Incidence of exit-site infection with various exchange systems in continuous ambulatory peritoneal dialysis

Background and purpose: The disconnect min-bag (TB) system was first introd uced in Taiwan for use as an exchange system in continuous ambulatory perit oneal dialysis (CAPD) in 1995. Following its introduction, the incidence of CAPD-associated peritonitis declined, but the incidence of exit-site infec tion (ESI) increased. To determine the cause of the increase in ESI inciden ce after the introduction of the TB system, this study compared the inciden ce of ESI among patients using the O set, ultraviolet antiseptic (UV) devic e, and the TB system. Methods: A total of 170 patients who had received CAPD for more than 3 mont hs were enrolled in this study. Poisson test and Kaplan-Meier survival anal ysis were used to compare the ESI incidence and ESI-free catheter survival among patients using the O set, UV device, or TB system. Cox stepwise forwa rd proportional hazard analysis was used to assess the impact of sex, educa tion, cause of uremia, age, and type of exchange system on ESI. Results: The incidences of ESI differed significantly among patients using the three exchange systems, with 20.9, 13.8, and 4.0 episodes per 100 patie nt-years for patients using the TB system, O set, and UV device, respective ly. New patients using the TB system also had a shorter mean interval of ES I-fr-ee catheter survival than those using the UV device (26.9 vs 58.8 mont hs, p = 0.002). In the Cox stepwise forward proportional hazard analysis, n on-lupus patients had a lower risk of developing ESI than lupus patients (r elative risk [RR] 0.40, p = 0.03). The RR of ESI in patients using the UV d evice was also lower than in those using the TB system (RR 0.15, p < 0.01). Conclusion: In this study, use of the TB system was associated with a highe r incidence of ESI. The increased ESI incidence may be related to the heavi er mini-transfer set of the TB system. Therefore, special attention should be given to fastening the mini-transfer set tightly during the exchanging p rocedure to prevent traction on the exit-site, which is associated with an increased incidence of subsequent ESI.