi, Austrian, Syrian, and UAE patients, respectively. We compared the customer satisfaction coefficient and the frequencies of response categories ("must be," "attractive," "one-dimensional," and "indifferent") for each of the 20 service attributes and in each of the 3 national groups of patients. We also investigated whether any differences seen were related to sex, age, literacy rate, or duration on dialysis. RESULTS: We observed higher satisfaction coefficients and "one-directional" responses among Arab patients and higher dissatisfaction coefficients and "must be" and "attractive" responses among Austrian patients. These were not related to age or duration on dialysis but were related to literacy rate. CONCLUSION: We speculate that these discrepancies between Austrian and Arab patients might be related to underdeveloped sophistication in market competitive forces and to cultural influences.

Diabetes complications in 1952 type 2 diabetes mellitus patients managed in a single institution in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Because there is no recent update on the state of diabetes and its concomitant complications in Saudi Arabia, we undertook a study of the prevalence of health complications in patients with type 2 diabetes mellitus admitted to our institution. METHODS: We conducted a retrospective review of medical records of adult Saudi patients with type 2 diabetes who were seen in clinics or admitted to the Security Forces Hospital, Riyadh, Saudi Arabia, between January 1989 and January 2004. RESULTS: Of 1952 patients, 943 (48.3%) were males. For the whole study population the mean age at enrollment was 58.4+/-14.2 years, the mean age at onset of diabetes was 48.1+/-12.8 years, the mean duration of diabetes was 10.4+/-7.5 years, and the mean duration of follow-up was 7.9+/-4.6 years. Nephropathy was the most prevalent complication, occurring in 626 patients (32.1%). Acute coronary syndrome occurred in 451 (23.1%), cataracts in 447 (22.9%), retinopathy in 326 (16.7%), and myocardial infarction in 279 (14.3%), Doubling of serum creatinine was seen in 250 (12.8%) and 79 (4.0%) went into dialysis. Hypertension was present in 1524 (78.1%) and dyslipidemia in 764 (39.1%). Overall mortality was 8.2%. Multiple complications were frequent. Males had higher prevalence of complications than females (P<.05). Mortality was significantly higher in males 92 (9.8%) than females 69 (6.8%) (P=.024). The prevalence of complications significantly increased with duration of diabetes and age (P<.05). CONCLUSION: Among Saudis, the prevalence of concomitant diabetic complications is high, with cardiovascular and renal complications the most frequent. Many patients had multiple complications. Early and frequent screenings in the patients with type 2 diabetes are desirable to identify patients at high risk for concomitant complications and to prevent disabilities.

Effectiveness of a separate training center for peritoneal dialysis patients.

The aim of this study is to analyze the patients' database of the Baxter's Training Peritoneal Dialysis Program (BTPDP) adopted at the Baxter Renal Education Center (BREC), Riyadh, Saudi Arabia in order to determine its effectiveness in the management, compliance, and outcome of the trained peritoneal dialysis (PD) patients. The study analyzes the database of the BTPDP, which includes the demographic data, duration of follow-up, complications, and outcome of the patients trained on PD between September 2003 and November 2007. Records of 376 patients with a mean age of 46.0+/-22.6 years were available in the database for analysis. Of them, 187 (49.7%) were males, 312 (82.9%) were trained at the BREC, 315 (83.8%) were new PD patients, and 298 (79.3%) were trained on automated PD (APD). The dropouts during the study period included 172 patients (46%); 42 (24.4%) were transplanted, 45 (26.2%) switched to hemodialysis, 57 (33.1%) died and 28 (16.3%) were lost to follow-up. A comparison was made between the group trained at the BREC and the group trained at the hospital. There was an overwhelming adoption of BTPDP by the different hospitals during the study period (p<0.00001). There were 264 (84.6%) patients trained on APD at the BREC vs. 34 (53.1%) at the hospital (p<0.00001), and the patients trained at the BREC had significantly less dropouts than those trained at the hospital during the study period 135 (43.3%) vs. 38 (59.4%) respectively (p<0.02). The mean period of follow-up was significantly different between the patients trained at the BREC and those trained at the referring hospital (390+/-461 days vs. 679+/-779 days respectively (p<00000.8). Also, there was a trend for better technique survival after the second year, among the patients trained at the BREC. We conclude that the BREC model has increased the recruitment to PD, and helped in spreading this method of renal replacement therapy among patients. This model emphasizes the role of a designated training course by an expert team, and unifies the training standards. Furthermore, application of this model can be expanded nationwide and even to other countries.

Normal non-functioning kidney transplant.

Severe form of HCV infection complicated by early liver failure was reported after solid organ transplantation and described as fibrosing cholestatic hepatitis (FCH). We highlight the need for early detection and possible treatment in this rare but often fatal complication of HCV infection.

Treatment of acute hepatitis C virus infection with alpha interferon in patients on hemodialysis.

To evaluate the response to alpha-interferon (INF) in patients who develop acute hepatitis C virus (HCV) infection during hemodialysis, we studied 17 patients who had infection while on dialysis. We administered three million units of alpha interferon subcutaneously to nine adult patients three times per week for 12 weeks; the rest of the patients served as controls. The patients in both groups were followed for 24 months after the diagnosis of seroconversion to anti-HCV antibody. Serum alanine aminotransferase (ALT) levels, anti-HCV antibody levels and HCV- poly chain reaction (HCV-PCR) were performed at regular intervals during the follow-up. Two patients in the treatment group dropped out; one because of colitis and another because of non-compliance. Of the seven patients who completed the course of therapy, all the patients had normal serum ALT levels in 2-8 weeks of therapy, three (42%) patients converted back to anti-HCV antibodies negative and six (86%) had HCV-PCR negative at 12 weeks of therapy (primary virological response) and remained so till the end of follow-up (sustained virological response). The liver biopsy performed in all the responders to therapy at 4-24 months after completion of treatment showed mild hepatitis. In the control group, all the patients continued to have raised serum ALT levels throughout the study; 12% converted anti-HCV antibodies to negative and HCV-PCR (performed on five patients) remained positive during the whole study period. In conclusion our study suggests the efficacy and safety of alpha interferon in the therapy of acute HCV infection in hemodialysis patients.

Frequency of risk factors for coronary heart disease among diabetic patients in Al-rabwah phc center in riyadh.

BACKGROUND: Diabetes mellitus associated with high prevalence and incidence of CHD is a common problem in Saudi Arabia. OBJECTIVES: To assess the percentage of major modifiable risk factors for CHD among diabetic patients. METHODS: This is a retrospective study conducted on 495 diabetic patients (292 males and 203 females) attending the Miniclinic at Al-Rabwah PHC center in Riyadh. Their records for the months of April and May 2001 were reviewed. Data collected from the patient's files included body mass index (BMI), blood pressure, total cholesterol, triglyceride, and smoking status. In addition, information on the duration of diabetes was obtained and fasting blood sugar was done. RESULTS: The percentage of overweight males was 43.2% as against 22% females, the figure for males being highly significant (p<0.0001). Obesity which was 27.9% in males and 64.1% in females, was highly significant in females (p<0.0001). For cholesterol (≥ 5.2 mmol/l) was 49.5% in males versus 68.5% in females (p=0.0036). High triglyceride (≥ 1.7%) was 50% in both genders. 13.4% of males were hypertensive as against 44.3% female hypertensives which was highly significant in females (p<0.0001). 19.5% of the males smoked. There was no significant difference between risk factors for CHD and duration of diabetes except that there were more smokers among those who had had diabetes for less than 10 years. Most of the diabetics with poor glycemic control (FBS> 8.3mmol/l) tended to be smokers, were more obese, had high triglyceride and high total cholesterol. CONCLUSION: The findings indicated that diabetic patients have high percentage of risk factors for CHD and more females than males are at risk. Therefore, early intervention is required if the incidence of CHD among diabetic patients is to be reduced.

Tuberculous peritonitis in patients on chronic peritoneal dialysis: case reports.

Two cases of tuberculous (TB) peritonitis on chronic peritoneal dialysis (PD) are described. The cases were diagnosed by positive acid fast bacilli (AFB) culture from the PD fluid effluent. Catheter removal and transfer to hemodialysis were needed in one, while the other remained on continuous ambulatory peritoneal dialysis. The patients recovered with antituberculous therapy. A high index of suspicion for early diagnosis and treatment is emphasized. A six-month course of anti-TB drugs for TB peritonitis is a viable option of therapy.

Anti-glomerular Basement Membrane Antibody Disease Presenting as Acute Renal Failure During Pregnancy.

A 30-year-old seventh gravida presented with acute renal failure at 28 weeks of gestation. All her previous pregnancies were normal. With a differentional diagnosis of acute pyelonephritis, acute interstitial nephritis (cefuroxime induced) or rapidly progressive glomerulonephritis, treatment with antibiotics, intensive hemodialysis (HD) and pulse methylprednisolone followed by oral prednisolone was initiated. She was maintained on HD 5-6 times per week aiming at serum urea level of less than 15 mmol/L. After six weeks on HD, she underwent a cesarean section at 34 weeks of gestation with delivery of a baby weighing 1.6 kg. Percutaneous left renal biopsy performed one week post-delivery showed anti-glomerular basement membrane (GBM) antibody-mediated crescentic glomerulonephritis. The anti-GBM antibody, which was negative during pregnancy, was found to be positive at this juncture and remained so until ten months post-delivery while on HD. The patient continues to be on regular maintenance HD.

Chronic peritoneal dialysis a single-center experience.

OBJECTIVE: In Saudi Arabia, experience with continuous ambulatory peritoneal dialysis (CAPD) as a renal replacement therapy is limited, and publications are scanty. The present study was undertaken to evaluate CAPD in the Saudi population. PATIENTS AND METHODS: All patients managed by CAPD from May 1993 to September 2002 were included in the study. Tenckhoff indwelling silicone-rubber double-cuff catheters were surgically implanted. Peritoneal dialysis (PD) was started 2 weeks after catheter insertion. Generally, 2-L exchanges 4 times daily were used. Our total of 91 PD patients included 50 men in the age range 13 - 80 years (mean: 48 +/- 18 years), and 41 women in the age range 16 - 76 years (mean: 52 +/- 18 years). Forty-nine patients performed dialysis by themselves; 42 patients needed a helper. RESULTS: Between April 2001 and September 2002, we noted, on average, 1 episode of peritonitis per 21 patient-months and 1 episode of exit-site infection per 24 patient-months. The most common causative organisms for peritonitis were Pseudomonas (16%), Staphylococcus epidermidis (16%), and Staphylococcus aureus (7%). No organisms were grown in 13% of peritonitis episodes. The organisms most commonly responsible for exit-site infection were Pseudomonas aeruginosa (50%) and Staphylococcus (31%). We removed catheters from 32 patients, 12 of those for mechanical reasons. Of the 20 patients whose catheter was removed for infection, P. aeruginosa was cultured in 11 cases. Nine of 23 patients switched to hemodialysis were switched for refractory peritonitis. By the end of the study, 38 patients were still on CAPD, 23 had been switched to hemodialysis, 10 had undergone renal transplantation, and 20 had died. The major causes of death were peritonitis with sepsis (n = 6), cardiovascular causes (n = 5), and sudden death at home or in other hospitals (n = 5). CONCLUSION: Continuous ambulatory peritoneal dialysis is a viable option of renal replacement therapy in Saudi Arabia. The main problem encountered was peritonitis.