Continuous ambulatory peritoneal dialysis: An option in the developing world?

Objective: To evaluate specified biomedical, socioeconomic, and psychosocial criteria as predictors of therapeutic success to optimize patient selection for continuous ambulatory peritoneal dialysis (CAPD) in a developing country. Design: A restrospective cohort study investigating the relationship between episodes of peritonitis and exit-site infection, and predetermined biomedical, socioeconomic, and psychosocial data. Setting: A CAPD unit in a large tertiary care teaching hospital. Patients: All 132 patients entering the CAPD program between 1987 and 1991. Results: Overall mean survival time on CAPD was 17.3 months. Peritonitis rates were high, especially among blacks. Multivariate analysis demonstrated that increased peritonitis rates were associated with age, black race, diabetes, and strongly so with several psychosocial factors. Because being black was strongly linked to poor socioeconomic conditions, repeat analysis excluding blacks showed the same associations with the above variables, but, additionally, several socioeconomic factors were associated with high peritonitis rates. No significant explanatory variables were shown for exit-site infections. Conclusions: The association of biomedical, socioeconomic, and psychosocial variables with high peritonitis rates has important implications for the selection of patients for CAPD in this setting.