Introduction:
In Bangladesh, intermittent peritoneal dialysis (IPD) was started in 1973 and continuous ambulatory peritoneal dialysis (CAPD) was started in 1981. CAPD is increasingly becoming popular among end stage renal disease (ESRD) patients. In this study, we share our experience of CAPD performed at a specialized kidney hospital of Bangladesh.
Methods:
This study was conducted at Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh. It was a retrospective study. Patients who performed CAPD from 2011 to 2023 at Kidney Foundation Hospital were included. Data was collected from patient’s file and by contacting patients over phone. Ethical approval was obtained from the Ethical review committee (ERC) of Kidney Foundation Hospital. Data was analyzed using SAS software.
Results:
A total of 585 patients performed CAPD from 2011 to 2023 at Kidney Foundation Hospital. The mean age of patients was 62±10 years, male 314 (53.7%), female 271 (46.3%). All CAPD catheters were inserted percutaneously (Seldinger technique) using double cuff coiled Tenckhoff catheters. The manual exchange was started on average 9.5±3 days after catheter insertion.
The causes of ESRD among 189 CAPD patients were diabetic nephropathy (76.2%), chronic glomerulonephritis (CGN) (20.1%), hypertension (HTN) (3.2%) and others (0.5%). Most of the CAPD patients had multiple co-morbidities including ischemic heart disease (39.7%), cerebrovascular disease (20.1%), hypothyroidism (13.8%) and bronchial asthma (5.8%). More than half of the patients (55.3%) started CAPD first without receiving any hemodialysis prior to CAPD while 44.7% received hemodialysis first and then performed CAPD.
Peritonitis was the most worrying complication in CAPD patients. Among 260 CAPD patients, 21.2% suffered from peritonitis. The rate of peritonitis was 0.35 episodes per patient year in 2021, 0.28 episodes per patient year in 2022 and 0.29 episodes per patient year in 2023. Among 177 CAPD patients, non-infectious complications were noted in 24.3% cases (43 out of 177). Fluid leakage was the most common non-infectious complications (9.0%) followed by haemoperitoneum (8.5%), malfunction (5.6%), hernia (0.56%) and severe diarrhea (0.56%).
The outcome of 585 patients revealed that 81 (13.8%) patients were continuing CAPD, 12 (2.1%) patients shifted to HD, 7 (1.2%) patients received kidney transplant, 111 (18.9%) patients were lost to follow up and 374 (63.9%) patients died. The main causes of death were septicemia, myocardial infarction, cerebrovascular disease, pneumonia and COVID-19 infection.
Conclusions:
In summary, more than two third CAPD patients were diabetic and nearly 40% had cardiovascular co-morbidities. Peritonitis was experienced by about one fifth patients but the rate of peritonitis at our center was low. The main problem of CAPD in Bangladesh is the cost of CAPD fluid which is often unaffordable to initiate and maintain by majority of ESRD patients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.