Y-set and double bag systems offer the most protection against peritonitis during continuous ambulatory peritoneal dialysis (CAPD)

Daly C, Campbell MK, Cody JD, Grant A, Khan I, Lawrence P, MacLeod AM, Rabindranath KS, Vale L, Wallace SA

Published Online:

January 21, 2009

People with advanced kidney disease may be treated with CAPD where a catheter is permanently inserted into the peritoneum (lining around abdominal contents) through the abdominal wall and sterile fluid is drained in and out a few times each day. The most common serious complication is infection of the peritoneum - peritonitis. This may be caused by bacteria accidentally being transferred from the catheter. This review of trials compared three types of connecting systems (used to connect the bags and the catheter) and found the Y-set and double bag exchange systems are the most effective in preventing peritonitis.

Abstract (click to read)

Background:

Peritonitis is the most frequent serious complication of continuous ambulatory peritoneal dialysis (CAPD). It has a major influence on the number of patients switching from CAPD to haemodialysis and has probably restricted the wider acceptance and uptake of CAPD as an alternative mode of dialysis.

Objectives:

This systematic review sought to determine if modifications of the transfer set (Y-set or double bag systems) used in CAPD exchanges are associated with a reduction in peritonitis and an improvement in other relevant outcomes.

Search strategy:

Five electronic databases were searched (MEDLINE 1966-1997, EMBASE 1984-1996, CINAHL 1982-1996, BIOSIS 1985-1996 and The Cochrane Library), authors of included studies and relevant biomedical companies were contacted, reference lists of identified RCTs and relevant narrative reviews were screened and Kidney International 1980-1997 was hand searched.

Selection criteria:

Randomised controlled trials (RCTs) or quasi-RCTs comparing double bag, Y-set and standard peritoneal dialysis (PD) exchange systems in patients with end-stage kidney disease.

Data collection and analysis:

Data were abstracted by a single investigator onto a standard form and analysed by Review Manager. Analysis was by a random effects model and results were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI).

Main results:

Twelve eligible trials with a total of 991 randomised patients were identified. Despite the large total number of patients, few trials covered the same interventions, small numbers of patients were enrolled in each trial and the methodological quality was suboptimal. Y-set and twin-bag systems were superior to conventional spike systems (7 trials, 485 patients, RR 0.64, 95% CI 0.53 to 0.77) in preventing peritonitis in PD.

Authors' conclusions:

Disconnect systems should be the preferred exchange systems in CAPD.

This record should be cited as:

Daly C, Campbell MK, Cody JD, Grant A, Khan I, Lawrence P, MacLeod AM, Rabindranath KS, Vale L, Wallace SA. Double bag or Y-set versus standard transfer systems for continuous ambulatory peritoneal dialysis in end-stage renal disease. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003078. DOI: 10.1002/14651858.CD003078

Assessed as up to date:

February 22, 2005

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Primary Review Group:

Renal Group

Health topics:

Kidney disease > End-stage kidney disease > General management

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Y-set and double bag systems offer the most protection against peritonitis during continuous ambulatory peritoneal dialysis (CAPD)

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