Continuous Ambulatory Peritoneal Dialysis in South Africa -A Four-Year Experience

Abstract

This study describes our experience with continuous ambulatory peritoneal dialysis (CAPD) over a four year period, during which 88 patients were offered CAPD. It compares and contrasts the response to CAPD among four racial groups in Natal viz asiatics, blacks, coloureds and whites. Peritonitis -the major complication, occurred with an overall incidence of one episode every 4.41 patient months. CAPD remains a useful alternative therapy in developing countries where a high percentage of patients with chronic renal failure would be denied a chronic renal failure program because of lack of expertise in hemodialysis and/or renal transplantation, or limited financial resources. Continuous ambulatory peritoneal dialysis (CAPD) was first described by Moncrief and Popovich (1) and, since its modification by Oreopoulos and his group (2), this technique has gained world wide usage. South Africa, like many developing countries has a high incidence of end-stage renal disease (ESRD) but because of lack of resources and economical problems, few patients with ESRD can be treated by dialysis or renal transplantation. CAPD affords a relatively simple and inexpensive form of therapy for these patients. At the present time about 200 patients are on CAPD in South Africa. Natal, the smallest of four provinces in South Africa, has a population of about five million, the majority being blacks. The minority groups include whites, asiatics and coloureds. There is only one chronic dialysis centre in Natal; situated in Durban, it serves the entire province including parts of the Transkei. This paper describes a four-year experience with CAPD in this mixed population and discusses problems unique to this situation.

Continuous Ambulatory Peritoneal Dialysis - A South African Experience

“…Between 1979 and 1983 the incidence of peritonitis was 2.72 episodes per patient year (2). Since then the incidence has ranged between 2.09 in 1985 and 3.1 episodes in 1987 and 1988 (Tab.…”

“…The vast majority of our population in Natal are blacks, most of whom reside either in a rural environment or in peri-urban areas lacking basic ablution and sanitary facilities. For this reason our initial experience with CAPO in these patients was poor (2). We therefore realised that we had to include an "acceptable" socio-economic status to the list of other desirable attributes for CAPO to be a success, i.e.…”

“…Consequently only 2 per million population (PMP) in Natal on chronic dialysis are blacks, compared to 20 PMP of "mixed" racial origin, 55 PMP Indians and 59 PMP whites (1). To alleviate this situation we started a CAPD program in May 1979 to treat patients who would otherwise have been rejected (2). In this study we attempted to ascertain the viability of CAPD over the first ten years of its existence at our centre.…”

Exploring the bio-psychosocial effects of renal replacement therapy amongst patients in a state hospital in South Africa

“…However, this is not always a feasible option, leaving patients to depend on HD and CAPD despite both treatments being costly. CAPD is associated with advantages like better nutritional status, freedom of mobility, control of blood pressure and fluids and better rehabilitation (Naicker 2003;Parsoo et al 1984). In a quantitative study Lok (1996) concluded that CAPD patients experience a higher quality of life than HD patients.…”