Catheter-related factors and peritonitis risk in CAPD patients

In a national study of essentially all patients starting CAPD therapy at home during January through June, 1989 (n = 2,807), the peritonitis risk was assessed by patient demographics, connection techniques, and catheter-related factors. The present report focuses on several CAPD catheter-related factors, while adjusting for other patient and facility characteristics using Cox proportional hazards models. This study also provides a description of the actual practice, utilization, and insertion of peritoneal catheters. The relative peritonitis risk, assessed during the 10.5 to 21 month follow-up in days to first peritonitis episode, was increased for single-cuff versus double-cuff catheters (RR = 1.20, p = 0.01) and with use of intraperitoneal drugs (RR = 1.14, p = 0.08). A lateral catheter placement was associated with a reduced relative risk, but this finding deserves further study. No significant association with peritonitis risk was found for catheter design, insertion technique or operator, nor for antibiotic prophylaxis at time of catheter placement. This study defines the magnitude of relative risks in a national sample, and helps direct future work towards reducing the risk of peritonitis and/or catheter loss in CAPD patients.