1999 Volume 32 Issue 7 Pages 1059-1064
The incidence and the causes of discontinuation of continuous ambulatory peritoneal dialysis (CAPD) were examined in our hospital for 12 years since 1985. The number of subjects were 38 (64.4%) of a total of 59 patients on CAPD with positive selection, including 15 who died during CAPD and 23 who were transferred to hemodialysis (HD). About half of the causes of discontinuation was due to CAPD-related complications. It was particular problematic in patients who were transferred to HD due to poor ultrafiltration, frequent and/or intractable CAPD peritonitis due to catheter infection and the sclerosing encapsulating peritonitis (SEP). Moreover, five of six patients who underwent abdominal surgery were transferred to HD. The duration of CAPD and the episodes of CAPD peritonitis were major risk factors for discontinuation of CAPD.
Three patients (5.1%) developed SEP. Marked ascites after discontinuation of CAPD due to poor ultrafiltration was considered to precede before clinically-overt SEP. Four cases with these findings were successfully treated with steroids.
The amylase levels in CAPD effluents were determined under various conditions. Preoperative amylase levels in cases of both perforating peritonitis and acute pancreatitis were markedly higher than those in other conditions. The amylase measurement in CAPD effluent may be useful to differentiate CAPD peritonitis from serious intra-abdominal complications which require surgery. One case developed major leakage at the anastomosis postoperatively, and the peritoneum revealed a histologically late stages of peritoneal sclerosis.
Sixteen peritoneal samples were examined histologically after removal of CAPD catheter or during abdominal surgery. Twelve (92.3%) of 13 cases who had continued CAPD for more than 60 months revealed medial (5 cases) or late (7 cases) stages of peritoneal sclerosis, being considered to require discontinuation because of irreversible peritoneal dysfunction.
