Outcomes and trends in continuous ambulatory peritoneal dialysis: a retrospective analysis at Najaf Centers (2014-2022)

Abstract

Introduction. Continuous ambulatory peritoneal dialysis (CAPD) offers an alternative renal replacement therapy for patients with end-stage renal disease (ESRD), combining the benefits of mobility and a home-based treatment regime. Since its introduction at Najaf Center's Al-Sader Nephrology Center in 2011, techniques have evolved from open laparotomy to laparoscopic methods, starting officially in 2018. This study aims to evaluate patient outcomes, trends in CAPD techniques, and factors contributing to mortality. Methods. This retrospective study collected data from 643 patients who initiated CAPD between 2014 and 2022 at Najaf Governate's three centers. The study focused on demographic data, technique survival, transitions to other dialysis modalities, patient outcomes, mortality, and trends and complications associated with various CAPD catheter insertion techniques (open laparotomy, percutaneous insertion, and laparo­scopic). Out of these, 211 patients died, and 432 continued with CAPD or switched to other modalities. Twenty patients received a kidney transplant, 189 transitioned to hemodialysis and 130 remained on CAPD. Result. Technique-wise, laparoscopic insertions showed higher patency rates and fewer early complications, while percutaneous insertions had higher instances of needing revisions, and open methods were most associated with infection complications. The technique success rate was highest for laparoscopic CAPD (79.5%), followed by percutaneous CAPD (45.6%) and open laparotomy (46.5%). Conclusion. CAPD is a vital renal replacement therapy, yet it carries risks, including mortality. This study's insights into the causes of death, technique efficiency, and patient outcomes are crucial for enhancing patient care and clinical practices in CAPD. The shift from open laparotomy to laparoscopic techniques at Najaf Centers mirrors a broader trend in medical practice favoring minimally invasive procedures, which have shown better outcomes in this study.