"Flush before fill" in children receiving automated peritoneal dialysis

Area of Science:

• Nephrology
• Pediatric Dialysis
• Infectious Disease Prevention

Background:

• Peritonitis is a common complication in pediatric patients undergoing automated peritoneal dialysis (APD).
• The "flush before fill" technique is a procedural modification aimed at reducing infection risk during APD exchanges.
• Understanding factors influencing peritonitis rates is crucial for optimizing treatment outcomes in pediatric patients.

Purpose of the Study:

• To investigate the efficacy of the "flush before fill" technique in mitigating peritonitis frequency among children on APD.
• To determine if the impact of this technique varies based on patient gender.

Main Methods:

• A randomized prospective multicenter study was conducted involving 121 pediatric patients on APD.
• Patients were assigned to either use (flush group) or not use (no flush group) the "flush before fill" option.
• Peritonitis rates were the primary outcome measure, with 66 patients followed for at least 12 months.

Main Results:

• The overall peritonitis rate was 1 infection per 16.8 patient-months in the flush group versus 1 per 12.6 patient-months in the no flush group (p=0.193).
• Female patients in the flush group showed a significantly lower peritonitis rate (1 infection per 44.7 patient-months) compared to the no flush group (1 per 12.4 patient-months, p<0.01).
• No significant difference in peritonitis rates was observed between male patients in the flush and no flush groups.

Conclusions:

• The "flush before fill" technique demonstrates a significant benefit in reducing peritonitis rates for female pediatric patients undergoing APD.
• The technique did not show a similar benefit for male pediatric patients on APD.
• Further investigation is warranted to elucidate the underlying reasons for the observed gender-specific differences in peritonitis risk.