2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Strippoli, G. F.M. Articles by Craig, J. C. Search for Related Content PubMed PubMed Citation Articles by Strippoli, G. F.M. Articles by Craig, J. C.

Catheter-Related Interventions to Prevent Peritonitis in Peritoneal Dialysis: A Systematic Review of Randomized, Controlled Trials

Giovanni F.M. Strippoli^*,, Allison Tong, David Johnson, Francesco P. Schena and Jonathan C. Craig^||

*NHMRC Centre for Clinical Research Excellence in Renal Medicine, Cochrane Renal Group, University of Sydney, Sydney, Australia; Department of Emergency and Organ Transplantation, Section of Nephrology, University of Bari, Italy; Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, and Department of Medicine, School of Medicine, University of Queensland, Queensland, Australia; and ^||School of Public Health, University of Sydney, Australia

Correspondence to Dr. Giovanni FM Strippoli, Centre for Kidney Research, NHMRC Centre for Clinical Research Excellence in Renal Medicine, Cochrane Renal Group, Locked Bag 4001, The Children’s Hospital at Westmead and the University of Sydney, Westmead, NSW 2145, Australia. Phone: +61-2-98453088; Fax: +61-2-98453038; E-mail: gfmstrippoli{at}katamail.com and GiovannS{at}chw.edu.au

As many as 15 to 50% of end-stage kidney disease patients are on peritoneal dialysis (PD), but peritonitis limits its more widespread use. Several PD catheter–related interventions (catheter designs, surgical insertion approaches, and connection methods) have been purported to reduce the risk of peritonitis in PD. The goal was to assess the trial evidence supporting their use. The Cochrane CENTRAL Registry, MEDLINE, EMBASE, and reference lists were searched for randomized trials of catheter types and related interventions in PD. Two reviewers extracted data on the rates of peritonitis and exit-site/tunnel infection, catheter removal/replacement, technique failure, and all-cause mortality. Analysis was by a random effects model, and results are expressed as relative risk and 95% confidence intervals. Thirty-seven eligible trials (2822 patients) were identified: eight of surgical strategies of catheter insertion, eight of straight versus coiled catheters, 10 of Y-set versus conventional spike systems, four of Y-set versus double-bag systems, and seven of other interventions. Despite the large total number of patients, few trials covered the same interventions, small numbers of patients were enrolled in each trial, and the methodologic quality was suboptimal. Y-set and twin-bag systems were superior to conventional spike systems (seven trials, 485 patients; relative risk, 0.64; 95% confidence intervals 0.53 to 0.77), and no other catheter-related intervention was demonstrated to prevent peritonitis in PD. This systematic review demonstrates that of all catheter-related interventions designed to prevent peritonitis in PD, only disconnect (twin-bag and Y-set) systems have been proved to be effective (compared with conventional spike systems). Despite the importance of PD as a renal replacement therapy modality and the large number of patients who receive it, it is still not known whether any particular PD catheter designs, implantation techniques, or modalities are effective, given the limitations of available trials.

This article has been cited by other articles:

				A. Peppelenbosch, W. H. M. van Kuijk, N. D. Bouvy, F. M. van der Sande, and J. H. M. Tordoir Peritoneal dialysis catheter placement technique and complications NDT Plus, October 1, 2008; 1(suppl_4): iv23 - iv28. [Abstract] [Full Text] [PDF]

				J. M. Bargman New Technologies in Peritoneal Dialysis Clin. J. Am. Soc. Nephrol., May 1, 2007; 2(3): 576 - 580. [Abstract] [Full Text] [PDF]

				R. Saxena and C. West Peritoneal dialysis: a primary care perspective. J Am Board Fam Med, July 1, 2006; 19(4): 380 - 389. [Abstract] [Full Text] [PDF]

				N. M. Selby, S. Fonseca, L. Hulme, R. J. Fluck, M. W. Taal, and C. W. McIntyre Hypertonic glucose-based peritoneal dialysate is associated with higher blood pressure and adverse haemodynamics as compared with icodextrin Nephrol. Dial. Transplant., September 1, 2005; 20(9): 1848 - 1853. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673