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Peritonitis rate: traditional versus low calcium dialysate
A Stein1, F Baker, J Moorhouse
1Department of Nephrology, Leicester General Hospital, United Kingdom.
Summary
Low calcium dialysate (LCD) does not increase peritonitis risk in continuous ambulatory peritoneal dialysis (CAPD) patients compared to traditional dialysate (TD). This randomized study found similar peritonitis rates between LCD and TD, challenging previous nonrandomized findings.
Area of Science:
- Nephrology
- Clinical Medicine
- Dialysis
Background:
- Nonrandomized studies suggested low calcium dialysate (LCD) increases peritonitis risk in continuous ambulatory peritoneal dialysis (CAPD).
- Traditional dialysate (TD) has a higher ionized calcium concentration (1.75 mmol/L) than LCD (1.25 mmol/L).
Purpose of the Study:
- To investigate the association between LCD and peritonitis incidence in CAPD patients.
- To compare peritonitis rates between LCD and TD in a randomized controlled trial.
Main Methods:
- 86 new CAPD patients were randomized to LCD or TD for 1 year.
- Single-blinded study with intention-to-treat analysis.
- Peritonitis episodes and patient-months were recorded for rate calculation.
Main Results:
- The proven peritonitis rate was 0.49 episodes/patient/yr for TD and 0.48 episodes/patient/yr for LCD (P=NS).
- Patient outcomes including transplant, death, and transfer to hemodialysis were similar between groups.
- No significant difference in peritonitis incidence was observed between the two dialysate groups.
Conclusions:
- There is no controlled evidence that LCD is associated with a higher incidence of peritonitis than TD.
- Randomized controlled trials do not support the hypothesis that LCD increases peritonitis risk in CAPD.
- Clinical practice regarding dialysate calcium concentration may not need to be altered based on peritonitis risk.