Comparison of exit-site infections in disconnect versus nondisconnect systems for peritoneal dialysis.
OBJECTIVE
To determine if disconnect systems reduce the incidence of exit-site infections when compared to nondisconnect systems.


METHODS
We prospectively monitored exit-site infections and peritonitis rates in 96 disconnect patients (Y-set, automated peritoneal dialysis (APD)) and 60 nondisconnect patients (spike, ultraviolet connection device (UVXD)).


METHODS
A freestanding chronic peritoneal dialysis unit staffed by physicians from both a medical school and a private setting.


METHODS
All patients who began peritoneal dialysis at our unit were monitored, regardless of cause of end-stage renal disease (ESRD) or age.


METHODS
Patients were dialyzed using the system (Y-set, spike, etc.) most appropriate for their life-style and their ability to administer self-care.


RESULTS
We attempted to follow disconnect and nondisconnect patients for a similar median time on dialysis and compared differences in exit-site infections.


RESULTS
Peritonitis rates (episodes/pt year) were reduced for disconnect (0.60) versus nondisconnect (0.99) systems (p = 0.0006). Despite the marked reduction in peritonitis rates, there was no difference in exit-site infection rates (0.35 vs 0.38), the time to the first exit-site infection, or the time to the first catheter removal for disconnect versus nondisconnect groups. When individual systems were compared, differences in exit-site infection rates (episodes/pt years) were noted (0.62,spike; 0.26,UVXD; 0.32,Y-set; 0.41,APD).


CONCLUSIONS
We found no overall difference in exit-site infection rates for disconnect versus nondisconnect systems, despite a reduction in peritonitis rates for disconnect systems.
Burkart
J M
JM
Department of Medicine/Nephrology, Bowman Gray School of Medicine, Winston-Salem, North Carolina.
Jordan
J R
JR
Durnell
T A
TA
Case
L D
LD
D000328:Adult; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000295:instrumentation; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012874:Skin Diseases, Infectious / Q000453:epidemiology* / Q000209:etiology