Pre-spiking dialysate bags: improved peritonitis prevention in patients on CAPD

We review experience with 238 patients over 5.5 years to determine the impact of techniques of spiking dialysis bags in advance of their use (pre-spiking) on peritonitis incidence. Our two units provide peritoneal dialysis therapies only with liberal patient acceptance policies. The Y-set was used almost exclusively over the last 4 years (192/238 patients), peritonitis rate 1:31.5 patient-months (99 episodes/3,122 months). Nineteen patients spiked each exchange, 23 episodes/282 months, 1:12.3; 173 pre-spiked 1-14 days in advance using Y-set and compact exchange device (CXD), 76 episodes/2,840 months, 1:37.4. Peritonitis rates did not worsen with increased pre-spiking intervals: 1 day, 1:16.2; 2-6 days, 1:47.9; 7 days, 1:62.2; 8-14 days, 1:34.3. Similarly, pre-spiking in CCPD patients at 10 day intervals (4 patients) yielded a peritonitis rate of 1:19. We conclude that pre-spiking dialysis bags using the Y-set and CXD promotes significant peritonitis prevention. By spiking at less frequent intervals, technical performance improves, exchanges are simplified and done under more flexible circumstances. Participation by patient-assistants is facilitated. Transfer from CAPD to CCPD is decreased. Low peritonitis rates contribute to excellent patient acceptance and retention. The potential CAPD-eligible population is broadened.