Risk of peritonitis among disadvantaged CAPD patients in Mexico.
OBJECTIVE
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.
Garcia-Garcia
Guillermo
G
Nephrology Division, Hospital Civil de Guadalajara, Guadalajara, Jal, Mexico.
Tachiquín-Bautista
Noemi
N
Luquin-Arellano
Victor Hugo
VH
Ibarra-Hernandez
Margarita
M
Aviles-Gomez
Raymundo
R
Briseño-Renteria
Gregorio
G
Cueto-Manzano
Alfonso M
AM
D000328:Adult; D004202:Disinfectants / Q000494:pharmacology*; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data*; D010538:Peritonitis / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012973:Sodium Hypochlorite / Q000494:pharmacology*; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
D004202:Disinfectants; D012973:Sodium Hypochlorite