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Risk of peritonitis among disadvantaged CAPD patients in Mexico
Guillermo Garcia-Garcia1, Noemi Tachiquín-Bautista, Victor Hugo Luquin-Arellano
1Nephrology Division, Hospital Civil de Guadalajara, Guadalajara, Jal, Mexico.
Background/Aims:
Continuous ambulatory peritoneal dialysis is the first-choice treatment for ESRD in Mexico. Peritonitis is the most frequent cause of morbidity and is among the leading causes of technique failure in our country. Our objective was to compare the efficacy of the standard and double-bag disconnect systems for the prevention of peritonitis in a high-risk population with poor living standards, and high prevalence of malnutrition and diabetes rates.
Methods:
Episodes of peritonitis registered between July 1989 and June 2003 were included. Patients were divided in conventional and double-bag groups. Between July 1989 and May 1999, all patients used the conventional system. From May 1999, all incident patients were placed on a double-bag disconnect system.
Results:
Six-hundred and forty-seven patients started dialysis in the study period, 383 in the conventional group, and 264 in the double-bag. The peritonitis rate observed was 1 episode per 7.2 patient-months in the conventional group, and 1 episode per 25.1 patient-months in the double-bag system (p < 0.001). Cumulative peritonitis-free survival rate at 6 (50 vs. 82%), 12 (27 vs. 69%) and 24 (12 vs. 45%) months, respectively, was significantly lower in the conventional group (p < 0.001). Technique survival at 1 (75 vs. 85%), 2 (68 vs. 80%), and 3 years (50 vs. 80%), was worse in the conventional group (p < 0.001). By multivariate analysis, the only factor associated with peritonitis was the connecting system.
Conclusions:
We conclude that switching from a standard to a double-bag system using electrolytically produced sodium hypochlorite disinfectant markedly decreased the peritonitis rate, even in a high-risk population like ours.
Insights
The double-bag disconnect system significantly reduced peritonitis rates in continuous ambulatory peritoneal dialysis patients. This improved technique survival, even in high-risk populations with poor living conditions.
Area of Science:
- Nephrology
- Infectious Disease Prevention
- Dialysis Technology
Background:
- Peritonitis is a major complication and cause of technique failure in continuous ambulatory peritoneal dialysis (CAPD).
- Mexico faces challenges with high rates of malnutrition and diabetes among ESRD patients undergoing CAPD.
- Standard dialysis systems are associated with significant peritonitis risk in vulnerable populations.
Purpose of the Study:
- To compare the efficacy of standard versus double-bag disconnect systems in preventing peritonitis.
- To evaluate the impact of these systems on technique survival in a high-risk CAPD population.
- To assess peritonitis rates in patients with poor living standards, malnutrition, and diabetes.
Main Methods:
- A retrospective study included 647 patients from July 1989 to June 2003.
- Patients were divided into conventional (n=383) and double-bag (n=264) groups.
- The switch from conventional to double-bag systems occurred in May 1999.
Main Results:
- Peritonitis rate was significantly lower with the double-bag system (1 episode/25.1 patient-months) compared to the conventional system (1 episode/7.2 patient-months) (p < 0.001).
- Peritonitis-free survival rates at 6, 12, and 24 months were substantially higher in the double-bag group (82%, 69%, 45% vs. 50%, 27%, 12%).
- Technique survival was also significantly better with the double-bag system (85% at 1 year, 80% at 3 years vs. 75% and 50%).
Conclusions:
- Switching to a double-bag disconnect system markedly decreased peritonitis rates.
- The double-bag system is effective in reducing peritonitis even in high-risk CAPD populations.
- The connecting system was the sole factor associated with peritonitis in multivariate analysis.
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