Incidence and Clinical Characteristics in Infected CAPD Patients in Sisaket hospital Between 2018 - 2020

Abstract

Continuous Ambulatory Peritoneal Dialysis (CAPD) is considered one of the effective dialysis ways for end-stage patients, which is cost-effective and available for self-care at home. However, the number of peritonitis cases, leading to the cause of death among those CAPD patients had increased and become a major concern currently. The objective is to study the associated factors related to Peritonitis among CAPD patients registered in Sisaket hospital during 2018-2020. 505 Data have been selected from the Home-Visited record of CAPD patients and In-patient records. The descriptive method has been used to describe the average, frequent and percentage of factors such as No self-training education program, cannot follow the steps of training, and Poor environmental factors. Clinical factors such as patient survival rates, dropout rates, and severity of peritonitis are also included in the analysis. From data have been female more than male, the average age is 59 years old and over 60. The average income is 5,000 baht per month. The average visit due to peritonitis is 1 time per year. 74.1% Visit the hospital once a year. 79.2% of participants have underlying diseases, which hypertension and diabetes mellitus. From the nutritional record, participants with BMI lower than 23 are 93.1%. Participants with serum albumin lower than 3g/dl are 97.4%, and Hemoglobin lower than 11g/dl is 95.5%. After sending Peritoneal Culture for gram-negative bacteria, 73.1% are culture positive, which 21.6% were Escherichia and Klebsiella. The gram-positive culture was 26.8%, of which 16.8% were found to be Coagulase-negative staphylococci. The study also found that gram-negative caused more death than gram-positive. According to the knowledge and ability to follow the training steps, those who had peritonitis tended to have a poor environment, were unable to follow the training steps and had not passed the training. 54.4% were discharged and 33.7% were sent back to continue treatment at local hospitals. 35.4% were able to be removed the Tenckhoff catheter. 44.9% of participants continue CAPD treatment while 62% switch to hemodialysis, 38% death and 5.8% dropped off. As result, the surveillance of age, sex, socioeconomic status, underlying diseases and reinfection in the first 5 years are factors needed to be aware to reduce the prevalence of infected CAPD cases. In addition, hypoalbuminemia and low BMI condition should be early detected and treated in order to reduce the risk of CAPD infection. Gram-negative bacteria are the most common organism found from laboratory culture in infected CAPD cases, due to the contamination in the CAPD process and poor hygiene. Therefore, intensive training patients and caregivers are one of the solutions to reduce the infectious rate. Moreover, local government and related community healthcare should support patients and caregivers to organize a clean environment and ventilated living areas. On this account, this could increase the quality of life and long term care to ESRD patients.