Three years of clinical experience with continuous ambulatory peritoneal dialysis are summarized. Serum urea nitrogen, creatinine, hematocrit, nerve conduction velocity, calcium, inorganic phosphorus, serum proteins, and electrolytes have been maintained in acceptable ranges. Peritonitis, although reduced in incidence because of solutions in plastic bags and a new adapter, is still a problem. Excessive carbohydrate absorption, obesity, and high serum triglyceride concentrations may be long-term problems in some patients.

In five patients, peritonitis caused by uncommon agents was acquired during continuous ambulatory peritoneal dialysis. Three patients had yeast (two Candida albicans, one C parapsilosis), one Aspergillus fumigatus, and one Nocardia asteroides infections. A review of the literature indicates that yeasts are the most common cause of peritoneal dialysis-associated fungal peritonitis; only one other possible case of Aspergillus sp and no Nocardia infections have been proved, to our knowledge. Observations are recorded in reference to diagnosis and suggested methods of treatment.

Protein losses in peritoneal dialysate were determined in 220 exchanges from 19 patients undergoing continuous ambulatory peritoneal dialysis. With four exchanges per day, mean protein losses in 79 dialysate collections over 24 h were 12.2 g. Protein losses per exchange increased with cycle time, however, protein losses per day were greater with more exchanges per day.

Continuous ambulatory peritoneal dialysis (CAPD) might result in peritoneal membrane changes. First, CAPD exposes essentially continuously the peritoneum to peritoneal dialysis solutions. Such solutions differ from the usual extracellular fluid bathing peritoneal tissues. Second, this technique may be complicated by an increased frequency of peritonitis when compared to intermittent peritoneal dialysis. We undertook a prospective study of patients undergoing CAPD to determine if there were decreases in peritoneal clearances and if the peritoneal microcirculation maintained its responsiveness to nitroprusside. Peritoneal transport, as assessed by the clearances of urea, creatinine, inulin, and dialysate protein concentration, with and without nitroprusside addition in the dialysis solution, is unchanged in patients undergoing CAPD for up to 1 year, despite frequent episodes of peritonitis.