The Antibiotic effect of Silver CAPD Catheter on Peritoneal Dialysis-related infections (ASCA-PD) study: a multicenter randomized open-label trial protocol

Background: Peritoneal dialysis (PD) offers greater flexibility than hemodialysis, especially in patients with limited mobility or demanding schedules; however, PD-related infection is a major complication and a cause of withdrawal from peritoneal dialysis. The Antibiotic effect of Silver continuous ambulatory peritoneal dialysis (CAPD) Catheter on Peritoneal Dialysis-related infections (ASCA-PD) study will evaluate the effectiveness of a novel silver CAPD catheter, incorporating silver-based antimicrobial technology, for preventing these infections and improving PD adherence. Methods/Design: This randomized, open-label, parallel-group, multicenter trial will evaluate the efficacy and safety of a silver CAPD catheter compared with those of a conventional catheter at 14 Japanese facilities. A total of 250 adult patients with newly initiated PD will be enrolled and randomized 1:1 to receive either catheter type. The key exclusion criteria are prior PD, emergency PD initiation, non-abdominal exit-site placement, metal allergy, life expectancy <1 year, severe liver disease, certain dermatologic conditions, and immunosuppression. After providing informed consent, patients will undergo nasal swab screening for methicillin-resistant Staphylococcus aureus . Randomization will be stratified by facility and diabetes status. The primary outcome is the composite endpoint of all exit-site and tunnel infections within 12 months of PD initiation. Secondary outcomes include individual infection events, catheter removal, peritonitis, catheter patency, allergic reactions, technique failure (transition to hemodialysis for ≥30 days or death), and transition to hybrid dialysis. A Poisson regression model will be used to analyze the primary outcome, adjusting for observation time, treatment group, and stratification factors. Time-to-event secondary outcomes will be analyzed by competing risk regression. Subgroup analyses will be carried out to explore the impacts of age, sex, diabetes, insertion method, and body mass index. Discussion: Unlike previous designs, our silver CAPD catheter incorporates AgNPs into silicone, enabling sustained antimicrobial effects both externally and internally, potentially overcoming limitations seen in prior human studies. This study will demonstrate the efficacy of silver CAPD catheters for preventing PD-related infections, especially during the initiation phase of PD, with the aim of providing a new therapeutic option. Trial registration: Japan Registry of Clinical Trials, jRCTs052250003. Registered on April 4, 2025.