Objectives : CAPD has established itself as an effective therapeutic modality as hemodialysis or renal transplantation in the treament of patients with end stage renal disease. Although much progress of technology of CAPD has been made, peritonitis or catheter-related complications are still important problems until now. Therefore, we investigated about risk factors which are related to peritonitis and exit infection in CAPD patients.
Methods : We analysed retrospectively the clinical results of 51 patients on CAPD at Dongguk University Kyoung-ju Hospital from April 1994 to December 1998.
Results :
1) There were 31 male and 20 female patients who are 28 to 79 age-old(mean age 55.4±11 years).
2) Underlying disorders of CAPD patients were diabetic nephropathy(33.3%), hypertensive nephrosclerosis(27.5%) and glomerulonephritis(17.7%).
3) The incidence of peritonitis was 0.73/year/patient and peritonitis free interval period was 9.31.4 months. The isolation rate of microorganisms from patients with peritonitis was 57.3% and the order of frequency of isolated organims was Staphylococcus aureus, Staphylococcus epiermidis, Streptococcus species, Pseudomonas species and Acinetobacter species. The peritonitis was treated with antibiotics only(83.4%), catheter removal (14.8%) and death(1.8%).
4) The incidence of peritonitis was higher in patients with older age(>50yr), DM, exit site infection and without occupation, physical activity according to univariate analysis (p<0.05).
5) The incidence of exit site infection was 0.37/year/patient and the order of frequency of isolated organisms was Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus species, and Pseudomonas species. The statistical analysis for risk factor of exit site infection had no significant value. The exit site infection was treated with antibiotics only(45.7%), external cuff extemalization(8.6%), external cuff removal(28.6%), and catheter removal(14.8%).
6) 21 of 63 catheters(33.3%) were removed. The peritonitis and exit site infection or tunnel infection were main causes of catheter removal. The catheter survival rate was 82%, 73%, 68% and 50% at one, two, three and four years, respectively. Mean survival time of all catheters was 39.3±1.4 months.
7) The causes of death were most frequently cardiac disease(28.4%), followed by vascular disease(14.4%), malignancy(14.4%) and infections(14.4%). The patient survival rate was 92%, 82%, 78% and 70% at one, two, three and four years, respectively. Mean survival time of all patients was 61.2 1.8 months.
Conclusion : Although CAPD is an effective therapeutic modality in the treatment of patients with end stage renal disease, CAPD peritonitis and exit site infection are the most important pitfalls of CAPD. From the above results, we can know that the risk factors significantly affecting the incidence of peritonitis were old age, no occupation, no physical activity, DM, and exit site infection. Therefore, we must consider the risk factors affecting the incidence of peritonitis and exit site infection when we choose the renal replace therapy in end stage renal failure.
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