How to Set up a Peritoneal Dialysis Program: Indian Experience

Abstract

C hronic ambulatory peritoneal dialysis (CAPD) was generally accepted as a renal replacement therapy in the developed countries since its first description by Popovich and Moncrief in 1975 (1). Oreopoulos popularized the therapy by substituting collapsible PVC bags for the glass bottles that held the dialysis fluid (1977) (2). The infection rate came down substantially with the introduction of the Y-system by Buoncristiani (1980) (3). The introduction of continuous cyclic peritoneal dialysis (CCPD) by Nakagawa, which incorporated automation by using a cycler, provided a free daytime for all procedures (1981) (4). INDIAN SCENARIO Although CAPD is a simple technique, it was not until 1990 that Abraham et al introduced and pOpUlarized it in India as an alternative to hemodialysis and as a bridge to transplantation in India (5). An elderly diabetic patient with left ventricular failure on hemodialysis was initiated on CAPD at Madras using the O-system, after implantation of a doublecuffTWH (Toronto Western Hospital) catheter for the first time. The Dianeal fluid (Baxter Healthcare, Deerfield, IL, U.S.A.) was imported, as there was no local manufacturer. The import of the fluid was strictly controlled by the Directorate of Health Services in New Delhi. This situation led to untold difficulties to the patient in terms of cost and delay in procuring supplies. In 1991, the first patient was initiated on CCPD using a portable cycler supplied by Medionics, (Markham, ON) Canada. The disposable ultrabag was introduced in 1993. Following repeated appeals by pa