6 YEARS EXPERIENCE WITH CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS ANDCHRONIC-HEMODIALYSIS IN SAUDI CHILDREN

Eighty children with End Stage Renal Disease (ESRD) were treated in ou r unit over a six year period. Forty-eight were treated with CAPD (mea n age = 5.8 years) and thirty-two with HD (mean age = 8.2 years). The average duration of treatment was 14.8 months in the CAPD group and 14 .2 months in the HD group. There were 22 failures of peritoneal cathet er in the CAPD group out of 70 catheters compared to 19 failures of va scular access devices out of 45 in the HD group. Peritoneal catheter f ailure was due to resistance or recurrent peritonitis in 10 (45.4%) an d obstruction in nine (41%), whereas vascular access device failure wa s due to thrombosis in six (31.5%) and infection in five (26.3%). Fift een (31.3%) of the CAPD patients died and eight (16.7%) transferred to HD, whereas five (15.6%) HD patients died and four (12.5%) transferre d to CAPD. The three year actuarial rates for CAPD were 81% at one yea r, 55% at two years and 42% at three years, while for HD was 94%, 85% and 64%, respectively. In this unique experience at the Kingdom so far , we found that a fully integrated service of dialysis including both CAPD and HD are essential. Such a system allows the optimal mode of tr eatment to be chosen for a child at any time and allows the child to m ove freely from one treatment to another when needed.