Main Article Content
Background: Half of all of the end stage renal disease patients in Thailand use the continuous ambulatory peritoneal dialysis. They need surgical intervention for catheter placement permanently. This type of renal replacement therapy carry on many surgical complications; peritonitis, catheter malfunction and hernia e.g. these complications need surgical treatment.
Objective: Analyze clinical characteristic and factor which associated with surgical complications that need surgical treatment in the end stage renal disease patients who use the continuous ambulatory peritoneal dialysis who were underwent peritoneal catheter placement at Burapha University Hospital.
Material and Method: Reviewed the medical record of the end stage renal disease patients who were underwent peritoneal catheter placement at Burapha University Hospital between 1 August 2010 to 31 July 2016, collected data; sex, age, body weight, height, underlying disease, anticoagulant or antiplatelet usage, surgical technique, operating time, onset of first peritoneal dialysis after catheter placement, volume of dialysate and surgical complication were analysed to find the factor that influence the surgical complication.
Results: One hundred fifty six patients were recruited. Mean age 59.5 year (19-89 years) mostly (58.3%) in 40 to 60 years old range, body mass index mostly normal range (64.7%), anticoagulant or antiplatelet usage 12.8%, diabetes mellitus 12.8%, mostly were below umbilical incision for catheter placement (79.5%), operating time mostly less than 1 hour (95.5%), first peritoneal dialysis mostly more than 7 days after surgery (97.4%) and dialysate volume mostly 1.5 litres (58.9%). Overall surgical complications were 78 patients (50%) mostly were infection (29.5%) (28.8 patient-month), catheter malfunction 14.1%, hernia 4.5%. Factor associated with infection was diabetes mellitus odds ratio = 2.78 (95% CI 1.0681 - 7.2239), p = 0.0362. Factors associated with hernia were diabetes mellitus odds ratio = 11.08 (95% CI 2.2732 - 54.0395), p = 0.0029 and first peritoneal dialysis less than 7 days after surgery odds ratio = 29.40 (95% CI 3.4139 - 253.1910), p = 0.0021.
Conclusion: The first three surgical complications of the end stage renal disease patients who use the continuous ambulatory peritoneal dialysis were infection, catheter malfunction and hernia. Diabetes mellitus increased risk of infection that need surgical removal of catheter and increased risk of hernia that need surgical repair. The first peritoneal dialysis less than 7 days after surgery increased risk of hernia in peritoneal dialysis patient.
2. Korzets Z, Korzets A, Golan E, Zevin D, Bernheim J. CAPD peritonitis--initial presentation as an acute abdomen with a clear peritoneal effluent. Clin Nephrol. 1992; 37(3): 155-7.
3. Li PK-T, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, et al. ISPD Peritonitis recom-mendations: 2016 update on prevention and treatment. Perit Dial Int 2016; 36: 481–508.
4. Thailand Renal Replacement Therapy Registry 2015 Report. สมาคมโรคไตแห่งประเทศไทย[Cited 2018 August 1]. Available from https://www.nephrothai.org/images/Final_TRT_report_2015_%E0%B8%89%E0%B8%9A%E0%B8%9A%E0%B9%81%E0%B8%81%E0%B9%84%E0%B8%82.pdf
5. Dhanakijcharoen P, Sirivongs D, Aruyapitipan S, Chuengsaman P, Lumpaopong A. The “PD First” policy in Thailand: three-year experiences (2008-2011) J Med Assoc Thai. 2011; 94 (Suppl 4): s153-61.
6. del Peso G, Bajo MA, Costero O, Hevia C, Gil F, Diaz C, et al. Risk factors for abdominal wall complications in peritoneal dialysis patients. Perit Dial Int 2003; 23:249–54.