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Continuous Ambulatory Peritoneal Dialysis (CAPD) In Chronic Kidney Disease/End Stage

Renal Disease At Haji Adam Malik General Hospital Medan: 3 Years Experienced.

Ardiansyah Periadi Sitompul, Yacobda H. Sigumonrong

Urology Division, Departement of Surgery Faculty of Medicine USU / Adam Malik General
Hospital Medan

Background

Chronic Kidney Disease (CKD) is defined as persistence abnormalities of the glomerular


filtration rate (GFR) by various causes. The working group of the National Kidney Foundation,
United States, Kidney Disease Outcomes Qualitaty Initiative (K / DOQI) Advisory Board
recommended that CKD is defined as an injury to the kidney for 3 months which resulted in a
(1)
GFR less than 60 mL / min / 1.73 m2 . CKD and End Stage Renal Disease (ESRD) has a high
prevalence in the world in both industrial and developing countries and changed the
epidemiology in the last decades, especially in developing countries with diabetic neofropati now
assumed to be an epidemic. An estimated 20-25 million people in the United States have CKD (2).

In developing countries, the morbidity and mortality of ESRD is still high at around 22%. In
Indonesia, the prevalence of kidney failure in 2002, increased from 290 per 1 million population
to 350 per 1 million population. The high incidence of patients with ESRD will increase the
number of patients who will be treated with dialysis and transplantation is predicted to increase
from 340.00 in 1999 and will reach 651,000 in 2010 (3, 4).

Morbidity and mortality can be reduced if the patient gets Renal Replacement Therapy (RRT).
So far there are 3 types of RRT is hemodialis, peritoneal dialysis, and kidney transplantation.
Continuous ambulatory peritoneal dialysis (CAPD) has been the management of patients with
ESRD, and an estimated 150,000 patients using CAPD in the world (5).

In developing countries with peritoneal dialysis patient population is likely to increase. This
happens because it is considered that peritoneal dialysis is as well as hemodialysis even some
studies suggest that peritoneal dialysis is more superior than hemodialysis. Some studies were
conducted to compare the use of hemodialysis and peritoneal dialysis based on aspects of quality
of life, the survival rate, even at the cost. Huang mentioned that there is no difference in the

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survival rate for a long time between hemodialis and peritoneal dialysis (6). Research in Canada in
2012 mentions, peritoneal dialysis showed the same survival rate significantly compared with
(7)
hemodialysis, especially in younger patients, especially in the first 2 years of therapy .
Peritoneal dialysis is also more favorable than the other RRT compared from the aspect of cost.
Estimation and comparison of costs of RRT in Spain found that peritoneal dialysis is cheaper at
cost (8).

In the Haji Adam Malik General Hospital, peritoneal dialysis is one of the RRT used rather than
hemodialysis. However, data on the use of peritoneal dialysis has not been published. Sanglah
Hospital, from the period of June 2004 to February 2006 found 31 patients with CKD / ESDR
mounted CAPD catheters with the number of comparisons between men and women is almost
(12)
the same, namely 16 and 15, and the age of majority in the age group 40-49 years . In dr.
Sardjito, from 1995 to May 2007 there were 182 patients with CKD / ESDR performed CAPD
catheters with a complication rate of 17.4%.

This study aims to determine the characteristics of CAPD patients at the hospital. Haji Adam
Malik based on age, sex, education, etiology, and complications after CAPD.

Research methodology

The research was conducted at Adam Malik General Hospital from January to June 2015. This
study is a retrospective descriptive study. The samples in this study were all patients with CKD /
ESRD in Adam Malik Genral Hospital and carried CAPD in January 2012 until January 2015.

Data were collected by seeking medical records of patients who did CAPD and then the patient
characteristics such as age, sex, and education of patients were recorded. The etiology of CKD /
ESRD and complications arising after doing CAPD later also recorded. The research data
obtained will be analyzed descriptively using SPSS 20. After the results of the data analysis will
be presented in tabular form and narrative.

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Results

From the results of a retrospective study obtained during the January period 2012 to June 2015
found 51 patients with CKD / ESRD who use CAPD in Adam Malik General Hospital with an
average patient age of 35.29 years old, the youngest is 2 years old and the oldest is 85 years old.
From this study, patients with CKD / ESRD were more found in the age group > 21-30 years
(25.5%).

Tabel 1: Characteristic Patients with CAPD in Adam Malik General Hospital based on Age

Age Group Number Percentage


(Years) (%)
< 10 3 5.9
10-20 7 13.7
21-30 13 25.5
31-40 8 15.7
41-50 8 15.7
> 50 12 23.5
Total 51 100%

Patient Distribution Based on Sex


From 51 patients who underwent surgery during the period CAPD catheters during the January
period 2012 to June 2015, obtained a equal comparison between men and women. The number of
male patients was 26, while women was 25 (Figure 1).

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Tabel 2: Patient Characteristics with CAPD in Adam Malik General Hospital

Characteristics Number Percentage


Number of Patients
Total 51
Men 26 51
Women 25 49
Level of Education
Uneducated 4 7.8
Elementary School 8 15.7
Junior High School 10 19.6
Senior High School 19 37.3
University 10 19.6
Occupation
Housewife 16 31.4
Entrepreneur 10 19.6
Government Employee 8 15.7
Student 12 23.5
Farmer 3 5.9
Jobless 2 3.9

Etiology
GNC 20 39.2
Hipertension 21 41.2
Diabetes Melitus 6 11.8
Obstruction and infection 3 5.9
Nephrotic Syndrome 1 2
Complication
Bad Catheter 4 7.8
Bleeding 1 2
Post Op Infection 1 2
Peritonitis 0 -

Patient Distribution Based on Level of Education


The majority of the education level of CAPD patients at Adam Malik General Hospital from
January period 2012 to June 2015 was high school graduation in the amount of 19 people or
37.3%. There were 4 patients or 7.8% are not in school because it was still under school age.