Residual kidney function is important for patient and technique survival in peritoneal dialysis (PD). Biocompatible dialysis solutions are thought to improve function and viability of peritoneal mesothelial cells and to preserve residual renal function (RRF). We conducted a randomized controlled study comparing use of biocompatible (B) with standard (S) solutions in 93 incident PD patients during a 1-year period. The demographics, comorbidities, and RRF of both groups were similar. At 3 and 12 months, 24-h urine samples were collected to measure volume and the mean of urea and creatinine clearance normalized to body surface area. Surrogate markers of fluid status, diuretic usage, C-reactive protein concentration, peritonitis episodes, survival data, and peritoneal equilibrium tests were also collected. Changes in the normalized mean urea and creatinine clearance were the same for both groups, with no significant differences in secondary end points. Despite non-randomized studies suggesting benefits of these newer biocompatible solutions, we could not detect any clinically significant advantages. Additional studies are needed to determine if advantages are seen with longer term use.

Peritoneal dialysis is the archetypal home-based therapy and is often favoured by patients. However, as patients with end-stage renal failure become more elderly, with more co-morbidity, their dependence on carers to provide physical, emotional and logistical support increases. The effect of this chronic burden has not been systematically studied. We have prospectively studied patients with end-stage renal failure starting peritoneal dialysis and their carers over a 1-year period. We selected a cohort of caregivers that are actively involved with the care of their partners' dialysis. Quality of Life (QoL) assessed by SF-36 questionnaires showed the patients and carers had impairment of QoL at the start of dialysis. As expected, the baseline QoL Physical Component Scores highly correlated with co-morbidity and assessment of functional capacity. Scores of all QoL domains improved after 1 year and this reached statistical significance for social functioning for both patients and carers. When we compared carers of highly dependent patients (required to perform daily dialysis) with carers of less dependent patients, we noted that the former had a statistically significant worsening of their mental health but other parameters were not different. We have shown that despite increasing the burden for caregivers, with careful selection, education and support, we did not adversely impact on the QoL of carers whilst there was some evidence of improvement, especially in social functioning. This gives reassurance that establishing dependent patients on PD is compatible with a holistic approach to the patients and their families.

Introduction Availability of assisted PD (asPD) increases access to dialysis at home, particularly for the increasing numbers of older and frail people with advanced kidney disease. Although asPD has been widely used in some European countries for many years, it remains unavailable or poorly utilised in others. A group of leading European nephrologists have therefore formed a group to drive increased availability of asPD in Europe and in their own countries. Methods Members of the group filled in a proforma with the following headings: personal experience, country experience, who are the assistants, funding of asPD, barriers to growth, what is needed to grow, and their top 3 priorities. Results Only 5 of the 13 countries surveyed provided publicly funded reimbursement for asPD. The use of asPD depends on overall attitudes to PD with all respondents mentioning need for nephrology team education and/or patient education and involvement in dialysis modality decision making. Conclusion and call to action Many people with advanced kidney disease would prefer to have their dialysis at home, yet if the frail patient chooses PD most healthcare systems cannot provide their choice. AsPD should be available in all countries in Europe and for all renal centres. The top priorities to make this happen are education of renal healthcare teams about the advantages of PD, education of and discussion with patients and their families as they approach the need for dialysis, and engagement with policy makers and healthcare providers to develop and support assistance for PD.

Prophylactic mupirocin for peritoneal catheter exit sites reduces exit site infection (ESI) risk but engenders antibiotic resistance. We present early interim safety analysis of an open-label randomized study comparing polyhexamethylene biguanide (PHMB) and mupirocin. A total of 106 patients randomized to 53 in each group were followed up for a mean of 12.68 months per patient. On safety analysis, the PHMB group had a significantly greater ESI rate than the mupirocin group (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.09 to 0.80), leading to discontinuation of the trial. P eritoneal dialysis (PD) catheter exit site infections (ESI) can lead to peritonitis, morbidity, and mortality. Prophylaxis against ESI with the topical antibiotic mupirocin is recommended (1, 2, 3). Resistance to mupirocin is emerging, prompting a search for antiseptics, such as polyhexamethylene biguanide (PHMB), which will not confer resistance (4,5,6). Topical PHMB has an in vitro antibacterial activity comparable to that of mupirocin, is well tolerated, and is licensed as a wound care medical device in Europe (7,8,9,10). PHMB has a published record of safety in wound care; however, there is no published data on its use in prophylaxis of PD catheter ESI in humans.We designed a randomized clinical trial to compare ESI rates with PHMD and mupirocin. In order to detect a 50% reduction of Gram-negative ESI, we expected to recruit 200 patients. However, an intermediate safety analysis at 50% recruitment was required by the Ethics Committee and the Safety Monitoring Committee. The results of the interim safety analysis and its implication for the randomized trial are presented here. MATERIALS AND METHODSIn this interim safety analysis, we wished to determine that patients using PHMB would not have inferior ESI rates compared to those of patients randomized to mupirocin.Study group randomization and mupirocin/PHMB application. Patients who were receiving PD without active ESI or peritonitis or within 30 days of an episode gave consent to participate in the study and were randomized to daily application of either PHMB or mupirocin. Approximately 10 mg PHMB (Prontosan wound gel) was applied directly or with a cotton bud, or a "pea-size" amount of mupirocin ointment was applied using a cotton bud. All other catheter care protocols were identical for the 2 groups.Definition and diagnosis of ESI and peritonitis. ESIs were defined by diagnostic criteria in keeping with current ISPD and United Kingdom Renal Association guidelines (11). ESIs were diagnosed clinically from peritoneal catheter exit site purulent discharge associated with pericatheter swelling, redness, or tenderness. Swabs were obtained, but identifying a causative organism was not required for diagnosis. Infection rates were calculated as the number of infections divided by the total time at risk and expressed as episodes per 100 patient-months at risk. Peritonitis, defined by ISPD guidelines, was diagnosed by cloudy effluent with Ͼ100/l white cells, with Ͼ50% of these polymorpho...

PeriScreen strip analysis correlated with microscopic WCC of PD. However, analysis of PD effluent on day 5 of treatment is not a good test to risk stratify patients for relapsing peritonitis.