CAPD

1
CAPD

• THE SAUDI EXPRIENCE

2
Dialysis in Saudi Arabia

• There are 6700 patients on dialysis in Saudi
  Arabia
• There is 130 haemodialysis centres in Saudi
  Arabia
• The incidence of hepatitis B is 6.7and 50 for
  HCV

SCOT data Saudi J kid 2001 12 (3)
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CAPD

• There is only 335 patients on CAPD in Saudi
  Arabia (3)
• Only 35 patients are HCV ve ( 10)
• 285 are on CAPD (85) 50 are on IPD (15)

SCOT data Saudi J kid 2001 12 (3)
4
Dialysis in the Kingdom

• It had been estimated that the number of dialysis
  patients would exceed 10000 patients in the year
  2010
• Most centres are saturated and need to expand in
  order to accept new patients
• There is a great need for CAPD in Saudi Arabia

SCOT data Saudi J kid 2001 12 (3)
5
CAPD awareness

• We did a questionnaire for 50 renal physicians
  about CAPD in 18 centres in the western area of
  Saudi Arabia
• Only tow centres had CAPD

6
CAPD awareness

• 35 physicians (70) had no previous experience
  with CAPD
• 30 physicians (60)thought that it is not
  suitable for our patients
• 50 had no future intention to start CAPD in the
  future
• 40 only were well informed about CAPD

7
KKNGH experiencecurrent status

• 65 patients on dialysis
• 43 are on haemodialysis
• 22 are on CAPD 34

8
KKNGH experience

• The CAPD program started with tow patients
  in1994 and reached 22 patients in the year 2000
  
• 32 patients were recruited in the program between
  Jan 1994 March 2000

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Patient selection in KKNGH

• Patients were selected very carefully taking into
  consideration
• Capability and ability to perform
  
• procedures
• Desire to become independent
• The education level
• Social status and conditions at home
• (home visits were done)
  

10
CAPD KKNGH experience

• 32 patients were recruited in the program between
  Jan 1994 March 2000
• 17 males 16 females
• Ages between 16 _ 70 years at the time of
  recruitment in the program
• 12 patients were diabetics

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CAPD KKNGH EXPERIENCEOriginal disease

• 12 patients had diabetic nephropathy
• 11 patients had chronic glomerulonephritis
• 2 patients had chronic interstitial nephritis
• One patient had chronic rejection
• 6 patients had unknown cause of CRF

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KKNGH experiencehepatitis status

• 3 patients only had HCV(10) compared to 50
  incidence in the haemodialysis patients

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KKNGH experienceperitonitis

• Initially the rate of peritonitis was one episode
  every 6 months in the first 18 months
• One episode every one year per patient over the
  following tow years
• One episode every 18 months in following 2 years
• One episode every 24 months in the following tow
  years

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KKNGH experienceperitonitis

• The main organism was Gramve bacteria (60)
• 20 culture negative
• 10 Gram-ve Bacteria
• 10 Tuberculous and fungal

15
KKNGH experience

• We have seen 4 cases of tuberculous peritonitis
• All had Neutrophil leuckocytosis in the PD fluid
  followed by lymphocytosis
• The presentation is insidious with slightly
  clouded fluid

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T.B. peritonitis

• One patient had concurrent bacterial peritonitis
• P.D fluid TB culture was positive in all patients
  
• PCR was positive in tow patients (50)
• Removal of catheter was necessary in all 4
  patients

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KKNGH experience

• 32 patients were recruited in the program between
  Jan 1994 March 2000
• Tow patients died with myocardial infarction
• 4 patients only were transplanted
• 4 patients were converted to haemodialysis
  because of peritonitis ( 3 had TB peritonitis and
  one had fungal peritonitis )

18
CAPDEastern province experience

• 31 patients were recruited over five years in
  Dammam central hospital
• 21 women and 11 men
• Mean age 41.3 17.2

Saudi J Kid Dis 2001 12 (4) 511
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CAPDEastern province experience

• The main indication for CAPD was poor or failed
  vascular access

Saudi J Kid Dis 2001 12 (4) 511
20
CAPDEastern province experience

• Peritonitis rate was 0.62 episode per patient per
  year
• Staphylococcus epidermidis was the main causative
  organism
• Therapy with CAPD lasted 26 7.4 months

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CAPDCentral province experience

• CAPD was started in 1986 in the university
  hospital in Riyadh
• The peritonitis rate improved to be one episode
  24 -36 patient month
• There was a careful selection criteria

Saudi J Kid 1998 9(1)
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CAPDconclusion

• There is a great need for CAPD in Saudi Arabia as
  a primary option for patients with CRF
• Patient selection is very important factor for
  program success
• Physician awareness and education is needed
• Peritonitis still the major complication but will
  not limit the use of CAPD