OUTCOMES OF PERITONEAL DIALYSIS AFTER RECOMMENCEMENT FOLLOWING AN EPISODE OF FUNGAL PERITONITIS

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E-Poster

https://storage.unitedwebnetwork.com/files/1099/e55978566317298584dd808c32ea8549.pdf

Abstract Title

First Name *

Kamal

Last Name *

Sud

Co-author 1

Ronald Castelino ronald.castelino@sydney.edu.au The University of Sydney Pharmacy School Sydney

Co-author 2

Trevor Hwee Yong Tan trevortan.hy@gmail.com National Centre for Infectious Diseases Infectious Diseases Singapore

Co-author 3

Kamal Sud kamal.sud@health.nsw.gov.au Nepean Hospital Renal Medicine Sydney

Co-author 4

Co-author 5

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

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Introduction

Fungal peritonitis is a serious complication in patients receiving peritoneal dialysis (PD). Although uncommon, it is associated with high rates of hospitalisations, treatment failure and death. There is limited information available on outcomes if PD is reinstituted after an episode of fungal peritonitis. Therefore, this study aimed to examine the incidence and outcomes of patients who recommenced PD after an episode of fungal peritonitis.

Methods

Using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, all PD patients who developed fungal peritonitis between 2004 and 2021 were included and analysed.

Results

A total of 741 episodes of fungal peritonitis were identified in 731 patients. The majority, 534 (72.1%) of the fungal peritonitis episodes were caused by Candida spp. Of these, 182/741 (24.6%) were due to Candida albicans, 99/741 (13.4%) were due to Candida parapsilosis, 253/741 (34.1%) were due to other Candida species and the remaining episodes were caused by other fungal/yeast 202/741 (27.3%) and mixed fungal and bacterial spp. 5/741 (0.7%). The median (interquartile range (IQR)) time from the diagnosis of fungal peritonitis to PD catheter removal was 4 (4-8) days. Overall, a majority of the patients 506/731 (69.2%) had permanent transfer to haemodialysis (HD), 124/731 (17.0%) died within 30 days of diagnosis of fungal peritonitis, 56/731 (7.7%) had interim HD, 33/731 (4.5%) remained on PD, and 12/731 (1.6%) were not reported. Of the patients on interim HD, 52/731 (7.1%) patients recommenced PD after a median (IQR) duration of 109 (53-179) days, 3/731 (0.4%) died during interim HD and 1/731 (0.1%) was not reported. Of those who recommenced PD, 24/52 (46.2%) transferred to HD and 14/52 (26.9%) died after a median (IQR) duration of 27 (2-41) and 12 (4-31) months, respectively. Six patients (11.5%) had kidney transplantation, and only 8/52 (15.4%) remained on PD.

Conclusions

Patients with fungal peritonitis have high rates of permanent transfer to HD and are less likely to return to PD despite prompt removal of the PD catheter. Reinstitution of PD after an episode of fungal peritonitis is associated with sub-optimal patient and technique survivals.

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