ABSTRACT.
Aims & Objectives:
Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). In Pakistan it is a new modality of dialysis and only a few Nephrologist are trained to do CAPD. The data related to CAPD is lacking in our region.
We study the outcomes, complications and survival of straight Tenckhoff catheter after implantation over one year.
Material & Methods:
A retrospective analysis of 22 end stage renal disease patients who opted for CAPD at Nephrology Unit, DHQ Teaching Hospital, Dera Ismail Khan from October 2004 to October 2005. Straight Tenckhoff catheters were inserted by open surgical methods in all the patients. The analysis was done to see the Occurrence of catheter-related complications such as dialysate leakage, drainage failure, malposition, infectious complications, and, ultimately, catheter loss was observed for 1 year.
Results:
A total of 22 patients on CAPD were studied over one year from date of insertion of Tenckhoff catheter. The mean age was 47.5 years (15 years to 80 years). Out of these 16 patients were male and 6 patients were female. 16 patients took CAPD as their first modality of dialysis while 6 patients choose it as a second modality after being on hemodialysis for some months. The etiologies of end stage renal stage were as follows Chronic Glomerulonephritis 8( 36.36%), Hypertension 6(27.27%)%, Diabetes Mellitus 5 (22.72%), Calculus disease 1(4. 55%), Idiopathic 1(4.55%) and Adult polycystic kidney disease in 1(4.55 %) patients. After straight Tenckhoff catheter implantation, Pericatheter dialysate leaks noted only in one patient, which was spontaneously stopped within 2 weeks. 5 patients had Tunnel or exit-site infection, 3 patients had catheter malposition, outflow failure and abdominal discomfort. 3 episodes of Peritonitis were noted. In 2 patients Tenckhoff catheter removed due to peritonitis within 3 months of insertion. 3 patient age 70 years died of cardiovascular events and one patient age 75 years died of carcinoma urinary bladder within 3 months of insertion of T/K. 4 patients switched to hemodialysis due to nonaffordabilty of daily cost of CAPD. The duration of hospitalization from the day of catheter insertion to discharge was 10-14 days. The actual 1-year catheter survival was 63.63%.
CONCLUSIONS:
The surgical insertion of Tenckhoff catheter for CAPD has got both early and late complications. Early complications are more common in elderly Diabetics and patients with infections. Good glycemic control, treatment and prophylaxis of infection prior insertion of catheter minimize these complications. Proper training of patients and Nursing staff also prevent the late complication of CAPD peritonitis.
One-year Tenckhoff catheter survival and removal rate was 63.63% and 9% respectively.
Key words: KEYWORDS:
CAPD, Peritonitis, Tenckhoff catheter, End stage renal disease.
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