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Fungal peritonitis is a rare, yet severe complication of patients with peritoneal dialysis (PD), associated with technique failure and a high morbidity-mortality.
Predictors of mortality are not fully identified, Nadeau et al reported the Charlson comorbidity index and PD fluid white cell count >3000/mm3 at presentation as predictors of death in a North American cohort.
Since there is scarce information of predictors of mortality in Latin-America, we aim to identify these and describe the clinical characteristics of fungal peritonitis patients in a Mexican cohort.
Retrospective cohort study from a single Mexican center. We searched for fungal peritonitis episodes reported, with the use of a specific report format, between January 2018 and December 2019. We also reviewed clinical records to obtain clinical data: etiology of chronic kidney disease (CKD), time on PD, number of previous episodes of peritonitis, initial empiric treatment, targeted therapy, biochemical facts: candida species, PD effluent white cell count at presentation and outcomes: permanent and temporal transfer to hemodialysis (HD), removal of PD catheter and mortality.
We use a univariate logistic regression model (ULRM) to identify predictors of death.
The study includes 37 fungal peritonitis episodes, the mean age and time in PD were 62.3 ± 12.57 and 3 (2-5) years respectively. Diabetes was the main etiology of CKD (86%). All the isolated fungi corresponded to Candida species, with Candida Guilliermondii as the most frequent (72%). Regarding the target therapy, fluconazole and voriconazole were prescribed in 48% and 45% respectively, the mean effluent´s white cell count at presentation was 159 x mm3 (68-400) and the mean lymphocytes 23%.
Outcomes: mortality 21%, permanent transfer to HD 35%, temporal transfer to HD 16% and 27% of patients did not require removal of PD catheter.
The ULRM recognized years on PD ([OR] 1.59, 95% CI 1.12 – 2.52) and white cell count in effluent > 264 at presentation ([OR] 7.87, 95% CI 1.474 – 62) as predictors of mortality.
Results support the previous findings of high mortality risk and permanent transfer to HD, interestingly a non-negligible percentage of patients did not require removal of the PD catheter (corresponding to those treated with voriconazole). We identify mortality related factors: years on PD and white cell count > 264 x mm3 at diagnosis, in this sense we contribute to filling a gap in the knowledge of this population in Latin-America and lastly, we should take this into account during the care of these patients.
The content of this abstract was submitted for the: 70 Congreso Internacional en Nefrología 2023 IMIN