[Role of continuous ambulatory peritoneal dialysis (CAPD) in a program for the treatment of chronic renal insufficiency. Problems posed by transfer of CAPD to transplantation or hemodialysis].

Continuous ambulatory peritoneal dialysis (CPAD) is a fully recognized method for treating end stage renal disease patients. However, literature data in agreement indicating that CAPD is a treatment modality for short to mid-term period. Largest series show that technical survival for CAPD averaged 50% at 3 years. Transplantation, curing temporarily ESRD patients, represents a success exit for CAPD in only 25 to 30% of patients. CAPD does not impair long term success of renal graft. Post-operative morbidity related to peritoneal catheter (exit skin infection and peritonitis) and abdominal problems represents a significant risk that should be prevented by appropriate measures. Hemodialysis transfer, failure of the method, represents an exit modality in 50 to 60% of patients. Whatever causes of CAPD failure, psycho-social difficulties, inadequacy of dialysis, edema due to fluid excess, malnutrition, severe peritonitis, transfer to hemodialysis must be considered as soon as possible to prevent deleterious effects on patient survival. Such facts indicate that CAPD program must be associated with large and appropriate withdrawal hemodialysis facilities. CAPD may be also a waiting modality for hemodialysis patients faced with temporary or repeated vascular access problems. In this last case it must be emphasized that hemodialysis to CAPD transfer will reduce "dialysis dose" efficiency (e.g., urea Kt/V) by 50%. We conclude that rationale use of CAPD would provide an excellent treatment modality for end stage renal disease patients for a short or mid-term period of time.