Infections associated with chronic peritoneal dialysis

Chronic peritoneal dialysis (CPD) is increasingly used as the renal replacement therapy of choice in many countries. The number of patients on CPD was approximately 4000 in 1980 but reached 95,200 by the end of 1994 (1). The annual increase from 1991 to 1994 was 15%. The proportion of patients with end-stage renal disease treated by CPD (versus hemodialysis) varies considerably from country to country, being less than 10% in Italy, France, Germany, and Japan, and 50% or greater in the United Kingdom, New Zealand, and Mexico. These differences are thought to be largely due to national differences in the way renal replacement therapy is organized and reimbursed. The CPD technique per se is not questioned. In contrast, CPD has been validated in many studies, and, although there are limits in dialysis adequacy, CPD has several advantages over hemodialysis (2,3). Currently, two types of CPD are practiced: Continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD). Continuous ambulatory peritoneal dialysis was first introduced in the late 1970s by Popovich et al. (4) and Oreopoulos et al. (5) as a machine-free regimen that entailed the continuous presence of dialysate in the peritoneal cavity. Approximately every 6 h, dialysate is exchanged for fresh PD fluid using only gravitational forces to drain and refill the abdominal cavity. CCPD was introduced in the early 1980s to take care of patients who were incapable of performing the exchanges manually or who were unwilling to interrupt their daily routines for dialysate exchanges (6). In CCPD, rapid nocturnal fluid exchanges are performed through a bedside cycling machine. Miniaturization technology has now allowed such machines to become easily portable, further improving patients’ freedom to schedule their own activities. By the end of 1994, approximately 25% of all CPD in the United States was of the CCPD variety.