The Outcome of Continuous Ambulatory Peritoneal Dialysis Therapy under the Universal Coverage Scheme in Maharat Nakhon Ratchasima Hospital: the First Year of Peritoneal Dialysis Policy

Abstract

          Background: Since 2008, a 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. Maharat Nakhon Ratchasima Hospital has been the first hospital in Nakhon Ratchasima Province that began CAPD program under the UCS for ESRD patients. Objective: To evaluate the clinical outcome of the patients with CAPD therapy at Renal unit, Maharat Nakhon Ratchasima Hospital, during the first year under the Universal Coverage Health System (UC). Patients & Methods:  Medical records of adults with newly diagnosed ESRD undergoing CAPD under UC in Maharat Nakhon Ratchasima Hospital during January 1-December 31, 2008 were reviewed. The collected data included demographic details, underlying diseases, body mass index (BMI), laboratory findings, peritonitis rate, death rate, technique failure and referral to other centers until December 31, 2008. The catheter survival analysis was also performed. Results:  Fifty-five ESRD patients were recruited, mean age was 47.9+14.2 years (range 15.4-76.8 years) and mean BMI was 22.4+3.3 kg/m2 (range 17.6-30.2 kg/m2). The common causes of ESRD were hypertension in 27.3% and diabetes mellitus in 18.2%. Laboratory findings in CAPD patients were anemia (100%), hypoalbuminemia (72.5%) and hypokalemia (49%). Tenckhoff catheters were inserted by nephrologists in 63.6% and by surgeons in 36.4%. The complications of Tenckhoff catheter insertion occurred in 20% of patients including abdominal bleeding, bowel perforation, bladder perforation, and catheter malposition. In the follow up period, 41 patients continued the treatment over a total observation period of 276.5 patient-months (mean 5.1+3.9 months, median 3.8 months). The mean time for the first episode of peritonitis was 10.7 patient-months per episode. At the end of December 31, 2008, one patient was referred to another center, 74.5% continued on CAPD, 7.3% switched to hemodialysis, 16.4% died (7 from sepsis and 2 cases from abdominal bleeding). Conclusion: The results suggested that the patient survival rate was low in our CAPD unit so we need to gain more experience with Tenckhoff insertion technique and with management of peritonitis in CAPD patients to increase the survival rate of our CAPD patients