Abstract
Objective: CAPD is a well recognized mode of dialysis for patients with end stage renal diseases for ESRD patients in Pakistan now. It is an accepted mode of dialysis for ESRD patients from remote rural areas who have no access to hemodialysis centers in many countries in the world like Pakistan. The CAPD experience as renal replacement therapy in Pakistan is limited and publications are very few. The purpose of this retrospective study was to report the outcome of CAPD in ESRD patients from predominately rural areas of KPK province of Pakistan and adjoining areas of Afghanistan who had no access to hemodialysis near their residence.
Design: Retrospective study
Setting: At District headquarter teaching Hospital Dera Ismail khan and Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar, KPK, Pakistan.
Material & Methods: All ESRD patients who were initiated on CAPD from January, 2005 to January, 2010 who had regular follow up were included in the study.
Results: A total of 50 patients were analyzed in this study. There were 36 male and 14 female. The mean age was 47.5 years (15 years to 80 years).A total of 43(86%) pts were from rural area and 3 (14 %) from urban area. 38 patients took CAPD as their first modality of dialysis while 12 patients choose it as a second modality after being on hemodialysis for some months. The etiologies of end stage renal stage were as follows Chronic Glomerulonephritis 18( 36.36%), Hypertension 12(27.27%)%, Diabetes Mellitus 11 (22.72%), Calculus disease 5(4. 55%), Idiopathic 2(4.55%) and Adult polycystic kidney disease in 3(4.55 %) patients. The total follow up was 642.40 patients-months.8 patients had Tunnel or exit-site infection, 5 patients had catheter malposition, outflow failure and abdominal discomfort. There were 30 episodes of Peritonitis. There was 53.53 patient-years of experience. The rate of peritonitis was 1 episode per 21.40 patient-months or 0.56 per patient-year during the treatment period. In 4 patients Tenckhoff catheter removed due to refractory peritonitis within 6 months of insertion. 3 patients had a successful renal transplant. 11 patients switched to hemodialysis due to nonaffordabilty of daily cost of CAPD after 8 months of CAPD. The patient survival at 1, 2 and 3 years was 63.63,41 and 22 %, respectively.
CONCLUSIONS: Continuous ambulatory peritoneal dialysis is better, cost effective,viable and safe mode of dialysis for remote rural areas of Pakistan and adjoining Afghanistan who had no access to hemodialysis at big cities.

Key words: CAPD, Pakistan, rural areas, peritonitis, Afghanistan.