Touch Contamination

In the US, hemodialysis is the standard of care for adults with end-stage kidney disease, but most children receive at-home peritoneal dialysis (PD) because it better regulates the child’s electrolyte balance and allows them to attend school. However, PD comes with a high risk of touch contamination at any of the labeled connection points (Figure 1). These small contaminations require immediate antibiotic treatment, but oftentimes providers do not realize when contaminations occur, which leads to peritonitis. Over $20 billion per year in both private and Medicare dollars is spent on treating infections due to dialysis. In addition to these huge healthcare costs, reducing the risk of touch contamination and the incidence of peritonitis will also improve the quality of life of patients. More adults would go on PD and thus they would generally feel better and would not have to miss work for hemodialysis treatments, which last 3- 4 hours per session, 3-4 times per week.

In addition to the clinical benefits of this project, there also exists a large commercial opportunity. There have been some attempts at solving this need; one such device was Puracath Firefly, which is an extra connection piece, but parents and providers did not accept it, as it added extra steps to an already complex at-home procedure. Fresenius also makes devices for CAPD (continuous ambulatory peritoneal dialysis) that works to minimize touch contamination, but this device is cumbersome and is not made for standard PD and most patients prefer to only be connected to dialysis machinery at night. There have also been papers published about PD infection; one interesting project discussed using antibiotic creams and found positive results, but this is not being implemented (I asked Dr. Neu about the reasoning for this). In addition, Dr.Neu’s organization, SCOPE, is primarily looking at ways to reduce infection caused by hemodialysis, so there is currently no one looking into peritoneal dialysis efforts. This is an extremely opportune time to approach this issue because in the very near future, there will be more work going into PD infection prevention. Thus, now is the time for the greatest commercial opportunity.

Lastly, the project seems to be very technically feasible. There exist many ways to prevent bacterial contamination, and this project requires some knowledge about the PD machine and processes, but does not require extensive knowledge of a foreign idea, nor does it seem to require extensive out-sourced skills/manufacturing. Need Statement: There is a need to reduce the likelihood of connector contamination in at-home peritoneal dialysis systems in order to reduce the incidence of peritonitis and improve the quality of life of kidney-failure patients by enabling more patients to receive peritoneal dialysis.