Peritonitis – Does Peritoneal Dialysis Modality Make a Difference?

Abstract

Background/Aims: Peritonitis remains a significant problem for patients on peritoneal dialysis (PD). There is a certain amount of controversy as to whether peritoneal modality is itself a risk factor for peritonitis, with one modality higher than another. Methods: A literature review was done (August 2009) searching under ‘peritoneal dialysis’, ‘peritonitis’ and ‘modality’ to find all articles related to the topic. The highest-quality articles were extracted for review. Results: Two randomized controlled trials (RCTs) done with disconnect systems for continuous ambulatory PD (CAPD) and Luer lock connections for automated PD (APD) showed important decrements in peritonitis rate on APD compared to CAPD. The variation of peritonitis rates in studies comparing peritonitis on continuous cycling PD (CCPD) and CAPD may relate to the difference in connection type for APD in Europe (Luer lock) and North America (spike) and to differing prescriptions, including in some cases midday exchanges on APD and in other cases a dry abdomen on APD. The variation in peritonitis rates from center to center is marked. In many studies sufficient details regarding the connectology and the prescription, both of which may impact on peritonitis risk, are absent. Conclusion: At the present time, the best data suggest that use of APD with Luer lock connections versus CAPD with a disconnect system results in a reduction in peritonitis risk. More studies are needed on this important topic, particularly the possible advantage of initiating PD with a dry day in those with residual kidney function. This question would be best studied with an RCT comparing peritonitis rates in three groups of patients, i.e. those initiating dialysis on CCPD, CAPD and APD with a dry day.