Characteristics and outcomes of fungal peritonitis in a modern North American cohort

Abstract

Introduction: Peritonitis remains a common complication of peritoneal dialysis (PD). Although representing only 1 - 12% of overall peritonitis in dialysis patients, fungal peritonitis (FP) is associated with serious complications, including technique failure and death. Only scarce data have been published regarding FP outcomes in modern cohorts in North America. In this study we evaluated the rates, characteristics and outcomes of FP in a major North American PD center.

Methods: We conducted a retrospective cohort study including all fungal peritonitis episodes among peritoneal dialysis patients followed in a large PD center between January 2000 and February 2013. Our pre-specified endpoints included rates of FP, characteristics, outcomes and determinants of death.

Results: Thirty-six episodes of FP were identified during the follow-up period (one episode per 671 patient-months), representing 4.5% of the total peritonitis events. Patients' mean age and peritoneal dialysis vintage were 61.3 ± 15.5 and 2.9 (1.5 - 4.8) years, respectively. Of the 36 episodes of FP, seven (19%) resulted in death and 17 (47%) led to technique failure with permanent transfer to hemodialysis. Surprisingly, PD was eventually resumed in 33% of cases with a median delay of 15 weeks (interquartile range 8 - 23) between FP and catheter reinsertion. In a univariable analysis, a higher Charlson comorbidity index (Odds ratio [OR] 3.25 per unit increase, 95% confidence interval [CI] 1.23 - 8.58) and PD fluid white blood cell (WBC) count greater than 3,000/mm(3) at presentation (OR 6.56, 95% CI 1.05 - 40.95) predicted death.

Conclusion: While fungal peritonitis is still associated with a high frequency of death and technique failure, one third of our patients eventually returned to PD. Patients with a high burden of comorbidities appear at higher risk of death. We postulate that the high mortality associated with FP is partially related to the severity of comorbidity among patients with FP, rather than the infection per se. Importantly, PD can be resumed in a significant proportion of cases.

Keywords: Peritoneal dialysis; death; fungal peritonitis; technique survival.

Figure 1 —

Flow chart.

Figure 2 —

Outcomes of fungal peritonitis: death (7 patients), definitive transfer to hemodialysis (17 patients), resumption or continuation of PD (12 patients).