Prevalence and factors affecting peritonitis in CAPD patients in Maharat Nakhon Ratchasima Hospital under universal coverage scheme during 2008-2010: a three-year experience
Liawnoraset, W.
Journal of the Medical Association of Thailand 94 Suppl. 4: S19-S24
2011
ISSN/ISBN: 0125-2208 PMID: 22043562 Document Number: 14237
Since 2008, the Thai government has subsidized the package to cover chronic ambulatory peritoneal dialysis (CAPD) for end stage renal disease (ESRD) patients under the universal coverage scheme (UCS) in Thailand. The aim of the program is to keep longer life in poor people instead of death due to inaccessibility to renal replacement therapy as usual. The present study was conducted to evaluate the prevalence and factors affecting peritonitis in patients with CAPD therapy under the UCS at Renal unit, Maharat Nakhon Ratchasima Hospital, during January 1, 2008-December 31, 2010. Medical records of ESRD patients undergoing CAPD under UCS at Maharat Nakhon Ratchasima Hospital during January 1, 2008-December 31, 2010 were reviewed. The collected data included demographic details, underlying diseases, body mass index (BMI), laboratory findings, peritonitis rate, and outcome of therapy at December 31, 2010. There were 318 ESRD patients with the mean age of 49.9 +/- 14.3 years and mean BMI of 23.1 +/- 3.9 kg/m2. The common causes of ESRD were hypertension (60.1%) and diabetes mellitus (34.9%). In the follow-up period, 318 patients received the treatment over a total observation period of 3,262.2 patient-months. The patient survival was 51.0% at 3 years. Most of the patients (74.8%) had no peritonitis. There were 128 peritonitis episodes. The mean duration from starting CAPD to the first episode of peritonitis was 25.5 patient-months per episode. Staphylococcus spp. was the most common organism causing peritonitis which is the major cause of technical failure. The factors affecting peritonitis is included age > 60 years, hypokalemia (< 3.5 mEq/L), and hypoalbuminemia (< 3.5 g/dl). To improve clinical outcome of CAPD patients by decreasing the peritonitis rate, the factors affecting peritonitis should be corrected. The patients and care-givers should also be educated about the importance of hygiene and exchanging methods to decrease the peritonitis rate in CAPD patients.