CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS - 3 YEARS EXPERIENCE

  • 1 January 1983
    • journal article
    • research article
    • Vol. 52  (206) , 165-186
Abstract
Experience at the Renal Unit at Newcastle upon Tyne [UK] over the 3 yr 1979-1981, during which 122 patients with chronic renal failure were treated by continuous ambulatory peritoneal dialysis (CAPD), is reviewed. Advantages of the technique including the elderly and diabetics. Patients who experienced both techniques preferred CAPD to hemodialysis because of the greater freedom and sense of well-being. Patient survival was 94% at 2 yr and rehabilitation was as good as could be expected for the age and primary medical complications of the patients. Control of plasma K and phosphate was easier than with hemodialysis. Renal osteodystrophy responded well to a combination of CAPD and .alpha.-calcidol therapy over the 2 yr period for which serial bone biopsies were performed. Serum Al was slightly raised as a result of consumption of phosphate binders and presumed uptake from dialysis fluid but no Al related disease was encountered. Anemia was partly corrected by CAPD with Hb rising to about 10 g/dl on average. CAPD was less costly than home hemodialysis over the first 3 yr and was adopted as standard treatment for patients who can expect an early transplant. Disadvantages were persisting problems with peritonitis which still occurred at an incidence of 1 attack/39 patient wk over the last 2 yr, and an actuarial success rate for the technique of only 63% at 2 yr. Patients (20) developed hernias. Weight gain was common and occasionally gross. There was a significant rise in serum cholesterol. CAPD allowed a 50% increase in the number of patients treated by the renal failure program. Continued expansion of the technique demands advances in prevention of peritonitis, adequate facilities for admission and particularly an expanding hospital hemodialysis program to accept the less successful patients from CAPD.