Effect of Exchange Systems and Procedure on Long Term Peritonitis in ESKD Patients Undergoing CAPD :A Retrospective Comparative Cohort Study.

Abstract

Introduction: Peritoneal dialysis utilizes two distinct double-bag exchange systems (ANDY-Disc from Fresenius Medical Care in Bad Homburg, Germany, and DIANEAL from Baxter in Deerfield, IL). These systems are widely used across the globe. The long-term outcomes of peritonitis with different types of treatment are still questionable. Therefore, we conducted a retrospective comparative cohort study to assess the long-term impact of these two distinct exchange procedures on the true peritonitis rate and the technique durability in real-world settings.

Methods: One hundred and twenty patients, treated with a double-bag exchange system in a Songklanagarind Hospital, located in the south of Thailand from January 2009 to December 2020 were included. The primary outcome was the incidence rate of peritonitis by treatment arm (ANDY-disc and DIANEAL). Secondary outcomes included the pathogenic organism causing peritonitis, time to the first peritonitis, and survival technique between the two systems.

Results: The peritonitis rate for patients using the ANDY-disc in continuous ambulatory peritoneal dialysis (CAPD) was 0.28 episodes per patient-year, while the DIANEAL group had a rate of 0.29 episodes per patient-year. There was no difference in the peritonitis rate between the two groups (P = .816). Gram-positive bacterial peritonitis accounted for 33.4% in the ANDY-disc arm and 43.7% in the DIANEAL arm. The 10-year technique survival was 86.1% in the ANDY-Disc group and 73.5% in the DIANEAL group; this did not reach statistical significance.

Conclusion: The ANDY-Disc and DIANEAL exchange systems are comparable in the long-term incidence of peritonitis. Both systems have similar long-term technique survival. However, this should be confirmed by a high-quality trial.