A new study will look at the effectiveness of using a unique silicone catheter with built-in antibiotics in preventing infection in patients using dialysis for kidney disease at home.
The CAP study (Clinical Evaluation, Development and Commercialisation of an Antimicrobial – Impregnated Catheter Against Peritonitis) is receiving funding from the NIHR Invention for Innovation Programme, and is being led by Professors Maarten Taal and Roger Bayston, with a team of experts at the University of Nottingham and University Hospitals of Derby and Burton NHS Foundation Trust.
Peritoneal dialysis (PD) is a type of dialysis that is used to treat people with kidney failure at home. A silicone tube is placed with one end in the abdomen and the other exiting through the skin. Fluid is run into the abdomen through the tube, and then drained out again after 1-4 hours. The process is repeated multiple times every day.
While the fluid is in the abdomen, toxins and other waste chemicals move from the body into the fluid and are removed when the fluid is drained out. In this way, PD partially replaces kidney function.
However, infection related to the tube is the most common risk associated with PD. This may be mild if it affects only the skin, but can be severe if the infection spreads to the abdomen. This is called peritonitis, which may cause severe pain and even life-threatening sepsis.
Currently, the only measures available to prevent PD tube infections are careful hygiene when handling the tube and antibiotics. Despite these measures, peritonitis is one of the most common causes of people having to stop PD and change to another form of dialysis that involves direct filtration of the blood (haemodialysis).
In this study the team will test a PD tube that has had three different antibiotics built into the silicone using a special patented process developed by the University of Nottingham group.
The team will study 40 people needing PD who will have the antibiotic-treated tubes placed as part of their normal care. They will look at whether the tubes are safe to use and, importantly, are acceptable to patients. They will also check whether the tubes are associated with any increase in bacteria that are resistant to antibiotics.
Peritonitis accounts for 20% of PD patient deaths, and the only available measure to prevent it is careful hygiene when handling the tube. PD is such an important treatment for people with kidney disease, as it can be done in their own homes, so we need to find a way of reducing the infection risk."
Niall Buntain, 58, from Burton on Trent, has been using PD for two years. He said: "When you first start using PD, the renal team cannot stress enough the importance of being clean and hygienic, and when you first start to go through the process it can be overwhelming. It's a fairly robotic process and you have to keep focus. A lot of people who start on this type of dialysis find it takes time to get into the habit and in the early days you're far more likely to pick up an infection, simply because you're not used to it. As much as you try to be careful, it can be hard to adjust to the routine. This new type of catheter will really help and will take a lot of the risk away."
