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Changing Pattern of Peritoneal Dialysis-Related Fungal Peritonitis: A 21-Year Single-Center Experience
Hao Yan1,2,3, He Zhang1,2,3, Yue Qian1,2,3
1Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Rationale & Objective:
Fungal peritonitis (FP) in peritoneal dialysis is rare but associated with catastrophic outcomes. This study evaluated the longitudinal evolution of FP incidence during 2004-2024, with particular interest in the effects of antifungal prophylaxis, which was introduced in 2016, on the development of FP and the risk factors for FP-associated death.
Study Design:
Retrospective cohort study.
Setting & Participants:
Sixty-two episodes of FP in 62 patients undergoing peritoneal dialysis who experienced FP at our center between January 2004 and December 2024.
Exposure:
Antifungal prophylaxis with oral fluconazole 100 mg/d.
Outcomes:
Incidences of overall, secondary, and primary FP; risk factors for FP-associated death.
Analytical Approach:
Linear by linear association; Poisson regression; logistic regression.
Results:
The average FP rate was 0.0065 episodes/patient-year. The annual FP rates significantly decreased over the 21 years (P = 0.019). The secondary FP rate declined from 0.0052 episodes/patient-year during 2004-2015 to 0.0022 episodes/patient-year during 2016-2024 (P = 0.016), while the primary FP rate remained stable (0.0035 episodes/patient-year during 2004-2015 vs 0.0036 episodes/patient-year during 2016-2024, P = 0.943). The proportion of primary FP increased from 39% before 2016 to 62% afterward (P = 0.078). Multivariable analysis showed that a higher Charlson comorbidity index (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.10-2.74) was associated with FP-associated death, while Candida parapsilosis as the sole causative fungus (OR, 0.17; 95% CI, 0.03-0.94) was associated with a lower risk of mortality.
Limitations:
Single-center, observational study.
Conclusions:
Incidences of overall FP and secondary FP declined at our center, advocating the effectiveness of antifungal prophylaxis in programs with a low baseline FP rate. Primary FP represented the major subtype after implementation of antifungal prophylaxis, and high mortality remained an issue. A greater comorbid condition burden, as well as certain species of causative fungi, were associated with risks of death.
Insights
Antifungal prophylaxis significantly reduced fungal peritonitis (FP) in peritoneal dialysis patients, particularly secondary cases. However, primary FP increased, and mortality risk factors like comorbidities remain critical.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Epidemiology
Background:
- Fungal peritonitis (FP) is a rare but severe complication in peritoneal dialysis (PD).
- Understanding the longitudinal trends of FP incidence and associated mortality is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the long-term evolution of FP incidence in PD patients.
- To assess the impact of introducing antifungal prophylaxis on FP rates.
- To identify risk factors associated with FP-related mortality.
Main Methods:
- Retrospective cohort study analyzing 62 FP episodes in PD patients from 2004 to 2024.
- Examined incidence rates of overall, secondary, and primary FP.
- Utilized linear by linear association, Poisson, and logistic regression for analysis.
Main Results:
- Overall and secondary FP incidence rates significantly decreased after antifungal prophylaxis introduction in 2016.
- Primary FP incidence remained stable, but its proportion increased.
- Higher Charlson comorbidity index and specific fungal species (excluding Candida parapsilosis) were associated with increased mortality risk.
Conclusions:
- Antifungal prophylaxis appears effective in reducing overall and secondary FP in PD.
- Primary FP is becoming more prevalent, highlighting the need for continued vigilance.
- Comorbidities and specific fungal pathogens are key determinants of mortality in FP patients.
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