Peritonitis during Continuous Ambulatory Peritoneal Dialysis (CAPD): Risk Factors, Clinical Severity, and Pathogenetic Aspects

This study of 228 episodes of peritonitis occurring during a total observation time of 2365 treatment months over a six-year period in a uniformly selected, trained, and treated continuous ambulatory peritoneal dialysis (CAPD) population (N = 124) showed the following major findings: 1) the risk of developing peritonitis was 55% within the first year and 89% within the first three years on CAPD; 2) high age (≥60 years) and year of CAPD start were risk factors for peritonitis; 3) neither sex, diabetes, or hypoalbuminemia were found to be risk factors for peritonitis; 4) the year of start, but neither the degree of severity, nor the time of the first episode affected the risk of developing a second episode of peritonitis; 5) no specific characteristics were identified in patients with the highest mean peritonitis incidence or in the patients without peritonitis; 6) in 27% of all episodes, turbidity of the dialysate was the only clinical finding; 7) the proportion of asymptomatic episodes was lower in patients ≥ 60 years; 8) the degree of clinical severity of peritonitis was not statistically influenced by the number of previous episodes; 9) the cause of peritonitis was established in only 26% of all cases; and 10) no statistical association was found between the cause of peritonitis and patient characteristics.

Experience with 150 Consecutive Permanent Peritoneal Catheters in Patients on CAPO

From 1978 to 1984, 150 consecutive CAPD catheters have been implanted in our institution. Early (first-week) and late (up to 44 months) follow-up is presented with special attention to possible surgical related complications.

A paramedian incision and an original antileakage technique were used in 95% of the catheters. With this combination, hernia and leakage rates are very low (0.7%()). With the patient-training program, described here, and the installation of the catheter in the outpatient department, peritonitis during the first week dropped from 20% to 0%() (p < 0.05). Previous abdominal operations significantly increase early failures (p < 0.05). Skin exit-site infections were not seen in our patients. The most frequent long-term complications were catheter colonization, i.e. recurrent peritonitis with the same organism, and repeated peritonitis episodes leading to obstruction. The one year actuarial catheter survival is 40%. This paper discusses factors responsible for as well as possible improvement of this low figure.

Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). Recent surveys show that up to 45% of home-dialysis patients are in CAPD programs (1). Recently Oreopoulos analyzed the benefits and indications of CAPD and showed that the procedure is being used with increasing frequency (2).

The CAPD program in our institution was started in 1978. From January 1981 to October 1984, 150 Tenckhoff catheters were implanted as part of that program. These patients who have had careful metabolic and surgical followup form the basis of this report.

Six-And-A-Half Years of Experience with Three Two-Liter Daily Exchanges in CAPD

Our continuous ambulatory peritoneal dialysis (CAPD) program consists of three 2- L daily exchanges (usually two of 1.5% and one of 4.25% dextrose concentration). Between March 1981 and November 1987, 87 patients were started on this program. Mean age was 35 years, 55% were males, and mean follow-up was 20.1 ± 2 months for a total experience of 1748 patient months. At the end of the study, 27 (31%) were still on CAPD, 43 (49.5%) had received renal transplants, 8 (9.2%) had returned to hemodialysis, 6 (6.9%) had been transferred to other units, 2 (2.3%) died, and 1 (1.1%) voluntarily quit. Actuarial survival rates were 90%, 81 %, and 57% for patients, method, and catheters, respectively, at 66 months. Peritonitis appeared at a rate of one episode per 14 patient months for a total of 121 episodes occurring in 51 patients. Rates of other complications were not higher than those reported by others. Hospitalization rates were low. Hypertension improved, patient weight did not change, and laboratory data tended towards normal levels or normalized. In selected patients, three 2- L exchanges per day appear to be enough for an adequate CAPD, even for long-term treatment. At the same time, it allows a 25% reduction in cost and risk of peritonitis. Larger number of patients and longer follow-up periods will be required to exactly define its real usefulness and safety.