Comparison of double-bag and Y-set disconnect systems in continuous ambulatory peritoneal dialysis: A randomized prospective multicenter study

We performed a multicenter, single-blinded, prospective randomized study on the use of a double-bag disconnect system (B) versus a Y-set disconnect sy stem (Y), The peritonitis rate, exit site infection, clinical outcome, and patients' acceptance to the procedure were assessed. A total of 120 new end -stage renal failure patients of three regional hospitals were randomized: 60 each to the B and the Y systems. The results of 60 patients on the B sys tem and 51 on the Y system were analyzable. They were followed up for a med ian of 16 months, Peritonitis rates for the B and the Y systems were 33.5 a nd 29.4 patient-months per episode, respectively. Exit site infection rates for the B and Y systems were 17.4 and 16.0 patient-months per episode, res pectively. Four catheters were removed in each group. Patients on the B sys tem were hospitalized for 2.1 days per patient per year related to peritoni tis and exit site infection, and those on the Y system were hospitalized fo r 1.2 days. There was no significant difference between the B and Y systems in the incidences of peritonitis (all causes and those due to coagulase-ne gative staphylococci), exit site infection, and in hospitalization days. Ho wever, there was a higher percentage of gram-positive infections in the Y s ystem (52%) than in the B system (32%) and a lower percentage of gram-negat ive infections in the Y system (16%) than in the B system (32%), Patients o n the B system had a better acceptance of the procedure than patients on th e Y system, as assessed by a six-item, 10-point questionnaire (total score, 43.1 +/- 10.2 v 37.6 +/- 9.4; P < 0.005 at 1 month; 44.6 +/- 9.1 v 39.8 +/ - 8.6; P < 0.01 at 6 months). From this study, it is concluded that the B a nd Y systems are similar in the incidences of peritonitis and exit site inf ection, although the B system is better accepted by patients. This is proba bly the first multicenter randomized study comparing the double-bag and Y-s et disconnect system using only new patients who had never used other syste ms of continuous ambulatory peritoneal dialysis, (C) 1999 by the National K idney Foundation, Inc.