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Predictors and outcomes of fungal peritonitis in peritoneal dialysis patients

Rhianna Miles1, Carmel M Hawley, Stephen P McDonald

  • 1Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.

Kidney International
|June 12, 2009
PubMed

Insights

Fungal peritonitis, a serious complication of peritoneal dialysis, is linked to indigenous race and prior bacterial peritonitis treatment. Prompt catheter removal and antifungal therapy reduce risks of recurrence and death.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Public Health

Background:

  • Fungal peritonitis is a severe complication of peritoneal dialysis (PD).
  • Previous research on fungal peritonitis is limited to small, single-center studies.
  • This study utilizes a comprehensive national dataset to investigate fungal peritonitis in PD patients.

Purpose of the Study:

  • To identify predictors of fungal peritonitis in Australian PD patients.
  • To examine treatments and outcomes associated with fungal peritonitis.
  • To compare the effectiveness of different interventions for fungal peritonitis.

Main Methods:

  • Analysis of data from all Australian PD centers over a 4-year period.
  • Inclusion of 162 episodes of fungal peritonitis in 158 individuals.
  • Statistical analysis using logistic regression and multilevel, multivariate Poisson regression.

Main Results:

  • Candida species were the most common fungi identified (69%).
  • Indigenous race and prior bacterial peritonitis treatment were independent predictors.
  • Fungal peritonitis correlated with increased hospitalization, catheter removal, hemodialysis transfer, and mortality.
  • Combined catheter removal and antifungal therapy yielded the lowest risks for recurrence and death.

Conclusions:

  • Fungal peritonitis is a significant complication of PD with poor outcomes.
  • Recent antibiotic treatment for bacterial peritonitis warrants strong suspicion for fungal peritonitis.
  • Optimal management involves catheter removal and antifungal therapy to minimize adverse outcomes.

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