Double Bag L3 system 을 이용한 지속성 외래 복막투석의 임상 성적

Abstract

We are reporting our clinical experiences with double bag L3 system (L3 system) in 36 CAPD patients who were maintained on this system between May 1991 and June 1993 (L3 group). Clinical characteristics and the overall incidence of peritonitis and exit site infection in these 36 patients were compared to 27 CAPD patients who used the standard spike connecting system during the same period (SC group). The results were as follows; 1) In L3 group, 29 (80.6%) were new patients who had never had dialysis treatment previously, 5 (13.9%) changed their previous spike connector to L3 system, and 2 (5.6%) changed the dialysis modality from hemodialysis (HD) to CAPD, and in SC group, 23 (85.2%.) were new ESRD patients, 3 (11.1%) changed the dialysis modality from HD, and 1 (3.7%.) underwent chronic rejection after renal transplantation. 2) The sex ratio was 17:19 in L3 group and 18:9 in SC group, and the mean age in L3 and SC group was 46.7±12.0 year-old and 50.2±11.9 year-old, respectively. 3) The mean duration of CAPD was significantly longer in SC group (23.4±7.4 months) than that in L3 group (16.9±9.1 months ) (p<0.05). 4) Underlying diseases of ESRD in L3 group were chronic glomerulonephritis in 27 patients (75.0%), diabetes mellitus in 4 (11.1%), hypertension in 2 (5.6%), and others in 3 (8.3%), and in SC group, chronic glomer- ulonephritis in 21 (77.8%), diabetes mellitus in 5 (18.5%), and hypertension in 1 (3.7%). 5) In L3 group, the total patient months of follow up were 608 and there were 20 episodes of peritonitis, while in SC group the total patient-months of follow up were 633 and 32 episodes of peritonitis occurred. The overall incidence of peritonitis was lower in L3 group than that in SC group (30.4 vs 19.8 patient-months/episode), but there was no significant difference between them. Exit site infection occurred slightly more in L3 group than in SC group (29 vs 24 episodes), but there was no significant difference in the overall incidence of exit site infection (21.0 vs 26.4 patient-months/episode) between the two groups. 6) Staphylococcus coagulase (-) was the most frequent pathogen of peritonitis in L3 and SC group (40.0% 34.4%), and the largest proportion of exit site infection was caused by Staphylococcus aureus in both groups (58. 6%., 70.8%). No significant difference in the causative organisms of peritonitis and exit site.infection was observed between the two groups. 7) Eight patients (22.2%) in L3 group and 5 (18.5%) in SC group discontinued CAPD during the follow up period. Three (37.5%) in L3 group and 2 (40.0%) in SC group had renal transplantation, 2 in both groups (25.0%, 40.0%) died, and 1 in both (12.5%, 20.0%) suffered intractable peritonitis. One (12.5%,) in L3 group had peritoneal membrane injury during the operation for polycystic kidney disease, and another (12.5%) refused all the treatments by himself. In conclusion, L3 system is a simple and safe CAPD system and makes patients free from carrying an uncomfortable empty bag. But, further study with a large number of patients and a long term of follow up duration will be needed to evaluate the effect of L3 system on the prevention of CAPD peritonitis and exit site infection.