CAPD THE SAUDI EXPRIENCE THE SAUDI EXPRIENCE

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

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

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

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

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

KKNGH experience current status 65 patients on dialysis 65 patients on dialysis 43 are on haemodialysis 43 are on haemodialysis 22 are on CAPD 34% 22 are on CAPD 34%

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

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

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

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

KKNGH experience hepatitis status 3 patients only had HCV(10%) compared to 50% incidence in the haemodialysis patients 3 patients only had HCV(10%) compared to 50% incidence in the haemodialysis patients

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

KKNGH experience peritonitis The main organism was Gram+ve bacteria (60%) The main organism was Gram+ve bacteria (60%) 20% culture negative 20% culture negative 10% Gram-ve Bacteria 10% Gram-ve Bacteria 10% Tuberculous and fungal 10% Tuberculous and fungal

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

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

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

CAPD Eastern province experience 31 patients were recruited over five years in Dammam central hospital 31 patients were recruited over five years in Dammam central hospital 21 women and 11 men 21 women and 11 men Mean age Mean age Saudi J Kid Dis (4) 511

CAPD Eastern province experience The main indication for CAPD was poor or failed vascular access The main indication for CAPD was poor or failed vascular access Saudi J Kid Dis (4) 511

CAPD Eastern province experience Peritonitis rate was 0.62 episode per patient per year Peritonitis rate was 0.62 episode per patient per year Staphylococcus epidermidis was the main causative organism Staphylococcus epidermidis was the main causative organism Therapy with CAPD lasted months Therapy with CAPD lasted months

CAPD Central province experience CAPD was started in 1986 in the university hospital in Riyadh CAPD was started in 1986 in the university hospital in Riyadh The peritonitis rate improved to be one episode patient month The peritonitis rate improved to be one episode patient month There was a careful selection criteria There was a careful selection criteria Saudi J Kid (1)

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