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Continuous ambulatory peritoneal dialysis. Three years' experience at the Mayo Clinic
Insights
Continuous ambulatory peritoneal dialysis offers adequate short-term treatment for end-stage renal failure patients. While metabolic and technical issues exist, most patients find this therapy a viable alternative to hemodialysis.
Area of Science:
- Nephrology
- Internal Medicine
Background:
- End-stage renal failure (ESRF) necessitates renal replacement therapy.
- Continuous ambulatory peritoneal dialysis (CAPD) is an alternative to hemodialysis.
Purpose of the Study:
- To evaluate the efficacy and patient acceptance of CAPD in ESRF patients.
- To identify metabolic and technical challenges associated with CAPD.
Main Methods:
- Prospective study of 69 ESRF patients treated with CAPD from 1979-1982.
- Assessment of dialysis adequacy, ultrafiltration, hemoglobin levels, and patient outcomes.
Main Results:
- CAPD was adequate and stable in 65 out of 69 patients.
- Metabolic issues included hyperparathyroidism, nutrition, neuropathy, and weight gain.
- Technical problems involved peritonitis, access, and hernias.
Conclusions:
- CAPD provides adequate short-term treatment for most ESRF patients.
- Patient enthusiasm remained high despite challenges.
- Long-term CAPD potential requires further investigation.
Abstract:
From January 1979 through January 1982, 69 patients with end-stage renal failure of various causes were treated by continuous ambulatory peritoneal dialysis. The dialysis was adequate and stable in all except four patients; two of these four became irreversibly uremic, and the other two had inadequate ultrafiltration. Hemoglobin levels increased initially and remained stable in all but two patients. In our experience, metabolic problems included control of secondary hyperparathyroidism, adequate protein nutrition, progressive neuropathy, abnormal lipoprotein profiles, and excessive weight gain. Technical problems included recurrent peritonitis, maintenance of adequate peritoneal access, and development of abdominal hernias. In general, all but two patients remained enthusiastic about this type of therapy despite inherent problems. The long-term potential of continuous ambulatory peritoneal dialysis remains uncertain at this point, but for most patients, adequate short-term treatment by this method is a reasonable alternative to hemodialysis.