Continuous ambulatory peritoneal dialysis: A viable modality of renal replacement therapy in a hilly state of India

Abstract

<b>Objective:</b> Chronic ambulatory peritoneal dialysis (CAPD) has been an established form of therapy in adult patients with end-stage renal failure in India for more than a decade and has emerged as accepted form of renal replacement therapy in urban areas. The objective of this paper is to report the experience with CAPD as a modality of renal replacement therapy from a tertiary care hospital in a hilly state of India with predominant rural population. <b> Design:</b> Retrospective study. <b> Setting:</b> A government-owned tertiary care hospital in Himachal Pradesh, a state with a population of 6 million. <b> Materials and Methods:</b> This study involved the patients who were initiated on CAPD between October 2002 and December 2006 and who survived and/or had more than 6 months follow up on this treatment with last follow up till June 30, 2007. <b> Results:</b> A total of 25 patients were included in the analysis. The mean age of the patients was 61 ± 10.2 years. 13 (52%) patients were female. 18 (72%) patients out of these lived in rural areas. The total follow up was 553.1 patient-months with a mean follow up of 22.1 ± 12.4 months. The total duration on peritoneal dialysis treatment was 541.1 patient-months with a mean duration of 21.6 ± 12.2 months and median duration of 19 patient-months (range: 6-56.3 patient-months). No patient had exit-site infection. There were 26 episodes of peritonitis. The rate of peritonitis was 1 episode per 21 patient-months or 0.6 per patient-year during the treatment period. The main cause of death was cardiovascular complications. Patient and technique survival at 1, 2 and 3 years was 80, 36 and 12%, respectively. <b> Conclusion:</b> Chronic ambulatory peritoneal dialysis (CAPD) is a safe and viable mode of renal replacement in remote and rural places. It can emerge as a revolutionized procedure for ESRD patients dwelling in remote and geographically difficult regions in developing countries such as India.