CAPDCAPD

THE SAUDI EXPRIENCETHE SAUDI EXPRIENCE

Dialysis in Saudi ArabiaDialysis in Saudi Arabia

• There are 6700 patients on dialysis in There are 6700 patients on dialysis in Saudi ArabiaSaudi Arabia

• There is 130 haemodialysis centres There is 130 haemodialysis centres in Saudi Arabiain Saudi Arabia

• The incidence of hepatitis B is The incidence of hepatitis B is 6.7%and 50% for HCV6.7%and 50% for HCV

SCOT data Saudi J kid 2001 12 (3)

CAPD CAPD

• There is only 335 patients on CAPD in There is only 335 patients on CAPD in Saudi Arabia (3%)Saudi Arabia (3%)

• Only 35 patients are HCV +ve ( 10%)Only 35 patients are HCV +ve ( 10%)

• 285 are on CAPD (85%) 50 are on 285 are on CAPD (85%) 50 are on IPD (15%)IPD (15%)

SCOT data Saudi J kid 2001 12 (3)

Dialysis in the KingdomDialysis in the Kingdom

• It had been estimated that the number It had been estimated that the number of dialysis patients would exceed 10000 of dialysis patients would exceed 10000 patients in the year 2010patients in the year 2010

• Most centres are saturated and need to Most centres are saturated and need to expand in order to accept new patientsexpand in order to accept new patients

• There is a great need for CAPD in Saudi There is a great need for CAPD in Saudi ArabiaArabia

SCOT data Saudi J kid 2001 12 (3)

CAPD awarenessCAPD awareness

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

• Only tow centres had CAPDOnly tow centres had CAPD

CAPD awarenessCAPD awareness

• 35 physicians (70%) had no previous 35 physicians (70%) had no previous experience with CAPDexperience with CAPD

• 30 physicians (60%)thought that it is 30 physicians (60%)thought that it is not suitable for our patients not suitable for our patients

• 50% had no future intention to start 50% had no future intention to start CAPD in the futureCAPD in the future

• 40% only were well informed about 40% only were well informed about CAPDCAPD

KKNGH experienceKKNGH experiencecurrent statuscurrent status

• 65 patients on dialysis65 patients on dialysis

• 43 are on haemodialysis 43 are on haemodialysis

• 22 are on CAPD 34%22 are on CAPD 34%

KKNGH experienceKKNGH experience

• The CAPD program started with tow The CAPD program started with tow patients in1994 and reached 22 patients in1994 and reached 22 patients in the year 2000 patients in the year 2000

• 32 patients were recruited in the 32 patients were recruited in the program between Jan 1994 – March program between Jan 1994 – March 20002000

Patient selection in KKNGHPatient selection in KKNGH

• Patients were selected very carefully taking into Patients were selected very carefully taking into consideration consideration

• Capability and ability to perform Capability and ability to perform

• procedures procedures

• Desire to become independentDesire to become independent

• The education levelThe education level

• Social status and conditions at home Social status and conditions at home

• (home visits were done) (home visits were done)

CAPD KKNGH experienceCAPD KKNGH experience

• 32 patients were recruited in the 32 patients were recruited in the program between Jan 1994 – March program between Jan 1994 – March 20002000

• 17 males 16 females17 males 16 females

• Ages between 16 _ 70 years at the Ages between 16 _ 70 years at the time of recruitment in the programtime of recruitment in the program

• 12 patients were diabetics12 patients were diabetics

CAPD KKNGH EXPERIENCECAPD KKNGH EXPERIENCEOriginal diseaseOriginal disease

• 12 patients had diabetic nephropathy12 patients had diabetic nephropathy

• 11 patients had chronic 11 patients had chronic glomerulonephritisglomerulonephritis

• 2 patients had chronic interstitial 2 patients had chronic interstitial nephritisnephritis

• One patient had chronic rejectionOne patient had chronic rejection

• 6 patients had unknown cause of CRF6 patients had unknown cause of CRF

KKNGH experienceKKNGH experiencehepatitis status hepatitis status

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

KKNGH experienceKKNGH experienceperitonitisperitonitis

• Initially the rate of peritonitis was one Initially the rate of peritonitis was one episode every 6 months in the first 18 episode every 6 months in the first 18 monthsmonths

• One episode every one year per patient One episode every one year per patient over the following tow yearsover the following tow years

• One episode every 18 months in following One episode every 18 months in following 2 years2 years

• One episode every 24 months in the One episode every 24 months in the following tow yearsfollowing tow years

KKNGH experienceKKNGH experienceperitonitisperitonitis

• The main organism was Gram+ve The main organism was Gram+ve bacteria (60%)bacteria (60%)

• 20% culture negative20% culture negative

• 10% Gram-ve Bacteria10% Gram-ve Bacteria

• 10% Tuberculous and fungal10% Tuberculous and fungal

KKNGH experienceKKNGH experience

• We have seen 4 cases of tuberculous We have seen 4 cases of tuberculous peritonitisperitonitis

• All had Neutrophil leuckocytosis in All had Neutrophil leuckocytosis in the PD fluid followed by the PD fluid followed by lymphocytosis lymphocytosis

• The presentation is insidious with The presentation is insidious with slightly clouded fluid slightly clouded fluid

T.B. peritonitisT.B. peritonitis

• One patient had concurrent bacterial One patient had concurrent bacterial peritonitisperitonitis

• P.D fluid TB culture was positive in all P.D fluid TB culture was positive in all patients patients

• PCR was positive in tow patients PCR was positive in tow patients (50%)(50%)

• Removal of catheter was necessary in Removal of catheter was necessary in all 4 patientsall 4 patients

KKNGH experienceKKNGH experience

• 32 patients were recruited in the program 32 patients were recruited in the program between Jan 1994 – March 2000between Jan 1994 – March 2000

• Tow patients died with myocardial Tow patients died with myocardial infarctioninfarction

• 4 patients only were transplanted4 patients only were transplanted

• 4 patients were converted to 4 patients were converted to haemodialysis because of peritonitis ( 3 haemodialysis because of peritonitis ( 3 had TB peritonitis and one had fungal had TB peritonitis and one had fungal peritonitis )peritonitis )

CAPDCAPDEastern province experienceEastern province experience

• 31 patients were recruited over five 31 patients were recruited over five years in Dammam central hospitalyears in Dammam central hospital

• 21 women and 11 men21 women and 11 men

• Mean age 41.3+ 17.2Mean age 41.3+ 17.2

Saudi J Kid Dis 2001 12 (4) 511

CAPDCAPDEastern province experienceEastern province experience

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

Saudi J Kid Dis 2001 12 (4) 511

CAPDCAPDEastern province experienceEastern province experience

• Peritonitis rate was 0.62 episode per Peritonitis rate was 0.62 episode per patient per yearpatient per year

• Staphylococcus epidermidis was the Staphylococcus epidermidis was the main causative organismmain causative organism

• Therapy with CAPD lasted 26+ 7.4 Therapy with CAPD lasted 26+ 7.4 months months

CAPDCAPDCentral province experienceCentral province experience

• CAPD was started in 1986 in the CAPD was started in 1986 in the university hospital in Riyadh university hospital in Riyadh

• The peritonitis rate improved to be The peritonitis rate improved to be one episode 24 -36 patient monthone episode 24 -36 patient month

• There was a careful selection criteria There was a careful selection criteria

•

Saudi J Kid 1998 9(1)

CAPDCAPDconclusionconclusion

• There is a great need for CAPD in Saudi There is a great need for CAPD in Saudi Arabia as a primary option for patients Arabia as a primary option for patients with CRFwith CRF

• Patient selection is very important factor Patient selection is very important factor for program success for program success

• Physician awareness and education is Physician awareness and education is needed needed

• Peritonitis still the major complication but Peritonitis still the major complication but will not limit the use of CAPDwill not limit the use of CAPD