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Renal Disease
0025-7125/90 $0.00
+ .20
CAPD Peritonitis Incidence, Pathogens, Diagnosis, and Management
Mohammad C. Saklayen, MD*
Since the introduction of continuous ambulatory peritoneal dialysis (CAPD) by Popovich and Moncrief in 1976,40-41 ambulatory peritoneal dialysis had been gaining increasing acceptance as a suitable mode of home dialysis for patients with end-stage renal disease all over the world,35 and the number of patients using CAPD as the preferred mode of treatment for end-stage renal disease had increased considerably in the last decade. In the United States alone, approximately one fourth of the total 100,000 plus patients receiving dialysis treatment use CAPD. With wider use, newer complications and problems related to CAPD are increasingly reported, and many old problems are being better controlled. 35 In this changing scenario, CAPD peritonitis still remains the most important complication of this form of dialysis. 36.42.52 Although the incidence of peritonitis was much higher in the early 1980s, more experience and better techniques have decreased the rate and leveled it off at about 1.3 episode per patient per year. 53 In centers with less experience, the incidence may be higher, whereas in some centers, the incidence of peritonitis is less than 1 episode per patient per year. Although this is an average incidence figure, there are many patients who did not develop a single episode of peritonitis for 2 to 3 years or more. On the other hand, owing to poor compliance with aseptic techniques and individual susceptibility to infection or associated catheter problems, many less-fortunate patients get three or more episodes of peritonitis per year. About two thirds of patients develop peritonitis during the first year of dialysis. The median interval between the initiation of dialysis and the first episode of peritonitis is 8 to 9 months. 38 Recurrent peritonitis occurs in about one quarter of CAPD patients and is a leading cause of CAPD failure. Not all cases of peritonitis, however, are *Assistant Professor of Medicine, Wright State University; and Chief. Hemodialysis Unit, Veterans Administration Medical Center, Day ton, Ohio
Medical ClinicS of North America-Vo!' 74, No. 4, July 1990
997
0025-7125/90 $0.00
+ .20
CAPD Peritonitis Incidence, Pathogens, Diagnosis, and Management
Mohammad C. Saklayen, MD*
Since the introduction of continuous ambulatory peritoneal dialysis (CAPD) by Popovich and Moncrief in 1976,40-41 ambulatory peritoneal dialysis had been gaining increasing acceptance as a suitable mode of home dialysis for patients with end-stage renal disease all over the world,35 and the number of patients using CAPD as the preferred mode of treatment for end-stage renal disease had increased considerably in the last decade. In the United States alone, approximately one fourth of the total 100,000 plus patients receiving dialysis treatment use CAPD. With wider use, newer complications and problems related to CAPD are increasingly reported, and many old problems are being better controlled. 35 In this changing scenario, CAPD peritonitis still remains the most important complication of this form of dialysis. 36.42.52 Although the incidence of peritonitis was much higher in the early 1980s, more experience and better techniques have decreased the rate and leveled it off at about 1.3 episode per patient per year. 53 In centers with less experience, the incidence may be higher, whereas in some centers, the incidence of peritonitis is less than 1 episode per patient per year. Although this is an average incidence figure, there are many patients who did not develop a single episode of peritonitis for 2 to 3 years or more. On the other hand, owing to poor compliance with aseptic techniques and individual susceptibility to infection or associated catheter problems, many less-fortunate patients get three or more episodes of peritonitis per year. About two thirds of patients develop peritonitis during the first year of dialysis. The median interval between the initiation of dialysis and the first episode of peritonitis is 8 to 9 months. 38 Recurrent peritonitis occurs in about one quarter of CAPD patients and is a leading cause of CAPD failure. Not all cases of peritonitis, however, are *Assistant Professor of Medicine, Wright State University; and Chief. Hemodialysis Unit, Veterans Administration Medical Center, Day ton, Ohio
Medical ClinicS of North America-Vo!' 74, No. 4, July 1990
997
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