CAN ADVANCES IN CONNECTOR TECHNOLOGY REDUCE PERITONITIS IN CAPD?

Ever since continuous ambulatory peritoneal dialysis (CAPD) was introduced to manage patients with end-stage renal disease, the high incidence of peritonitis has been a major problem. In the beginning we believed that bacteria entered the peritoneal cavity through the open connections of the system and all hoped that the incidence of peritonitis would be eliminated by more sophisticated and safer connection devices. Thus a new connector technology (connectology) has developed. Indeed it seems that the introduction of better connectors, such as the Titanium adapter has reduced the frequency of peritonitis. However this has never been submitted to the scrutiny of clinical trials and the evidence for this effect remains anecdotal. After the various connecting devices were improved, we were offered more elaborate systems such as the ultraviolet (UV) box (Travenol), the Sterile Connection Device (SCD DuPont), the Millipore filter (Peridex) and connecting devices, which contained disinfectants-the O-Z connector (1) contains betadine, the Buonchristiani Y-tube system (2) contains hypochlorite, and soon. In the recent past peritonitis rates in major centers have declined but have levelled off to approximately one episode per year; thus the time has come to submit the new devices to clinical trials. In the present issue of the Bulletin Nolph and his associates have described such a trial on the ultraviolet device in which they found no significant differences between the user group and the control group. This valuable paper discusses their results and the reasons for the probable lack of differences