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Strategies to universally improve peritonitis rates, including use of dialysis solutions with low glucose degradation products.

Despite technology advances, prevention of peritonitis remains one of the major challenges in peritoneal dialysis (PD). Several innovative developments have shown an impact on peritonitis rates. Innovative antimicrobial-coated catheter modifications have been introduced, showing promising results in vitro. Topical application of antimicrobial agents such as mupirocin to prevent exit-site infections has been successfully used. New alternative agents for topical exit-site care with reduced potential for antimicrobial resistance are under development. Flushing before fill and avoidance of spiking of solution bags have improved peritonitis rates, as have innovative connectology and double-bag systems. Automated PD seems to be superior with regard to peritonitis rates, although clinical evidence for the benefit is not always conclusive. New PD solutions with neutral pH and low concentrations of glucose degradation products (GDPs) have shown beneficial effects on cell viability and have improved peritoneal host defense. Yet despite advantageous clinical outcomes in some studies, other trials with low-GDP solutions did not show any difference in peritonitis rates. The incidence of peritonitis has markedly improved since the end of the 1980s, but the infection remains a significant complication of chronic PD. Quantifying the role of the many practices and devices in reducing complications is difficult, but their combined effect has clearly improved peritonitis outcomes.