Tenckhoff Catheter Replacement or Intraperitoneal Urokinase: A Randomised Trial in the Management of Recurrent Continuous Ambulatory Peritoneal Dialysis (CAPD) Peritonitis

Abstract

A randomised trial, comparing Tenckhoff catheter replacement as a one-stage procedure and i.p. urokinase, was undertaken in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis. In addition to appropriate i.p. antibiotic treatment, 17 patients received i.p. urokinase (5000 i.u.) on the second and fourth days of antibiotic treatment, and 14 patients underwent CAPD catheter replacement. An additional six patients also underwent catheter replacement following the recurrence of peritonitis after urokinase treatment. The subsequent recurrence rate of peritonitis following CAPD catheter replacement (5%) was significantly less than after urokinase (41%) ( p < 0.001). Fourteen patients remained free of peritonitis for at least three months after catheter replacement, and five patients were peritonitis-free following urokinase for this period.

ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment

“…The rates of complete cure, catheter removal, or relapsing episode, as well as overall mortality were not affected by adjunctive treatment with IP urokinase. In contrast, 1 randomized controlled study showed that simultaneous catheter removal and replacement was superior to IP urokinase in reducing relapsing peritonitis episodes ( 341 ).…”

Chronic peritoneal dialysis in children

“…Williams et al, however, found that replacement of the catheter instead of urokinase therapy led to fewer repeat episodes. 40 Decreased macrophage bactericidal activity, opsonic activity, and immunoglobulin G concentration of peritoneal effluent have been found in children with a high rate of peritonitis.…”

5. Indications for the use of urokinase in peritoneal dialysis–associated peritonitis

“…Williams et al . performed a randomised controlled trial in which 17 patients received intraperitoneal urokinase (5000 IU) on the second and fourth days of appropriate antibiotic treatment for CAPD peritonitis; 14 patients underwent catheter replacement 1 . A further 6 patients who had a recurrence of peritonitis after urokinase treatment underwent catheter replacement.…”