Continuous ambulatory peritoneal dialysis (CAPD) in patients with diabetes mellitus and chronic renal failure. Use of erythropoietin for treatment of anaemia of chronic renal failure - abstract

ABSTRACT

The renal replacement options in ERSD are (1) Haemodialysis (HD) in hospital or at home; (2) Peritoneal Dialysis intermittent (IPD), continuous ambulatory (CAPD), continuous cyclic (machine) (CCPD); (3) Renal transplantation living donor kidney and cadaver donor kidney and (4) Haemofiltration. Since 1979, there has been a phenomenal growth in the number of patients on chronic peritoneal dialysis, increasing from 2,000 patients worldwide to over 75,000 in 1992. This accounts for 14 per cent of patients on dialysis worldwide. The percentage of patients on CAPD is 6 percent in Japan, 51 percent in the United Kingdom and 93 percent in Mexico. CAPD is the cheapest form of dialysis in Europe and Canada and as cheap as home haemodialysis in the USA. In the USA, 1 in 3 new patients commenced on CAPD is diabetic. Data from the United States Renal Data System (USRDS) show that for primary renal disease in the non-diabetic, survival on CAPD is as good as haemodialysis. In the diabetics younger than 50 years, survival on CAPD is better than HD, but, over 50 years, there is no difference in survival. This applies for both Blacks and Whites. There are advantages for CAPD for diabetic patients when compared to HD. There is rapid establishment as with home therapy, training usually taking about three weeks; a partner is not essential; there are fewer hypotensive episodes and there is minimal stress on the cardiovascular system. One of the main disadvantages is peritonitis. Other less common problems are obstruction of the peritoneal catheter, tunnel infections and peritoneal thickening, leading to loss of peritoneal membrane surface. The main symptoms and signs of peritonitis are cloudly dialysate fluid, fever, abdominal pain and tenderness. Major improvements in the type of catheter, the type of giving sets and aseptic techniques have led to reduced incidence of peritonitis and patient mortality. The use of Erythropoietin in Patients with Chronic Renal Failure - Erythropoietin is normally produced in the peritubular interstitial cells of the kidneys. About 10 percent is produced in the liver, and there are no pre-formed stores of erythropoietin. Hypoxia increases de novo production of erythropoietin. It recruits and maintains the survival of the erythroid progenitor cells and promotes their maturation. The main condition in which erythropoietin is deficient is chronic renal failure, but it has also been found deficient in patients with cancer, chronic inflammations and chronic infections. Erythropoietin has been produced by genetic engineering, and its major indication is for the treatment of anaemia of chronic renal failure patients on haemodialysis, CAPD and also for predialysis patients (AU)