Stein A, Baker F, Moorhouse J, Walls J
Peritonitis rate: Traditional versus low calcium dialysate

Am J Kidney Dis (Oct) 26:632-633 1995

This paper describes the influence of low versus traditional calcium containing dialysates on peritonitis rates in CAPD patients using disconnect systems. The protocol was a single blind study of traditional calcium (1.75 mmol/L, 7mg/dl) versus low calcium (1.25 mmol/l, 5 mg/dl) dialysate use in 86 consecutive randomized patients over a one year period. Patient demographics were almost identical (including age, sex, urea nitrogen, PCR, PT H, number, deaths, transfer to hemodialysis, etc). The peritonitis rate at the conclusion of the study was 0.49 episodes/pt/yr in the traditional calcium group vs. 0.48 episodes/pt/yr in the low calcium group. Not included in these figures was the "possible" but not proved episodes of peritonitis (33 vs 35, traditional vs low calcium).

The study was prompted by the demonstration in vitro that low calcium in ambient medium reduces macrophage killing of bacteria, and by small retrospective studies in man providing clinical support that higher calcium dialysate is associated with a lower rate of (Staph epiderm.) peritonitis. It must be pointed out that this is the first prospective study of this nature, but it must also be pointed out that the rate of infection was very low in both groups (because of disconnect probably). I am not sure about the statistical power of the small numbers, nor if a much longer or larger study would have brought out differences between the groups. However, as it stands it supports the use of low calcium dialysate as not being a clinical risk factor for increased peritonitis. (Winchester)

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