EFFECT OF PROLONGED SUBCUTANEOUS IMPLANTATION OF PERITONEAL CATHETER ON PERITONITIS RATE DURING CAPD - A PROSPECTIVE RANDOMIZED STUDY

We conducted a prospective randomized controlled study to confirm our earlier observation that prolonged subcutaneous implantation of perito neal catheter reduced peritonitis rate when compared to retrospective data from patients with catheters placed by conventional access techni que. A total of 60 patients were randomized into two groups: 30 patien ts had catheters left implanted subcutaneously for 6 weeks (I) and the other 30 patients had catheters inserted by conventional technique an d had 6 weeks of break-in period (C). Subgroups of 15 patients each wi th new and conventional techniques used Y-connector (IY, CY) and remai ning patients used standard spikes (IS, CS). Mean age was 47.7 years ( range 16-71); 61.0% were male and 44.1% diabetics. Peritonitis, exit s ite infection, simultaneous peritonitis and exit site infection, and c omplication related to Staphylococcus or Pseudomonas infections were o bserved for up to 2 years in each patient after initiation of bag exch ange or until termination of CAPD by transfer to hemodialysis or by de ath. Total duration of observation was 493.2 patient-months for new ac cess technique and 409.6 patient-months for conventional technique. Pa tients in IY group had the lowest incidence of peritonitis (1/14.9 pat ient-months) and exit site infection (1/16.8 patient-months) among fou r subgroups. Peritonitis rate in IY was significantly lower compared t o CY or CS. The total peritonitis-free period in those patients who di d not experience peritonitis during the observation period was also si gnificantly longer in IY (120 patient-months) than in CY (26 patient-m onths), IS (10.6 patient-months), or CS (10.4 patient-months). Simulta neous peritonitis and exit site infection was observed in none of IY g roup but 3 episodes in CY, 4 episodes in IS, and 3 episodes in CS. The rates of complications related to Staphylococcus aureus and Pseudomon as infections were also significantly lower in IY than in CY, IS, or C S. Technique survival did not differ between the two groups. The prese nt results confirm our previous observation that the new access techni que reduces the incidence of peritonitis probably by reducing infectio n via periluminal route. The Y-connector system further reduces perito nitis rate by reducing infection via intraluminal route.