CAPD practice in OAUTHC, Ile-Ife, Nigeria: A preliminary experience

Continuous ambulatory peritoneal dialysis (CAPD) is virtually non-existent in Nigeria. Here we report a preliminary study of 9 patients (8 males, 1 female) in end-stage renal failure (ESRF), with serum creatinine ranging from 528-1, 680 mu mol/L (mean = 1,319 +/- 425) for whom CAPD was instituted. The causes of ESRF were. hypertensive nephrosclerosis, 4 patients; chronic glomerulonephritis, 3 patients, diabetic nephropathy (non-insulin dependent), 2 patients. The Baxter System-2 was employed in 7 patients, and the Fresenius Safe-Lock System in 2 patients, using standard peritoneal dialysis (PD) solution regimens. Duration of dialysis varied from 2 wk to 9 mo, with a total of 44 patient-months. Performance on dialysis was evaluated by the following parameters: serial serum urea and creatinine levels; blood pressure (BP) control; fluid balance using the patients' weight and absence or presence of edema; nutritional status as measured by serial serum albumin and packed cell volume (PCV) levels, absence or presence, and frequency, of peritonitis; quality of life as assessed by the patients' ability to function at work, recreate and perform household tasks. After 2 wk of dialysis, serum creatinine levels fell from a mean of 1,319 +/- 425.1 mu mol/L to 400.1 +/- 165.6 mu mol/L (p<0.001), while serum urea levels fell from a mean of 27.3 +/- 17.7 mmol/L to 10.8 +/- 2.9 mmol/L. Systolic BP fell from 203.8 +/- 17.7 mmHg to 138.8 +/- 23 mmHg (p = 0.001); diastolic BP fell from 116.3 +/- 14.1 mmHg to 85.0 +/- 13.5 mmHg (p = 0.006). Patients' body weight fell from a mean of 68.5 +/- 10.9 kg to 62.2 +/- 12.2 kg. The PCV levels rose significantly, from a mean of 24.3 +/- 6.5% to 28.0 +/- 3.7% (p<0.05), and blood transfusion requirements were minimal. Serum albumin levels stabilized in 1 patient (34-37 g/L), while it dropped significantly in 8 patients (p<0.05). There was a total of 16 episodes of peritonitis among 7 patients over the course of 44 patient-months. Staphylococcus epidermidis, Pseudomonas aeruginosa, and coliform species were the organisms most often encountered in culture-positive peritonitis. Peritoneal protein excretion in patients with peritonitis ranged from 4.5-20.5 g/d. Other complications included line rupture in I and pancreatitis in another. Five patients died: 3 from sepsis syndrome, 1 from uunderdialysis due to technique failure, and 1 from an unknown cause. An interrupted supply of CAPD solution contributed to the underdialysis. Quality of life was rated as good in 3 patients, poor in 2 who had frequent hospitalizations, and suboptimal in the rest. It is concluded that CAPD is practicable in our setting, but its success is mitigated by poor compliance due to art unsteady supply of the necessary solutions and to frequent episodes of peritonitis. To the best of our knowledge, no other documented report of CAPD in this country is available.