Do the Y-set and double-bag systems reduce the incidence of CAPD peritonitis? A systematic review of randomized controlled trails

Background. Peritonitis is the most frequent serious complication of contin uous ambulatory peritoneal dialysis (CAPD). It has a major influence on the number of patients switching from CAPD to haemodialysis and has probably r estricted the wider acceptance and uptake of CAPD as an alternative mode of dialysis. This systematic review sought to determine if modifications of t he transfer set (Y-set or double-bag systems) used in CAPD exchanges are as sociated with a reduction ill peritonitis and an improvement in other relev ant outcomes. Methods. Based on a comprehensive search strategy, we undertook a systemati c review of randomized or quasi-randomized controlled trials comparing doub le-bag and/or Y-set CAPD exchange systems with standard systems, or compari ng double-bag with Y-set systems, in patients with end-stage renal disease (ESRD) treated with CAPD. Only published data were used. Data were abstract ed by a single investigator onto a standard form and subsequently enter-ed into Review Manager 4.0.4. Its statistical package, Metaview 3.1, calculate d an odds ratio (OR) for dichotomous data and a (weighted) mean difference for continuous data with 95%, confidence intervals. Results. Twelve eligible trials with a total of 991 randomized patients wer e identified. In trials comparing either the Y-set or double-bag systems wi th the standard systems, significantly fewer patients (133/363 vs 158/263; OR 0.33, 95% CI 0.24-0.46) experienced peritonitis and the number of patien t-months on CAPD per episode of peritonitis was consistently greater. When the double-bag systems were compared with the Y-set systems significantly f ewer patients experienced peritonitis (44/154 vs 66/138; OR 0.44, 95% CI 0. 27-0.71) and the number of patient-months on CAPD per episode of peritoniti s was also greater. Conclusions. Double-bag systems should be the preferred exchange systems in CAPD.