The influence of continuous ambulatory peritoneal dialysis connection technique on peritonitis rate and technique survival

Peritonitis is still the most common complication of continuous ambulatory peritoneal dialysis (CAPD). Several measures have been used to prevent peritonitis, including prophylactic antibiotics and a variety of connection techniques. This study was designed to evaluate the effects of different connection techniques, age at the start of CAPD, sex, and diabetic status on peritonitis rate and technique survival. Three hundred twenty-seven patients treated with CAPD and followed for 8,804.4 patient-months at the Vancouver General Hospital between February 13, 1978, and August 31, 1992, were reviewed. The mean age of the patients was 57.1 +/- 16.3 years. The overall peritonitis rate was 16.6 patient-months per episode. The overall technique survival was 79.6%, 60.2%, and 41.8%, at 1, 2, and 3 years, respectively. Patients using "standard" spike technique (group A, n = 87), Luer lock connector (group B, n = 77), and Luer lock with iodine instillation at the dialysis bag connection site (group C, n = 120) had peritonitis rates of 10.4, 14.7, and 33.3 patient-months per episode, respectively. The relative risk (RR) of peritonitis was 3.5 for group A (95% confidence interval, 2.1 to 4.5) and 2.6 for group B (95% confidence interval, 1.7 to 3.9) compared with group C. Patient age at the start of CAPD, sex, and diabetic status had no effect on the RR of peritonitis. None of the variables studied, except patient age, affected technique survival.