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CAPD
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CAPD

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  1. CAPD THE SAUDI EXPRIENCE

  2. Dialysis in Saudi Arabia • There are 6700 patients on dialysis in Saudi Arabia • There is 130 haemodialysis centres in Saudi Arabia • The incidence of hepatitis B is 6.7%and 50% for HCV SCOT data Saudi J kid 2001 12 (3)

  3. CAPD • There is only 335 patients on CAPD in Saudi Arabia (3%) • Only 35 patients are HCV +ve ( 10%) • 285 are on CAPD (85%) 50 are on IPD (15%) SCOT data Saudi J kid 2001 12 (3)

  4. Dialysis in the Kingdom • It had been estimated that the number of dialysis patients would exceed 10000 patients in the year 2010 • Most centres are saturated and need to expand in order to accept new patients • There is a great need for CAPD in Saudi Arabia SCOT data Saudi J kid 2001 12 (3)

  5. CAPD awareness • We did a questionnaire for 50 renal physicians about CAPD in 18 centres in the western area of Saudi Arabia • Only tow centres had CAPD

  6. CAPD awareness • 35 physicians (70%) had no previous experience with CAPD • 30 physicians (60%)thought that it is not suitable for our patients • 50% had no future intention to start CAPD in the future • 40% only were well informed about CAPD

  7. KKNGH experiencecurrent status • 65 patients on dialysis • 43 are on haemodialysis • 22 are on CAPD 34%

  8. KKNGH experience • The CAPD program started with tow patients in1994 and reached 22 patients in the year 2000 • 32 patients were recruited in the program between Jan 1994 – March 2000

  9. Patient selection in KKNGH • Patients were selected very carefully taking into consideration • Capability and ability to perform • procedures • Desire to become independent • The education level • Social status and conditions at home • (home visits were done)

  10. CAPD KKNGH experience • 32 patients were recruited in the program between Jan 1994 – March 2000 • 17 males 16 females • Ages between 16 _ 70 years at the time of recruitment in the program • 12 patients were diabetics

  11. CAPD KKNGH EXPERIENCEOriginal disease • 12 patients had diabetic nephropathy • 11 patients had chronic glomerulonephritis • 2 patients had chronic interstitial nephritis • One patient had chronic rejection • 6 patients had unknown cause of CRF

  12. KKNGH experiencehepatitis status • 3 patients only had HCV(10%) compared to 50% incidence in the haemodialysis patients

  13. KKNGH experienceperitonitis • Initially the rate of peritonitis was one episode every 6 months in the first 18 months • One episode every one year per patient over the following tow years • One episode every 18 months in following 2 years • One episode every 24 months in the following tow years

  14. KKNGH experienceperitonitis • The main organism was Gram+ve bacteria (60%) • 20% culture negative • 10% Gram-ve Bacteria • 10% Tuberculous and fungal

  15. KKNGH experience • We have seen 4 cases of tuberculous peritonitis • All had Neutrophil leuckocytosis in the PD fluid followed by lymphocytosis • The presentation is insidious with slightly clouded fluid

  16. T.B. peritonitis • One patient had concurrent bacterial peritonitis • P.D fluid TB culture was positive in all patients • PCR was positive in tow patients (50%) • Removal of catheter was necessary in all 4 patients

  17. KKNGH experience • 32 patients were recruited in the program between Jan 1994 – March 2000 • Tow patients died with myocardial infarction • 4 patients only were transplanted • 4 patients were converted to haemodialysis because of peritonitis ( 3 had TB peritonitis and one had fungal peritonitis )

  18. CAPDEastern province experience • 31 patients were recruited over five years in Dammam central hospital • 21 women and 11 men • Mean age 41.3+ 17.2 Saudi J Kid Dis 2001 12 (4) 511

  19. CAPDEastern province experience • The main indication for CAPD was poor or failed vascular access Saudi J Kid Dis 2001 12 (4) 511

  20. CAPDEastern province experience • Peritonitis rate was 0.62 episode per patient per year • Staphylococcus epidermidis was the main causative organism • Therapy with CAPD lasted 26+ 7.4 months

  21. CAPDCentral province experience • CAPD was started in 1986 in the university hospital in Riyadh • The peritonitis rate improved to be one episode 24 -36 patient month • There was a careful selection criteria Saudi J Kid 1998 9(1)

  22. CAPDconclusion • There is a great need for CAPD in Saudi Arabia as a primary option for patients with CRF • Patient selection is very important factor for program success • Physician awareness and education is needed • Peritonitis still the major complication but will not limit the use of CAPD