[The importance of CAPD in kidney replacement therapy]

Continuous ambulatory peritoneal dialysis (CAPD) a method suitable for self-treatment by patients with chronic renal failure, was introduced for clinical use at the end of the seventies. It was rapidly accepted and used worldwide. Based upon a ten-year-old clinical experience at the renal unit of the Stadtspital Waid, Zürich, and on data of a cohort of 113 unselected patients treated by this method, this report aims at the importance of CAPD for renal replacement therapy. Experiences with developments of materials, techniques and measures preventing complications, collected during an observation period, from 1979 to 1989 were analyzed and data from three arbitrarily fixed consecutive periods compared. The Tenckhoff catheter, primarily used for dialysis, has been replaced by the Oreopoulos-Zellermann catheter because of a reduced complication rate. The number of patients treated with CAPD doubled within these ten years. The survival rate for different methods was similar in the three time periods investigated. In accordance with other centers, peritonitis was found to be the most frequent cause for a drop-out and was equally the most frequent complication whose incidence, however, declined over the observation periods. Compared to other centers, incidence of peritonitis was already low before at the renal unit of SWZ. 41% of the patients died, most of them because of cardiovascular problems. Infections of the catheter tunnels were less frequent, but their rate could not be influenced in the course of the ten-year period. Clinical experiences of the first ten years with CAPD at the renal unit of SWZ yielded positive results: 1. CAPD represents a simple and effective method for dialysis therapy of equal value compared to hemodialysis. 2. Success of the CAPD program depends crucially on amelioration of the CAPD materials and techniques as well as on an optimal education of the patient by the nursing staff and the physician. 3. Obviously, the significant decline of the rate of peritonitis in the Stadtspital Waid was due to the introduction of a simple microbiologic method for self-control (so-called dialysate-digest medium tube-method) and to the prophylaxis for fungal peritonitis with Nystatin per os accompanying every antibiotic therapy. 4. A future challenge is seen in increased attention and better prevention of the second most common complication of CAPD, catheter-tunnel infection.