Chronic exit-site care using povidone–iodine versus normal saline in peritoneal dialysis patients

Continuous ambulatory peritoneal dialysis is an important treatment method for patients with end-stage renal disease. Although the incidence of catheter-associated complications such as peritonitis and exit-site infection has been decreasing, these complications have not been resolved completely. Therefore, prevention of catheter-associated infections is essential both soon after peritoneal dialysis (PD) catheter placement and during long-term PD treatment. The currently used local application materials for prophylactic exit-site care in PD patients in Korea are povidone–iodine (92.7%), hydrogen peroxide (4.4%), normal saline (1.2%), alcohol (0.9%), and chlorhexidine (0.8%) (personal communication; Baxter, Gambro and FMC, June 2014). The role of topical disinfectants in long-term exit-site care remains unclear. Moreover, much controversy surrounds the prophylactic strategies used to prevent such infections. Several reports indicated lower incidence rates of exit-site infection with the use of povidone–iodine than with other cleansing methods in PD patients. Luzar et al [1] reported that, in a large randomized trial, a nonocclusive dressing plus povidone–iodine was found to be associated with a lower rate of exit-site infection than soap and water alone (0.27 vs. 0.71 episodes/patient-year). In addition, in a nationwide survey for exit-site care in Austria, disinfectants for chronic exit-site care included povidone–iodine (n1⁄4155), sodium hypochlorite (n1⁄431), povidone–iodine plus sodium hypochlorite (n1⁄4102), and octenidine dihydrochloride/phenoxyethanol (n1⁄417). In this randomized controlled trial, local application of povidone–iodine solution at the exit-site significantly reduced the rate of exit-site infections, compared with local treatment with water and a nondisinfectant soap [2]. Grosman et al [3] reported that the alternative cleansing agent 50% Amuchina (electrolytic chloroxidizer) was more effective than 10% povidone–iodine and as effective as 4% chlorhexidine, but with fewer adverse secondary effects. Patients using 3% Amuchina presented an exit-site infection rate similar to that in patients using 50% Amuchina. No adverse secondary effects were observed with the use of Amuchina at either concentration. The cost of 3% Amuchina was significantly lower than that of the 50% concentration, and it was even lower than the cost for 10% povidone–iodine or 4% chlorhexidine. In the literature, no consensus has been reached regarding the prophylactic use of povidone–iodine or other antiseptics at