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Continuous ambulatory peritoneal dialysis: three years' experience.
The Quarterly Journal of Medicine
|January 1, 1983
Summary
Continuous ambulatory peritoneal dialysis (CAPD) offers wide patient acceptance and better well-being for chronic renal failure. While effective, peritonitis remains a challenge, necessitating further research for optimal patient outcomes.
Area of Science:
- Nephrology
- Internal Medicine
- Medical Technology
Background:
- Chronic renal failure (CRF) necessitates renal replacement therapy.
- Continuous ambulatory peritoneal dialysis (CAPD) emerged as an alternative to traditional hemodialysis.
- Early experiences with CAPD in the UK provided valuable insights into its efficacy and limitations.
Purpose of the Study:
- To review the clinical experience with CAPD in 122 CRF patients treated between 1979-1981.
- To evaluate the advantages, disadvantages, and patient outcomes associated with CAPD.
- To compare CAPD with home hemodialysis in terms of cost and patient preference.
Main Methods:
- Retrospective review of 122 patients with chronic renal failure.
- Treatment modality: Continuous ambulatory peritoneal dialysis (CAPD).
- Data collection included patient survival, rehabilitation, biochemical parameters, complications, and cost-effectiveness.
Main Results:
- CAPD showed wide patient acceptability, including elderly and diabetic patients.
- Patients preferred CAPD to hemodialysis due to increased freedom and well-being.
- Two-year patient survival was 94%; rehabilitation was satisfactory.
- CAPD facilitated easier control of plasma potassium and phosphate.
- Renal osteodystrophy responded well to CAPD with alfacalcidol.
- Peritonitis incidence was 1 attack per 39 patient-weeks; actuarial success rate was 63% at two years.
- Complications included hernias (20 patients), weight gain, and increased serum cholesterol.
- CAPD was less costly than home hemodialysis over three years.
Conclusions:
- CAPD is a viable treatment option for chronic renal failure, offering significant benefits in patient well-being and biochemical control.
- Persistent peritonitis and technique failure remain key challenges requiring further innovation.
- CAPD enabled a 50% increase in the renal failure program's capacity.
- Future expansion necessitates improved peritonitis prevention and robust hemodialysis support for less successful CAPD patients.