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Peritonitis in Continuous ambulatory peritoneal dialysis.

S K Sharma1, R K Chaurasia, M J Sijapati

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JNMA; Journal of the Nepal Medical Association
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Continuous ambulatory peritoneal dialysis (CAPD) is a viable option in Nepal, as peritonitis rates in a new program were comparable to previous attempts. However, patients with low albumin and diabetes require careful monitoring to prevent peritonitis.

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Area of Science:

  • Nephrology
  • Renal Replacement Therapy

Background:

  • Hemodialysis access in Nepal is restricted by geography and limited centers.
  • Continuous ambulatory peritoneal dialysis (CAPD) was previously unsuccessful due to high peritonitis rates.
  • A new CAPD program was initiated in 2002 to assess peritonitis incidence and predisposing factors.

Purpose of the Study:

  • To evaluate the incidence of peritonitis in a new CAPD program in Nepal.
  • To identify factors predisposing patients to peritonitis in the context of CAPD.
  • To determine if peritonitis remains a limiting factor for CAPD expansion in Nepal.

Main Methods:

  • A cohort of 50 chronic renal failure patients on CAPD from 2002 to 2007 were studied.
  • Patients were followed for complications, with 19 experiencing peritonitis and 31 without.
  • Comparison between peritonitis and non-peritonitis groups to identify risk factors.

Main Results:

  • Fifty patients contributed 600 patient-months of dialysis, with 26 peritonitis episodes in 19 patients.
  • Culture-positive peritonitis occurred in 14 episodes, and culture-sterile peritonitis in 12 episodes.
  • Low serum albumin and diabetes mellitus were identified as significant predisposing factors for peritonitis.

Conclusions:

  • The peritonitis rate in the new CAPD program is comparable to previous outcomes.
  • Peritonitis is not an insurmountable barrier to the growth of CAPD in Nepal.
  • Hypoalbuminemic and diabetic patients are at higher risk for CAPD-related peritonitis and require closer management.