OBJECTIVE: To evaluate the impact of the "flush before fill" technique on the frequency of peritonitis in children receiving automated peritoneal dialysis (APD). DESIGN: Randomized prospective multicenter study. SETTING: Participating pediatric dialysis programs of the Pediatric Peritoneal Dialysis Study Consortium. PATIENTS: 121 pediatric (< 21 years of age) patients that had received peritoneal dialysis for > or = 2 months and that were currently receiving APD were randomized to use (flush group) or non-use (no flush group) of the "flush before fill" option. 66 patients were followed for > or = 12 months. MAIN OUTCOME MEASURE: Peritonitis rates. RESULTS: Overall, patients enrolled in the flush group experienced a peritonitis rate of 1 infection every 16.8 patient months; patients in the no flush group experienced a rate of 1 infection every 12.6 patient months (p = 0.193). However, analysis by gender revealed the peritonitis rate of females in the flush group (1 infection every 44.7 patient months) to be significantly better than females in the no flush group (1 infection every 12.4 patient months) (p < or = 0.01). There was no difference noted in the male patients. CONCLUSION: The use of the "flush before fill" option in pediatric patients receiving APD is associated with a marked improvement in the peritonitis rate of female but not male patients. Further study is indicated to explain the gender differences.

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