Organizational aspects of continuous ambulatory peritoneal dialysis (CAPD)

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The treatment of end-stage renal disease (ESRD) with peritoneal dialysis has entered a new era with the development of continuous ambulatory peritoneal dialysis (CAPD). Since the initial description of this continuous internal dialysis procedure by Popovich et al,1 it has fulfilled early expectations and continues to generate enthusiasm in the treatment of ESRD. Our early experience with CAPD has reinforced the previously reported views of Oreopoulos2 calling for involvement of a well-organized and experienced medical-care team in the evaluation, initiation of treatment, and long-term follow-up of patients on CAPD. Only through a program addressing total needs in evaluation, training, and follow-up of patients will CAPD mature and become a viable alternative to other forms of dialysis. We describe the organizational philosophy and current approach to CAPD at The Cleveland Clinic Foundation.

The organizational framework for CAPD focuses on a number of essential steps in evaluating and training patients for this program. The “essential core” for our program is a dedicated team approach generating a thorough initial evaluation for selection, support during the training period, and continued interest in the needs of the patient after completion of the program. The primary structure of the CAPD program at the Cleveland Clinic is shown in the Figure.

Selection of patients

During the initial phase of our CAPD program, an effort was made to consider primarily patients doing poorly on the present form of dialysis, i.e., in-center or home hemodialysis or intermittent peritoneal dialysis (IPD). As our experience has increased we are considering CAPD . . .



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