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

Adnan Firdous Raina; Sheikh Mohd Saleem; Shah Sumaya Jan; Sabina Yousuf

doi:10.4103/amhs.amhs_116_16

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

Adnan Firdous Raina¹, Sheikh Mohd Saleem², Shah Sumaya Jan³, Sabina Yousuf⁴
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 Publication

16-Jun-2017

Correspondence Address:
Sheikh Mohd Saleem
Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/amhs.amhs_116_16

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 2023 Mar 31];5:21-3. Available from: https://www.amhsjournal.org/text.asp?2017/5/1/21/208185

Introduction

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

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

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

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

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.

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