ABSTRACT
Peritonitis is the most important complication of continuous ambulatory peritoneal dialysis (CAPD). We reviewed our experience with peritonitis over a 2 1/2-year period. Our patients spent 4% of their total time on dialysis in hospital due to peritonitis. Thirty-eight percent of the episodes of peritonitis were treated without hospitalization. We evaluated the dialysate bag change technique as commonly performed with currently available devices (extension tubing and titanium Luerlock Tenckhoff catheter adapter). The aseptic techniques described for dialysis extension tubing changes appear adequate (with no increased incidence of peritonitis demonstrated shortly after an extension tubing set change). Long-term sterility is maintained at the dialysate bag puncture port and at the orifice of the dialysis catheter adapter (no positive cultures from the bag port and orifice of the titanium adapter). Etiologic diagnosis of uremia was not a risk factor predisposing to peritonitis. The incidence of peritonitis was greater among patients with less formal education and lower income. Out data suggest that patients with less formal education and of lower economic status be carefully evaluated before commencing CAPD.
Subject(s)
Peritoneal Dialysis, Continuous Ambulatory , Peritoneal Dialysis , Peritonitis/etiology , Bicarbonates/blood , Blood Glucose/analysis , Blood Proteins/analysis , Diabetic Nephropathies/therapy , Family Characteristics , Glomerulonephritis/therapy , Hemodialysis, Home , Humans , Hypertension, Renal/therapy , Income , Kidney/physiopathology , Nephritis, Interstitial/therapy , Nephrosclerosis/therapy , Peritoneal Dialysis/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritonitis/microbiology , Skinfold ThicknessABSTRACT
We evaluated prospectively various outcome measurements of patients assigned initially to continuous ambulatory peritoneal dialysis (CAPD) and home hemodialysis (HHD) from February 1979 to August 1981 and the causes for failures of the techniques. Morbidity was assessed by time in hospital/time on dialysis. Fifty-six patients were trained for CAPD and 37 for HHD. Those assigned to CAPD experienced an increased frequency of hospitalization (7.5% CAPD, 2.8% HHD, respectively) primarily due to episodes of peritonitis. There was also a higher modality failure rate (43% vs. 16%). However, the groups were not comparable in all respects. For example, the CAPD population included 21 patients with major cardiovascular diseases versus only three in the HHD group. The demographic characteristics of both populations including race, sex, age, income, place of residence, marital status, and education were similar. At the time of this study there is no direct evidence showing that healthy patients otherwise able to perform HHD may be maintained with less morbidity for a prolonged period utilizing CAPD. Therefore, we suggest that HHD is the home method of choice for patients able to proceed with this technique. CAPD may be indicated for patients in whom the period of home dialysis is expected to be relatively short and who would be otherwise unable to carry out home dialysis, for example, patients awaiting transplantation and those unable to be maintained on hemodialysis because of impaired cardiac function. To fully evaluate CAPD as a long-term maintenance therapy, a prospective trial must be performed.
Subject(s)
Hemodialysis, Home , Peritoneal Dialysis, Continuous Ambulatory , Peritoneal Dialysis , Adult , Blood Pressure , Cardiovascular Diseases/complications , Female , Hemodialysis, Home/adverse effects , Hospitalization , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Peritoneal Dialysis/adverse effects , Peritoneal Dialysis/mortality , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/mortality , Peritonitis/etiology , Prospective Studies , Time FactorsABSTRACT
We found abdominal hernias in 12 of 51 patients trained for continuous ambulatory peritoneal dialysis. Five patients were noted to have abdominal hernias before the start of continuous ambulatory peritoneal dialysis, and the conditions of seven patients were diagnosed during routine clinic visits. Four patients had incarceration. We suggest that a careful search for the presence of a hernia be performed at the initial examination for peritoneal dialysis. Continued monitoring of the patient's condition for the development of a hernia is essential. If a hernia is found, elective repair should be performed.
Subject(s)
Hernia/etiology , Peritoneal Dialysis/adverse effects , Adolescent , Adult , Aged , Catheterization , Female , Hernia, Ventral , Humans , Male , Middle Aged , Peritoneal Dialysis, Continuous AmbulatoryABSTRACT
Peritonitis during peritoneal dialysis is the most frequent complication associated with this dialysis technique. We studied patients undergoing peritoneal dialysis when they were without peritonitis and during episodes of clinical infection. Peritonitis was associated with a significantly decreased dialysate effluent volume, increased absorption of glucose, clearance of urea and creatinine, and protein loss in the dialysate effluent. We suggest that the changes occurring to the peritoneal dialyzing surface with peritonitis might be explained by alterations in peritoneal blood flow, effective membrane surface area, or permeability.
