Newer modifications of peritoneal dialysis: options in the treatment of patients with renal failure.

Experience with peritoneal dialysis for the treatment of 69 patients suffering from renal failure is reported. Chronic intermittent peritoneal dialysis (CIPD) was used in 49 patients, and continuous ambulatory peritoneal dialysis (CAPD) in 34 patients. CAPD was well accepted by patients, and resulted in maintenance of laboratory parameters in a range similar to that achieved by hemodialysis and by CIPD. However, peritonitis occurred with a higher incidence in CAPD (one per 7.2 patient-months) than in CIPD (one per 19.2 patient-months). All episodes of peritonitis were caused by only 40% of the patients, and in CAPD, patients who developed peritonitis in the first 4 weeks of treatment were the most likely to develop repeat episodes. An organism was identified in 81% of cases, of which 50% were due to Staphylococcus, 16% due to Streptococcus, 5% due to Candida and the remaining 29% were due to gram-negative organisms. In addition to CAPD, we introduced an automated modification of prolonged-dwell peritoneal dialysis (PDPD) that is applicable to a larger number of patients. In 11 patients PDPD proved comparable to CAPD in ameliorating the laboratory parameters measured, but was associated with lower incidence of peritonitis (one per 18.2 patient-months).