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Aims: Nepal cannot afford renal replacement therapy (RRT) for ESRD due to lack of resources. Early diagnosis of CKD and its risk factors may reduce the need of RRT. Materials and Methods: In this first community-based screening program in Nepal, 3218 people iÝ 20 years were assessed by door-to-door survey in Dharan. Health status, lifestyle habit, physical examination and blood pressure were evaluated. Spot urine was examined for proteins and glucose by dipstick. Fasting blood glucose and serum creatinine were measured in a subset of 1000 people and the prevalence of CKD was evaluated. A cardiovascular risk factor score was also determined. Results: Overweight, obesity, hypertension, diabetes and proteinuria were found in 20%, 5.0%, 38.6%, 7.5%, and 5.1% respectively. 47% hypertensives were newly detected during the screening. In the subset of 1000 subjects, CKD was detected in 10.6%. Multivariate logistic regression analysis showed that age (P <0.0001) and presence of diabetes (P = 0.027) were statistically significant predictors for CKD. Two or more cardiovascular risk factors were present in 47.3%. 848 patients entered the management phase of the program with lifestyle modification and pharmacologic intervention. 15% drop out during follow-up. Five patients died (2 on RRT). Glycemic (fasting glucose < 120 mg/dL) and blood pressure control (< 140/90 mmHg) was achieved in 60% and 72%, respectively. Regression or stabilization of proteinuria was reported in 52% of patients. Conclusion: Burden of CKD and cardiovascular risk factors are high at community level in Dharan. Reasonable control of blood sugar, hypertension and proteinuria was achieved in this program. These findings indicate the need of activating a large prevention and intervention program to tackle CKD and CVD in Nepal. [ABSTRACT FROM AUTHOR]

Aims: Access to hemodialysis (HD) is limited in Nepal due to geographical terrain and hemodialysis centers being mostly limited to capital city of the country. Therefore, CAPD is likely to be a better option of dialysis in Nepal. In 1998, continuous ambulatory peritoneal dialysis (CAPD) was initiated in Nepal without success. High rate of peritonitis was cited for failure. Hot tropical climate of Nepal along with poor sense of hygiene among patients is thought to be responsible for the high rate of peritonitis. A new CPD program was started in 2002 in our institute. As only center for dialysis in eastern Nepal, the institute serves to around 25% of the population of Nepal. We reviewed the incidence of peritonitis and factors predisposing to peritonitis. Materials and Methods: A total of 30 patients who were initiated on chronic peritoneal dialysis since 2002 to 2005 were included in the study. Two CAPD nursed follow-up this patients and were responsible for the data recording along with resident doctor in dialysis unit. Peritonitis was diagnosed if patient reported cloudy effluent and/or pain abdomen and had dialysate white cell count > 100/mL of which 50% or more were polymorphonuclear leukocytes. All patients were on prophylactic mupirocine ointment. Patients complicated with peritonitis (N = 8) and patients without peritonitis (N=22) were compared. Results: Most patients were male (N=26). Mean duration of dialysis was 12 month per patients (Total patients month= 362). Nine episodes of peritonitis in eight patients were recorded during this period. Six episode of peritonitis were culture positive (staphylocoocus aureous-2, Psedornonous aurigonosae-1, other gram negative organism-2, fungal-1). Culture sterile peritonitis was recorded in 3 episodes (patients). Two patients in each group were shifted to hemodialysis therapy. End stage related due to diabetes mellitus and low serum albumin were predisposing factors for development of peritonitis. Conclusion: Peritonitis is not a limiting factor for growth of CAPD in Nepal. Low serum albumin and diabetes patients are prone for CAPD related peritonitis. [ABSTRACT FROM AUTHOR]