PREVENTION OF PERITONITIS WITH DISCONNECT SYSTEMS IN CAPD - A RANDOMIZED CONTROLLED TRIAL

Background. Recently, disconnect systems for CAPD that are associated with a reduced frequency of peritonitis have been introduced. Our obje ctive was to compare the incidence of peritonitis using three current CAPD systems in a high-risk population with low educational and socioe conomic levels, and high prevalence of malnutrition. Methods. In a pro spective controlled trial, 147 patients commencing CAPD were randomly assigned to one of three groups: 29 to the conventional, 57 to the Y-s et, and 61 to the twin bag systems. The number of peritonitis episodes was registered, and patients were followed up for an average of 11.3 months. Results. The average peritonitis-free interval for the convent ional group was 6.1 months, for the Y system was 12.0 months, and for the twin bag was 24.8 months (P < 0.001). By multivariate analysis, th e only factor associated with peritonitis was the CAPD system. Periton itis-related hospitalization was 5.3 +/- 2.0, 2.7 +/- 1.0, and 1.5 +/- 0.9 days/patient/year in the conventional, Y system, and twin bag gro ups, respectively. The cost per bag was similar for the conventional a nd Y system, but higher for the twin bag. However, the total costs of treatment (pesos/patient/year) were lower for twin bag (62,159 for the conventional, 70,275 for the Y system, and 54,387 for the twin bag), due to the lower peritonitis incidence and associated hospitalizations . Conclusions. Y system and twin bag use was associated with a reducti on of 50 and 75% peritonitis incidence, respectively, in patients on C APD. The cost of the twin bag was actually lower, because of savings f rom a decreased usage of antibiotics and fewer hospitalizations.