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CAPD on Long-term in India

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Dr Ram, Tirupati    29 December 2018

  • A study by Georgi Abraham on predictors of long-term survival on peritoneal dialysis (PD) suggested the following: Technique survival 3 years and longer on continuous peritoneal dialysis (CPD) is considered rare in South Asian regions. The dropout rate decreased to about 25% in 2006, compared to 51% a decade ago. The major causes of dropout, thereby reducing PD survival to <3 years, were sudden CV death in diabetics, unresolved peritonitis, inadequate dialysis due to cost constraints, suboptimal ultrafiltration and malnutrition. In the study, ultrafiltration volume was 1377 ± 452 mL/day at the start of therapy and 1400 ± 461 mL/day after 3 years. BP was 143/88 mmHg at the start of therapy and 136/85 mmHg after 3 years. The average PET characteristics (high-average and low-average transport status), which reflect beneficial peritoneal membrane properties, were in accordance with other studies showing technique survival. Peritonitis rate in patients who survived ≥3 years was 1 episode in 75 patient-months during the first 3 years and 1 episode in 30 patient-months subsequently. The majority of patients that survived belonged to the reimbursement group or the one lifetime payment group. This financial arrangement can be emulated in other developing regions of the world for the success of CPD. Icodextrin-based solutions at cost-effective rates can prolong technique survival, which in turn translates into enhanced patient survival in developing countries.
  • It has been shown that home visit by a Nephrologist is associated with 1-year technique survival of 54% compared to 36% with home visit by CC.
  • PD and Government - There is hardly any government financial support in several states of India.
  • Domestic manufacture of PD fluid and accessories in India, China, South East Asia and Latin American countries has reduced the cost of treatment. In Asia and Africa, if the dialysate manufacturing companies bring down the cost of their products on par with the GDP per capita income, a positive effect will be seen on PD utilization. In continuous ambulatory PD (CAPD) patients with high transport status, vegetarianism leads to progressive depletion of serum albumin stores impacting survival. They should be closely monitored for malnutrition by subjective global assessment while on CAPD, as nutritional intervention can slow down or improve malnutrition without switch to hemodialysis.

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