Peritonitis profile in a cohort of extreme poverty patients on continuous ambulatory peritoneal dialysis-5 year experience from a South Indian public private partnership model PD programme

Abstract

Introduction Limitations in finance and education is thought to translate into poor technique , understanding and thereby into higher incidence of peritonitis and ultimately poor patient and technique survival. This notion sometimes leads to such patients being denied Continuous Ambulatory Peritoneal Dialysis (CAPD). Methods: In 2013, 20 patients were initiated on CAPD under a Public Private Partnership (PPP) model project in Karnataka province, India. By regulation, they were required to belong to Below Poverty Line (BPL ) category which is a measure of extreme poverty. BPL is the equivalent of earning less than a dollar per day. They were followed up for peritonitis, technique and patient survival besides overall performance. Results: 20 patients were included ( Male: 60%, Mean age 56.7 years, Diabetic Nephropathy 48%). Peritonitis rate was 1 in 33.8 patient –months, with 3 episodes of Fungal Peritonitis (FP) including one of Candida Hemolunii. All FP led to termination of CAPD. Coagulase-Negative Staphylococcus (CoNS) was the most common pathogen isolated , accounting for 60% of the episodes. Technique survival was 15% and patient survival was 20% at 5 years. Cardiovascular disease, sepsis, and malignancy accounted for majority of the deaths. Conclusions: Patients with background of extreme poverty had peritonitis rates comparable to good centres, however patient survival at 5 years was lower. Educational or economic considerations did not seem to be an impediment to successful CAPD.