MON-070 NON-INFECTIOUS COMPLICATIONS OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS IN BANGLADESH: A SINGLE CENTRE EXPERIENCE

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Continuous Ambulatory Peritoneal dialysis (CAPD) is increasingly getting popularity as a form of renal replacement therapy in end stage kidney disease (ESKD) patients of Bangladesh. Although CAPD may offer some advantages over Haemodialysis (HD) and is generally better tolerated, it is not without complications. Peritonitis is a well known complication of CAPD. However, non-infectious complications, though less common, are increasingly being recognized and can impact survival of this technique. The aim of this study was to evaluate the non-infectious complications of CAPD along with the outcome of patients performing CAPD in Bangladesh. This retrospective study was performed in a specialized kidney hospital in Dhaka, Bangladesh. Patients with end stage kidney disease who underwent percutaneous peritoneal dialysis catheter (double cuffed coiled Tenckhoff catheter) insertion by Seldinger technique over a period of one year from August 2017 to July 2018 were included. Patient’s files were reviewed and patients were interviewed by telephone calls. The nature and frequency of non-infectious complications and its impact on patients were analyzed. During the study period a total of 68 patients underwent CAPD catheter insertion and in one patient operation was abandoned due to bowel perforation. Average age of the patients was 56.7 ± 11.6 (24 to 90 years). Number of female patients was higher than male patients (48.5% vs 51.5%). Diabetic nephropathy was the most common (67.7%) cause of ESKD. The mean duration of follow up was 7.7 ± 3.4 months (1–15 months). CAPD was started on an average of 11.4 ± 3.0 (5 to 29) days after catheter insertion. Overall non-infectious complications were noted in 30.9% cases (21 out of 68). Pain was most commonly reported (19.7%) followed by haemoperitoneum (9.1%), leakage of fluids (7.6%) and malposition of catheter (1.5%). None of the patients suffered from hydrothorax, hernia or ultrafiltration failure during the study period. All the haemoperitoneum cases were secondary to anticoagulant use and resolved after omitting the anticoagulant for few days and daily flushes. Patients who had exit site leakage required temporary withdrawal of CAPD with or without temporary haemodialysis and/or secondary stitches but their CAPD was resumed after an interval. The patient with catheter malposition required catheter repositioning and CAPD could be performed after that. At the end of one year, 51 (75%) patients were continuing CAPD, five patients were shifted to haemodialysis due to either peritonitis (n=2) or financial problem (n=2) or non-compliance (n=1); one patient underwent renal transplantation and in one patient catheter was removed as renal function recovered. A total of 10 patients died during the study period, giving an overall mortality rate of 14.7%. Our study demonstrated that non-infectious complications affected about one third of the patients performing CAPD, though majority of those were managed conservatively. None of these complications affected catheter survival during the study period. Better understanding of the non-infectious complications of PD will help prevent, early recognize and manage them appropriately, making PD more acceptable and long lasting form of renal replacement therapy.