Chirurgische complicaties bij behandeling met continue ambulante peritoneale dialyse; 9 jaar ervaring

To determine the number of surgical complications in patients treated with continuous ambulatory peritoneal dialysis (CAPD).

Design

Retrospective (1980-1989), partially prospective (1987-1989).

Setting

Rijnstate Hospital, Arnhem, the Netherlands.

Method

In 1978 CAPD was introduced in the Netherlands. Since 1980 we have used this technique in our clinic. Over the period 1980-1989 we studied the number of surgical complications of CAPD and the loss of catheter caused by these complications. With these numbers the probability of having a functioning Tenckhoff double cuff catheter was calculated with the Kaplan-Meier method.

Results

101 patients (54 men (mean age 52.5 years), 47 women (mean age 49.6 years)) with terminal renal insufficiency were treated during the study period. 123 catheters were implanted of which 33 had to be removed afterwards. The probability of having a functioning catheter after one year was 85, after two years 64 and after three years 53. Peritonitis was the main cause of temporary or final loss of the catheter. The number of observed cases of peritonitis was 187.

Conclusion

Methods to improve the survival of the catheter are prevention of peritonitis by using an appropriate system for the fluid exchanges, screening patients for the existence of diverticulosis before starting CAPD, and prevention of exit site and tunnel infections.