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Peritoneal Dialysis
CAPD, CCPD, and IPD should be offered as an
alternative to chronic renal failure, in any dialysis unit,
and this modality of therapy should be available at least in a
referral hospital in any region. CAPD is preferable to IPD,
APD (automated) should be available for clinical necessity
(high transporter status of preitoneum and loss of
ultrafiltration), psychological reasons or in small children.
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- A
trained nephrologist ratio of one for every 50
patients.
- A
trained nurse ratio of one to 20 patients.
- Dietician
ratio 1:50 patients.
- Social
worker ratio 1:50 patients.
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A
room inside or close to the hemodialysis unit should
be available for training and follow-up of CAPD
patients.
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Basic
equipment: a scale, fluids heaters, illustrative
posters and movable chairs should be available.
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An
operation manual should be established in any CAPD
clinic by the treating team (procedures, follow-ups,
and protocol of therapy etc.).
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- Disconnect
(Y) shape connecting systems are superior to the
earlier (straight) systems.
- Solutions
for CAPD.
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- Regulations
of practice
Those
standards listed for patients on hemodialysis which
apply equally to peritoneal dialysis are:
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Correction
of Anemia.
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Nutritional
status.
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Biochemical
profiles.
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Prevention
of transmissible.
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Infections
to patients and staff.
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Correction
of acidosis is readily achieved by the use of higher
lactate PD fluids and calcium carbonate. The steady
state serum bicarbonate level should be within the
normal range.
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Peritoneal
equilibration test is recommended in special
situations of loss of ultrafiltration and poor
biochemical control.
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Dialysis
adequacy: Current targets of adequacy of dialysis by
CAPD. Weekly KT/V of urea > 1.7. Total weekly
creatinine clearance > 50 L. at protein intake
> 1.0 g/kg/day.
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The
minimum recommended standard for acceptable rates of
peritonitis and its evaluation. Peritonitis rate
< 1 episode / 18 patients months. Culture
negative rate < 10%. Initial cure rate of
peritonitis > 80% (without removal of catheter).
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Guidelines
for insertion of peritoneal access catheters and
subsequent care have been published.
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Outcome
measures of patients and technique survival are
functions of case-mix, availability of appropriate
dialysis facility and patient related factors.
Similar recommendations to survival data of
hemodialysis apply here.
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Personnel
Specifications are available at SCOT for
the qualifications required of the personnel in a
transplant center.
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Transplant
center
Specifications are available at SCOT for
transplant centers (see regulations of
transplantation on our web site).
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The
protocol of the most commonly used medications in
immunosuppression is available at SCOT.
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Regulation
of practice.
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It
is advised to check the directory of the regulations of organ
transplantation in the Kingdom of Saudi Arabia for selection
of donors and recipients of kidney transplants (see
regulations of transplantation on our web site).
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Survival
of patients and grafts
depends on the comorbid conditions at time of
transplantation. However, one year patient survival
> 95% and subsequent annual death rate of <5%
can be achieved. First cadaveric grafts survival
should exceed 80% at one year and 70% at five years.
Grafts survival in highly sensitized patients (PRA
> 85%) and other high risk groups (for example
some diabetics) is less (approximately 75% at one
year). Patient and allograft survival with well
matched life related donors should be close to 100%
and 90% respectively at one year with subsequent
annual death and graft failure rates of <2.5%. A
method of assessing graft survival, with exclusion
of functioning grafts lost because of a patient's
death from other causes, is appropriate.
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