بررسی دیالیز صفاقی سرپایی دایم به عنوان روشی جهت درمان جای‌گزینی نارسایی مزمن کلیوی(گزارش 37 مورد در مرکز پزشکی شهید هاشمی‌نژاد)

Continuous ambulatory peritoneal dialysis(CAPD) is a well-known model of renal replacement therapy for end-stage renal disease patients in developed countries. This model of treatment has widely been used in our country in recent years. The present study was undertaken to investigate the efficacy of CAPD in Iran, patient population, medical and surgical complications and the etiology of discontinued treatment in the patients. This retrospective study reviewed patient population in terms of age, sex, etiology of primary disease, selection criteria and rationals, complication and reasons for discontinued treatment. 37 patients (13 females, 24 males) who had been under CAPD treatment were studied between Jan. 1997 and Jan. 2004. The patients were between 16-75 years of age. Primary etiology was judged to be diabetic nephropathy in 17 patients, chronic glomerulonephritis in 8, nephrosclerosis hypertension in 5, amyloidosis in 3, reflux nephropathy in 2 and in 2 remaining cases was unknown. 17 cases lacked a satisfactory vascular access for hemodialysis after multiple attempts. 9 cases were selected on the basis of old age and history of myocardial infarction. Five patients volunteered for switching to CAPD from Hd in order to revert to a home dialysis modallty. A double Cuff steright, Tenckhoff peritoneal catheter was inserted as a minor surgical procedure under brief general anesthesia. The minimum duration of treatment was one week in a patient whose CAPD catheter had no functioning even after replacement. The longest period of treatment was 5 years in a patient who ultimately received a successful renal transplantation. Presently, of 37 patients, 13 are still under treatment and 3 mortalities occurred after approximately 8 months due to septicemia following peritonitis. Treatment discontinued in 4 patients because of catheter malfunction and in 4 other ones upon the patients’ own request. In 9 cases a successful kidney transplantation was done and CAPD catheter was removed in the time of transplant operation. The experience accummulated in our department over 7 years contradicts preceding reports according to which CAPD is impractical in the developing countries due to cultured constrains in observing sterile technique. CAPD is a method of choice for treating diabetic and elderly patients suffering from vascular problems. The most common cause for discontinuing treatment is patient’s frustration over peritonetis need. CAPD can thus be of value when short periods are envisioned particularly during preparation interval preceding kidney transplantation.