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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