HDCN Article Review/Hyperlink

Goldie SJ, Kiernan-Troidle L, Torres C, Gorban-Brennan N, Dunne D, Kliger AS, Finkelstein FO

Fungal peritonitis in a large chronic peritoneal dialysis population: A report of 55 episodes

Am J Kidney Dis (Jul) 28:86-91 1996

Fungal peritonitis is a serious complication of chronic peritoneal dialysis (CPD) therapy. The objective of this paper was to determine the risk factors and outcome with various treatment strategies in a single unit over a 10 year period (1984-1994). Of 704 patients on CPD, there were a total of 1712 episodes of peritonitis and 55 episodes of fungal peritonitis (3.2%). Patients developing fungal peritonitis were similar to those with other forms of peritonitis with respect to age, gender, etiology of ESRD, and comorbid disease. However, incidence of peritonitis (1/5.1 months vs. 1/9.9 months) was higher in the fungal peritonitis group.

Antibiotic therapy was given during the previous 6 months in 87.3% of patients with fungal peritonitis, and 6 patients had received an immunosuppressive agent within the past 2 weeks. All patients received antifungal drugs, usually either amphotericin B alone or in combination with fluconazole (5 patients recieved only fluconazole and/or flucytosine). 47 patients underwent catheter removal; however, of the 8 who did not have catheters removed, 4 were able to continue CPD. Overall, only 27 patients were able to continued CPD, 17 were transferred to HD, and 11 died. In patients undergoing catheter removal followed by antifungal therapy, PD was subsequently successfuIly performed in 91% of patients.

In conclusion, fungal peritonitis is uncommon but accounts for serious mobidity and mortality. Previous antibiotic use is the major identifiable risk factor. The best approach is probably antifungal therapy plus early catheter removal, temporary hemodialysis, with replacement of the PD catheter 2-8 weeks later after resolution of symptoms.

Comment: This is a helpful report to clinicians because of the large number of patients reported. It is of note that only one patient was treated with the combination of oral flucytosine and fluconazole, which is currently recommended by the Peritonitis Advisory Group for fungal peritonitis. (David J. Leehey, M.D., Loyola University at Chicago)