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Continuous Ambulatory Peritoneal Dialysis (CAPD) is a home-based renal replacement therapy (RRT). It uses glucose-based dialysate solutions, typically 1.5% or 2.5% strength, to perform 3 to 4 dialysis cycles each day. The Number of PD exchange affects the quality of life. The cost and peritonitis episodes are related to the number of PD cycles. In our center, the primary challenges faced by the CAPD program were CAPD-associated peritonitis and difficulties in maintaining a constant supply of consumables. There is a significant number of elderly patients who qualify for RRT but have no access to the hemodialysis programs due to the limitation of dialysis slots or difficulty in travelling to institutional hemodialysis. Patients also encounter challenges in performing frequent CAPD exchange, and some may depend on the caregivers to assist with their treatment. This study aims to analyze the outcomes and complications of patients who adhered to 2.5 % two PD exchanges per day with a follow up for more than one year.
This retrospective analysis included data of patient satisfaction, edema, number of peritonitis episodes, hemoglobin and other biochemical parameters in all patients who adhere to two PD exchanges (2.5% x 2) per day with a follow up for more than 1 year at nephrology unit, Teaching hospital, Kurunegala. They were all elderly comorbid patients who chose 2 PD exchanges a day as they were unable to carry out 3 exchanges. The patients who developed fluid overload with 2 exchanges were moved to different PD regime or hemodialysis with patient consent. The patients who left 2 PD exchange less than one year were excluded. The data was extracted anonymously from the CAPD database from 2021 April to 2023 October. The ethical approval was obtained from the hospital ethical review committee.
There were 30 (26 males, 4 females) patients, with a mean age of 61.45 years and a mean duration of CAPD of 20.67 months. The mean eGFR at the commencement of PD was 5.67ml/min/1.73m². All patients had at least one comorbid condition, with 43.33% having two and 13.33% having three or more. Patient satisfaction, urine output, edema and biochemical parameters were assessed after 12,18, and 24 months of follow-up and compared with the values at the beginning of PD. All patients were satisfied with the smaller number of PD exchange per day. Residual urine output was preserved in most patients, and they had good hemoglobin level.
Performing two PD exchanges daily proves to be a convenient home-based therapy for elderly comorbid patients having residual renal function. This option is especially valuable when access to hemodialysis is restricted due to resource limitations. Peritonitis rates were acceptable. Patient satisfaction was good and biochemical parameters were within acceptable ranges. Residual renal function was well-preserved even after one year of treatment. Further confirmation of these benefits from twice-daily PD exchanges requires a multicenter, long-term analysis.