ABSTRACT. To evaluate the complications of CAPD and their contributing factors in order to improve the patients’ survival and reduce morbidity and mortality, we studied records of 65 CAPD patients treated at our hospital from October 1996 to January 2002. There were 32 (49%) males and the mean age of the patients was 48  16 years. All the patients were on the twin bag CAPD system. The mean duration of follow-up on CAPD was 29  20 months. There were 75 episodes of complications occurring in the patients with a rate of 0.41 episodes/patient years. Peritonitis was the most frequent and serious complication accounting for 55 episodes with a rate of 0.35 episodes/patient years. Only 51% of the episodes showed positive culture; the organisms included Staphylococcus epidermidis (18.2%), Staphylococcus aureus (3.6%), Pseudomonas (16.4%), E. coli (1.8%), Azadobacter (5.45%) and Serratia (3.6%). All the episodes of infection, except one, responded to treatment but 10 patients had recurrent infection; one patient was cured only after removal of the catheter. There were 12 exit site infection episodes and five catheters were removed due to mechanical and infectious reasons. Three patients were switched to hemodialysis (HD), nine patients were transplanted and 11 patients expired; none died due to peritonitis. We conclude that the mortality rate of the complications on CAPD has declined in the present study compared to our previous report early in the 1990s due mostly to the adoption of the twin bag CAPD system.

Key Words: CAPD, Peritonitis, Chronic Renal Failure, Complications, Infection.
 

Sexual Dysfunction in Male Patients Undergoing Hemodialysis in Morocco

Mohamed Zamd, Mohammed Benghanem Gharbi, Benyounès Ramdani, Driss Zaïd

Nephrology Department, Ibn Rochd Hospital, Casablanca, Morocco
 

ABSTRACT: Sexual dysfunction impairs the quality of life of patients undergoing hemodialysis (HD). The aim of this study was to evaluate the prevalence and the nature of sexual dysfunction in a Moroccan cohort of patients with chronic renal failure (CRF) on HD. This cross-sectional study was carried out with a questionnaire in 86 patients undergoing hemodialysis. Clinical and biological investigations were done. The mean age of our patients was 46.27  15.68 years old. 81.4% of the cases suffered from a decrease in sexual activity after the onset of HD. The decrease or the loss of libido was noted in 59.3% of the cases. Total impotence was present in 22.1% of the cases and 36% reported partial impotence. Ejaculation was present in 86% of the cases. The comparison between the group of patients who had no sexual dysfunction (group I) and the group of those who had this problem (group II) showed significant differences of age, social status and sexual life before HD. Other significant differences were found regarding frequency of intercourses and sexual satisfaction. Group II was divided into 2 subgroups: IIA included patients who had sexual dysfunction before HD and IIB: those who developed it after. The comparison of this subgroups showed that differences were significant regarding age, weight and vascular risk factors (diabetes mellitus, atherosclerosis). Sildenafil was more efficient in the patients of the subgroup IIB. This study suggested that HD was one of many factors causing sexual dysfunction in hemodialysed patients. After this clinical evaluation of sexual dysfunction, we emphasize the value of a global approach of this problem. The use of sildenafil seems to be more valuable in young patients with erectile dysfunction which appeared after long dialysis duration.

Key Words: Sexual dysfunction, Impotence, Chronic renal failure, Hemodialysis.
 

ABSTRACT. Renal transplantation is considered the optimal form of renal replacement therapy for patients with end stage renal disease. Kidney transplantation was started in Iraq in 1973 at Al-Rasheed military hospital after Jordan in 1972 and Lebanon in 1973. In this study we analyze retrospectively the data of (182) kidney recipient patients selected randomly from 1979 to 1999, including (165) male and (17) female patients. Their age ranging from 18 to 54 years and the follow up period was 0 to 240 months postoperatively. The average duration of dialysis before transplantation was 4 to 5 months. The donors in most instances were live related (89.6%). The immunosuppressive imereg include both double and triple therapy and all episodes of rejection were treated with pulse methyl prednisolon. The patient survival rates at 1, 5 and 10 years were 82.9%, 79.7%, and 71.2% respectively while the graft survival rate at 1, 5 and 10 years were 83.5%, 64.5% and 61.6% respectively. These results were found to be comparable to the average values of Arab countries reported in the survey of Arab Society of Nephrology & Renal Transplantation (ASNRT) in 1999. All the medical and surgical complications encountered in our series are described and discussed and the effect of sanction imposed on Iraq is clarified.

Key Words: Kidney transplantation, Long term complications, Iraq.