[Continuous ambulatory peritoneal dialysis, advantages and disadvantages]

Continuous ambulatory peritoneal dialysis (CAPD) represents a new method for the treatment of end-stage renal disease. It offers the advantages of greater clearance of higher molecular-weight substances than during haemodialysis, good control of blood pressure, marked improvement of anemia, and unrestricted diet. In contrast, the risks of peritonitis, hypoproteinemia, and hypertriglyceridemia are major disadvantages. Furthermore, CAPD is a time-consuming procedure. In spite of the need for technical improvements, CAPD is even now, for selected patients, a valuable alternative treatment to intermittent dialysis methods.

Twelve months' experience with continuous ambulatory and intermittent peritoneal dialysis

After a one-year experience with a continuous ambulatory and long-term intermittent peritoneal dialysis (CAPD and IPD, respectively) program in a Veterans Administration hospital, both forms of dialysis provided excellent biochemical control of the patients' conditions. The major drawback to peritoneal dialysis as opposed to hemodialysis is the high rate of rehospitalization resulting from peritonitis or problems related to the peritoneal catheter. The incidence of peritonitis was one episode per 4.1 patient months in CAPD and one episode per 7.3 patient months in IPD. Recurrent episodes of peritonitis in a given patient were associated with a decrease in the serum albumin level. Blood values for BUN, creatinine, serum electrolytes, calcium, and phosphorus, however, were not altered. To date, CAPD appears to be an effective alternative form of dialytic therapy.

Newer modifications of peritoneal dialysis: options in the treatment of patients with renal failure

Experience with peritoneal dialysis for the treatment of 69 patients suffering from renal failure is reported. Chronic intermittent peritoneal dialysis (CIPD) was used in 49 patients, and continuous ambulatory peritoneal dialysis (CAPD) in 34 patients. CAPD was well accepted by patients, and resulted in maintenance of laboratory parameters in a range similar to that achieved by hemodialysis and by CIPD. However, peritonitis occurred with a higher incidence in CAPD (one per 7.2 patient-months) than in CIPD (one per 19.2 patient-months). All episodes of peritonitis were caused by only 40% of the patients, and in CAPD, patients who developed peritonitis in the first 4 weeks of treatment were the most likely to develop repeat episodes. An organism was identified in 81% of cases, of which 50% were due to Staphylococcus, 16% due to Streptococcus, 5% due to Candida and the remaining 29% were due to gram-negative organisms. In addition to CAPD, we introduced an automated modification of prolonged-dwell peritoneal dialysis (PDPD) that is applicable to a larger number of patients. In 11 patients PDPD proved comparable to CAPD in ameliorating the laboratory parameters measured, but was associated with lower incidence of peritonitis (one per 18.2 patient-months).

Current concepts in peritoneal dialysis

Peritoneal dialysis has been increasingly employed to treat patients with end-stage renal failure. Solute transport can be enhanced by increasing ultrafiltration with hypertonic dialysate, infusing intraperitoneal vasodilators to increase the effective surface area for exchange, and by employing new methods of dialysate delivery which may improve dialysate mixing and decrease the effective membrane resistance to solute flux. While infection remains a major complication of peritoneal dialysis, techniques to prevent and treat infections have been effectively employed. Progress has also been made in the treatment of diabetic patients with peritoneal dialysis. Continuous ambulatory peritoneal dialysis, a relatively new technique with fast growing clinical application, may be the therapy of choice for many patients with end-stage renal failure.

Kinetics of amino acids equilibration in the dialysate during CAPD

The equilibrium between plasma and peritoneal dialysis fluid has been studies for 23 amino acids during peritoneal exchanges at dwell times up to 8 hours in patients on CAPD. It is demonstrated that equilibration is a particular process typical for each amino acid which after 8 hour is nearly complete only for Glycine, Alanine and Asparagine.

Continuous ambulatory peritoneal dialysis. Impact on management of patients with end-stage renal disease

Continuous ambulatory peritoneal dialysis has been demonstrated to be a successful dialysis therapy for those patients who are emotionally, socially, and intellectually capable of safely performing the self-dialysis technique. Rapid expansion of the procedure, modification of the technique to reduce the incidence of peritonitis, development of experienced personnel and adequate funding by the government can serve to increase the home dialysis population, save tax dollars and free patients from the requirement of machine dialysis.

[Continuous ambulatory peritoneal dialysis (author's transl)]

Continuous ambulatory peritoneal dialysis (CAPD) required rapid technique and high quality material. This paper describes the material prepared and supplied by the Central Pharmacy of Paris Public Hospitals and the results obtained with this material in the Nephrology Department of the Pitié-Salpêtrière Hospital. The peritoneal catheter, introduced under local anaesthesia, is the double-cuffed Tenckhoff catheter. The two dialysates routinely used mainly differ in glucose concentration (83 and 250 mmol/l respectively). The plastic bags are made of polyvinylchloride; those for adults have a capacity of 2.8 l and contain 2 l of dialysate; smaller bags are available for children and adolescents. The patients are trained in an independent out-patient unit opened from 8 a.m. to 9 p.m. The average duration of training is 10 days, and audio-visual aids are widely used. Between August, 1978 and February, 1980 forty-seven patients were accepted for training. Their mean age at the start of treatment was 65 years, and the follow-up was 308 patient-months. During this period there were 5 deaths, only one of which could be blamed on the dialysis technique. There was one peritonitis per 7.5 patient-months, and the mean duration of hospital treatment for all complications was 15 days per patient-year. In view of the patients' age and of the deliberate selection of high-risk patients (including 8 diabetics), these results are very encouraging. However, a longer follow-up is needed to determine the exact place of CAPD among the various treatments of end stage renal failure.

Amino acid losses during CAPD

Amino acid losses in peritoneal dialyzate during CAPD were less than 2 g a day (15, 128 micrometers). CAPD does not correct the tyrosine/phenylalanine ratio in plasma and does not prevent accumulation of 3-methylhistidine.