Continuous Ambulatory Peritoneal Dialysis and Scleroderma

Abstract

A patient with scleroderma has been maintained on continuous ambulatory peritoneal dialysis (CAPD) for the past 18 months after having developed associated renal failure. Peritoneal clearances, pulmonary function tests, and hand studies have shown seasonal changes from summer to winter with ambient temperature variations. Rehabilitation and quality of life have been acceptable, blood pressure has been well controlled off all medications, and there has been relatively little disease progression. Attempts have been made to maintain low-dose captopril therapy to suppress plasma renin activity. This case suggests that CAPD is an acceptable and, perhaps, indicated treatment modality for renal failure associated with scleroderma.

Continuous Ambulatory Peritoneal Dialysis in Scleroderma

“…This report accords with others [3,4] which show that CAPD is a satisfactory treatment for renal failure due to scleroderma. Although the good biochemistry would have been partly due to the residual renal function, equil ibration of urea and creatinine between blood and dialy sate was similar to that measured when CAPD has been used to treat renal failure due to other causes [5], which does not support the suggestion that peritoneal clear ances in scleroderma may be suboptimal [6], Dialysate protein loss was also comparable to patients receiving CAPD for renal failure due to other causes [7].…”

“…Haemodialysis [1] and trans plantation [1,2] have been used but experience is limited and success has been variable. There is also little experi ence with continuous ambulatory peritoneal dialysis (CAPD) and thus far only 3 cases have been reported [3,4], We have successfully treated a 55-year-old female with biopsy-proved renal failure due to scleroderma with CAPD for 12 months. Other complications of sclero derma which had developed prior to CAPD included malignant hypertension, pericarditis, upper limb peri pheral vascular insufficiency, reflux oesophagitis, sclerodactyly, carpal tunnel syndrome and Raynaud's pheno menon.…”

“…Special attention was necessary to diet in order to maintain ade quate nutrition, which may have been improved by the use of smaller volume exchanges. Difficulties with nutri tion [4] and gastrointestinal symptoms though due to dialysis fluid in the peritoneal cavity [3,4] have been noted in other cases. It has been suggested that renal replacement therapy for scleroderma is associated with improvement in extrarenal manifestations of the disease, particularly skin [1-3].…”