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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 21-23

Mechanical complications of continuous ambulatory peritoneal dialysis: A hospital based retrospective study in Kashmir Valley


1 Department of Medicine, Sher-i-Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India
2 Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
3 Department of Medicine, Modern Healthcare Hospital, Srinagar, Jammu and Kashmir, India
4 Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India

Date of Web Publication16-Jun-2017

Correspondence Address:
Sheikh Mohd Saleem
Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_116_16

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  Abstract 


Objectives: The objective of the study was to assess the mechanical and nonmechanical complications in patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD) and to access the contributing factors to improve the patient's survival and reduce morbidity and mortality. Materials and Methods: This observational study was carried out on 121 patients with ESRD undergoing CAPD at the Nephrology Unit of SKIMS, Srinagar, Jammu and Kashmir, India. We retrospectively reviewed the medical records of 121 CAPD patients, in which a double-cuffed straight Tenckhoff catheter was inserted using surgical technique from July 2012 to July 2016. Results: The mean age of the study patients was 45 ± 11.5 years. Males outnumbered female, with a ratio of 1.42:1. The most common etiology for ESRD was diabetes mellitus (38.84%), followed by hypertension (30.57%) and chronic glomerulonephritis (18.18%). About three-fourth of the study patients (77.19%) were on CAPD therapy for more than 6 months showing better acceptability of CAPD therapy. Peritonitis was the most common nonmechanical complication and was seen in 45.45% patients. 14.04% patients had recurrent episodes of peritonitis. Catheter-related complications are early encountered and are mostly due to faulty technique. Conclusion: The complications associated with CAPD are diverse and most of the mechanical complications are catheter related and often result from errors made during catheter implantation. Furthermore, the presence of comorbid factors plays a provital role in exacerbating these complications. Proper evaluation of the patient, care during catheter insertion, and postoperative period can markedly reduce most of these complications and reduce mortality and morbidity associated with CAPD.

Keywords: CAPD, CAPD in Kashmir, end-stage renal disease with CAPD, end-stage renal disease Saleem end stage renal disease


How to cite this article:
Raina AF, Saleem SM, Jan SS, Yousuf S. Mechanical complications of continuous ambulatory peritoneal dialysis: A hospital based retrospective study in Kashmir Valley. Arch Med Health Sci 2017;5:21-3

How to cite this URL:
Raina AF, Saleem SM, Jan SS, Yousuf S. Mechanical complications of continuous ambulatory peritoneal dialysis: A hospital based retrospective study in Kashmir Valley. Arch Med Health Sci [serial online] 2017 [cited 2017 Oct 19];5:21-3. Available from: http://www.amhsjournal.org/text.asp?2017/5/1/21/208185




  Introduction Top


Continuous ambulatory peritoneal dialysis (CAPD) is an established form of renal replacement therapy for patients with end-stage renal disease (ESRD) and this technique has gained popularity as it is well accepted by the patients, it improves patients well-being, and it has better technical survival, better hemodynamic stability, better biochemical profiles, less invasive, and decline in complications such as peritonitis.[1],[2],[3],[4],[5] These findings have made CAPD an increasingly opted modality of renal replacement therapy worldwide.[1],[2],[3] CADP is the modality of choice nowadays and a better option for elderly patients.[6] However, it is associated with several complications (infectious or noninfectious), and one of the most serious of complications is peritonitis responsible for increased mortality and morbidity.[7] Mechanical complications of CAPD are diverse, mild in evolution and can be diagnosed easily; however, in 20% of patients, a change to hemodialysis (HD) may be required.[8],[9] To our knowledge, there has not been any documented study conducted on complications arising from CAPD in Kashmir Valley. In this study, we attempt to evaluate the complications of CAPD and the contributing factors to improve the patients' survival and reduce morbidity and mortality.


  Materials and Methods Top


This observational study was carried out on 121 patients with ESRD undergoing CAPD at the Nephrology Unit of SKIMS, Srinagar, Jammu and Kashmir, India. We retrospectively reviewed the medical records of 121 CAPD patients in which a double-cuffed straight Tenckhoff catheter was inserted using surgical technique from July 2012 to July 2016. Data were recorded on demographic profiles of the patient, etiology of ESRD, catheter insertion methods, duration of CAPD, noninfectious complications, favoring factors, treatment, and impact on the technique survival. The etiology of ESRD comprised hypertension, diabetes mellitus, chronic glomerulonephritis, obstructive uropathy, and polycystic kidney disease.


  Results Top


The data from 121 ESRD patients on CAPD therapy were retrospectively observed from July 2012 to July 2016. The mean age of the patients was 45 ± 11.5. Males outnumbered females, with a ratio of 1.42:1. The most common etiology for ESRD was diabetes mellitus (38.84%), followed by hypertension (30.57%) and chronic glomerulonephritis (18.18%) [Table 1].
Table 1: Demographic characteristics and etiology of ESRD in study patients

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Duration of CAPD therapy in study patients is shown in [Table 2]. About three-fourth of the study patients (77.19%) were on CAPD therapy for more than 6 months showing better acceptability of CAPD therapy in patients.
Table 2: Duration of CAPD therapy in study patients

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In our study, peritonitis was the most common complication arising from CAPD therapy and was seen in 45.45% patients. 14.04% patients had recurrent episodes of peritonitis. Incidence of complications in CAPD therapy is shown in [Table 3].
Table 3: Incidence of Complications in CAPD Patients

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Predisposing factors and evolution/treatment of CAPD complications are illustrated in [Table 4]. Migration of the catheter favored by constipation was treated by laxatives. Obstruction of the catheter was relieved by intraperitoneal heparin and surgical unblocking. The most common cause for catheter leak was infections which were treated with antibiotics. Few patients had developed hydrothorax due to out-flow obstruction which was treated by catheter removal and replacement.
Table 4: Predisposing factors and evolution of CAPD complications

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  Discussion Top


Continuous ambulatory peritoneal dialysis (CAPD) is the procedure of choice for patients with ESRD; however, there is a significant number of infectious and noninfectious complications associated with this procedure. Catheter-related complications are early encountered and may be due to faulty technique, congenital anatomic abnormalities, increased intra-abdominal pressure, and bacterial infections.[10] In our study, significant number of patients developed exit-site infections and pericatheter leak. Furthermore, 45.45% patients developed peritonitis and studies have proved the role of Staphylococcus epidermidis in causing the same. S. epidermidis, a part of normal skin flora, can adhere and proliferate on the surface of catheters and may cause subsequent peritonitis through the catheter lumen.[11],[12],[13],[14] Peritonitis is the most common of the complications and major cause of failure of the technique and returns to HD.[15]

Patients with diabetes mellitus, glomerulonephritis, and ongoing sepsis are at a greater risk of early complications and must be stabilized before catheter insertion.[16] In our study, diabetes mellitus was noted in 38.84% patients followed by hypertension in 30.57% as the cause for ESRD which is in accordance with the published literature.[17],[18]

Most of the noninfectious complications associated with CAPD in our study patients were treatable and did not interfere with catheter survival. Some precautionary measures will help prevent these complications [Table 4].


  Conclusion Top


The complications associated with CAPD are diverse and are classified into mechanical and nonmechanical complications. Most of the mechanical complications are catheter related and often result from errors made during catheter implantation. Furthermore, the presence of comorbid factors plays a provital role in exacerbating these complications. Proper evaluation of the patient, care during catheter insertion, and postoperative period can markedly reduce most of these complications and reduce mortality and morbidity associated with CAPD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Geerlings W, Tufveson G, Ehrich JH, Jones EH, Landais P, Loirat C, et al. Report on management of renal failure in Europe, XXIII. Nephrol Dial Transplant 1994;9 Suppl 1:6-25.  Back to cited text no. 1
    
2.
Al Wakeel J, Abu-Aisha H, Mitwalli AH, Huraib SO, Memon N, Marzouk AS. Peritonitis in patients on CAPD at King Khalid University Hospital: Less infection-rate with more center-experience. Saudi J Kidney Dis Transpl 1998;9:12-7.  Back to cited text no. 2
    
3.
Mitwali AH, Malik GH, Al Wakeel JS, Mohaya AS, Gamal HE, Kechrid M, et al. Intermittent peritoneal dialysis (IPD) in the elderly. Experience at security forces hospital Riyadh, Saudi Arabia Geriatr Nephrol Urol 1996;6:21-5.  Back to cited text no. 3
    
4.
Serkes KD, Blagg CR, Nolph KD, Vonesh EF, Shapiro F. Comparison of patient and technique survival in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis: A multicenter study. Perit Dial Int 1990;10:15-9.  Back to cited text no. 4
    
5.
Maiorca R, Vonesh EF, Cavalli P, De Vecchi A, Giangrande A, La Greca G, et al. A multicenter, selection-adjusted comparison of patient and technique survivals on CAPD and hemodialysis. Perit Dial Int 1991;11:118-27.  Back to cited text no. 5
    
6.
Nissenson AR, Diaz-Buxo JA, Adcock A, Nelms M. Peritoneal dialysis in the geriatric patient. Am J Kidney Dis 1990;16:335-8.  Back to cited text no. 6
    
7.
Smith WG, Tsakiris DJ, Junor BJ, Briggs JD, Alcock SR, Reading P, et al. Peritonitis in continuous ambulatory peritoneal dialysis. Scott Med J 1986;31:85-9.  Back to cited text no. 7
    
8.
Schaubel DE, Blake PG, Fenton SS. Trends in CAPD technique failure: Canada, 1981-1997. Perit Dial Int 2001;21:365-71.  Back to cited text no. 8
    
9.
Mujais S, Story K. Peritoneal dialysis in the US: Evaluation of outcomes in contemporary cohorts. Kidney Int Suppl 2006;103:S21-6.  Back to cited text no. 9
    
10.
Diaz-Buxo JA. Complications of peritoneal dialysis catheters: Early and late. Int J Artif Organs 2006;29:50-8.  Back to cited text no. 10
    
11.
Continuous ambulatory peritoneal dialysis (CAPD) peritonitis treatment recommendations: 1989 update. The Ad Hoc Advisory Committee on Peritonitis Management. Perit Dial Int 1989;9:247-56.  Back to cited text no. 11
    
12.
Keane WF, Everett ED, Golper TA, Gokal R, Halstenson C, Kawaguchi Y, et al. Peritoneal dialysis-related peritonitis treatment recommendations 1993 update. The Ad Hoc Advisory Committee on Peritonitis Management. International Society for Peritoneal Dialysis. Perit Dial Int 1993;13:14-28.  Back to cited text no. 12
    
13.
Zimakoff J, Bangsgaard Pedersen F, Bergen L, Baagø-Nielsen J, Daldorph B, Espersen F, et al. Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID). J Hosp Infect 1996;33:289-300.  Back to cited text no. 13
    
14.
Korbet SM, Vonesh EF, Firanek CA. Peritonitis in an urban peritoneal dialysis program: An analysis of infecting pathogens. Am J Kidney Dis 1995;26:47-53.  Back to cited text no. 14
    
15.
Peterson PK, Matzke G, Keane WF. Current concepts in the management of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. Rev Infect Dis 1987;9:604-12.  Back to cited text no. 15
    
16.
Tiong HY, Poh J, Sunderaraj K, Wu YJ, Consigliere DT. Surgical complications of Tenckhoff catheters used in continuous ambulatory peritoneal dialysis. Singapore Med J 2006;47:707-11.  Back to cited text no. 16
    
17.
Attaluri V, Lebeis C, Brethauer S, Rosenblatt S. Advanced laparoscopic techniques significantly improve function of peritoneal dialysis catheters. J Am Coll Surg 2010;211:699-704.  Back to cited text no. 17
    
18.
Moreiras Plaza M, Cuíña L, Goyanes GR, Sobrado JA, Gonzalez L. Mechanical complications in chronic peritoneal dialysis. Clin Nephrol 1999;52:124-30.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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