An African community-based chronic ambulatory peritoneal dialysis programme.
BACKGROUND
The reasons for failure of continuous ambulatory peritoneal dialysis (CAPD) are varied. Against a background of mass poverty, poor resources, and the cheaper cost of CAPD it is the primary choice of dialysis. The aims of this study were to determine infection rates and document factors responsible for CAPD failure.


METHODS
We report a prospective study in a large African tertiary hospital and its community based satellite clinics. Infection rates as well as factors that may influence them were studied. Sites of infections were documented and causes of CAPD failure recorded. All patients qualifying for dialysis from January 1998 to July 1999 were included.


RESULTS
Eighty-four patients were enrolled. There were 55 males and 29 females. The mean age was 39+/-10 (range 16-71) years and mean duration on dialysis at the end of the trial period was 17 months. The peritonitis rate was one episode every 27.9 patient months. Attrition to haemodialysis occurred in 16.6% of patients (n=14) and loss to follow-up in 29.8% (n=25). Fourteen patients regained renal function or were transplanted. Peritonitis appeared to be related to a poor BAD-C score (Bara Adapted Dialysis Compliance), i.e. combination of clinical status and clinic visits (P=0.07). The odds ratio for failure of CAPD with peritonitis was 5.3 times higher (confidence interval (CI) 1.7-17.1; P=0.0085). A low BAD-C score was a significant indicator of CAPD 'failure' (P=0.0001). The natural turnover rate of patients was 46%. Home conditions, employment, and education levels did not correlate with CAPD 'failure'.


CONCLUSIONS
The peritonitis rate and aetiology are similar to the developed world. Socioeconomic factors did not appear to play a role in peritonitis rates or CAPD failure.
Katz
I J
IJ
Division of Nephrology, Department of Medicine, Chris Hani Baragwanath Hospital Renal Unit, University of the Witwatersrand, Soweto, South Africa. bara.renal@icon.co.za
Sofianou
L
L
Hopley
M
M
D000293:Adolescent; D000328:Adult; D000349:Africa; D000368:Aged; D003154:Community Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D006435:Renal Dialysis; D019233:Retreatment; D017211:Treatment Failure