Experience with 150 Consecutive Permanent Peritoneal Catheters in Patients on CAPO

Abstract

From 1978 to 1984, 150 consecutive CAPD catheters have been implanted in our institution. Early (first-week) and late (up to 44 months) follow-up is presented with special attention to possible surgical related complications. A paramedian incision and an original antileakage technique were used in 95% of the catheters. With this combination, hernia and leakage rates are very low (0.7%()). With the patient-training program, described here, and the installation of the catheter in the outpatient department, peritonitis during the first week dropped from 20% to 0%() (p < 0.05). Previous abdominal operations significantly increase early failures (p < 0.05). Skin exit-site infections were not seen in our patients. The most frequent long-term complications were catheter colonization, i.e. recurrent peritonitis with the same organism, and repeated peritonitis episodes leading to obstruction. The one year actuarial catheter survival is 40%. This paper discusses factors responsible for as well as possible improvement of this low figure. Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). Recent surveys show that up to 45% of home-dialysis patients are in CAPD programs (1). Recently Oreopoulos analyzed the benefits and indications of CAPD and showed that the procedure is being used with increasing frequency (2). The CAPD program in our institution was started in 1978. From January 1981 to October 1984, 150 Tenckhoff catheters were implanted as part of that program. These patients who have had careful metabolic and surgical followup form the basis of this report.