Well-informed patients with end-stage renal disease prefer peritoneal dialysis to hemodialysis.

One hundred and one azotemic patients, from March 1988 to March 1992, expected to be in need of active treatment of uremia within the next 6 months, were invited to four information meetings concerning conservative treatment of uremia, hemodialysis, peritoneal dialysis, and transplantation. Eighty-three percent of the invited patients attended. Another 13 started active treatment of uremia after receiving individualized information. At the end of the observation period, 37 of 97 patients had chosen continuous ambulatory peritoneal dialysis (CAPD), and 23 hemodialysis. Twenty-nine had not yet decided which mode of active treatment of uremia they wanted, and 4 patients had died. Patients choosing CAPD had a mean age of 52 years, compared to 59 years for those choosing hemodialysis. Thirty-six of 37 patients who had chosen CAPD and 19 of 23 patients who had chosen hemodialysis had started treatment. The cumulative patient and technique survival at 12 months for CAPD was 92% and 66%, and for hemodialysis 70% and 70%, respectively. The patients were asked to give their views on their choice of active treatment of uremia and the information meetings once they had started treatment. Eighty-six percent of the patients did not want to change their chosen therapy, and 88% of the patients found the information provided adequate. When patients with renal insufficiency are given adequate information, the majority prefer peritoneal dialysis to hemodialysis and are very satisfied with their choice.

Grading of exit sites cannot predict peritonitis in patients on CAPD.

Grading of exit sites was performed at 265 routine outpatient visits of 28 patients starting CAPD between January 1988 and February 1990, with a total observation time of 398.5 months to December 1990. Six patients had no peritonitis episode. The remaining 22 patients suffered from 43 peritonitis episodes. Fifty-eight per cent of these were caused by Staphylococcus epidermidis. Eighty-six per cent of the examinations of exit sites of patients with peritonitis episodes showed 0 to 1 point on an arbitrary grading scale of up to 9 points. Staphylococcus aureus was found after bacterial culture from exit site smears in 3 cases. All were adequately treated. None of these cases showed any peritonitis episodes with this bacteria. No relationship could be found between the grading of the exit site at routine outpatient clinic visits and the appearance of a peritonitis episode. Grading of exit sites is of clinical importance but cannot predict the appearance of peritonitis.