Fungal peritonitis in peritoneal dialysis:8-year review from a single Chinese center

Fungal peritonitis (FP) is a rare but serious complication of peritoneal dialysis (PD). This study retrospectively analyzed the clinical manifestations, pathogen types, treatment and prognosis of FP patients in Fuzhou University Affiliated Provincial Hospital from 2018 to 2025, with a view to summing up experience and improving clinical management capabilities.

1.Research subjects: PD patients with fungal peritonitis who were hospitalized in the Department of Nephrology, Fuzhou University Affiliated Provincial Hospital from January 2018 to June 2025. The diagnostic criteria were determined according to the ISPD guidelines.
2. Data collection: Collect patient demographic and clinical data.
3. Statistical method: SPSS 25.0 software was used for statistical analysis. All tests are two-sided, and P<0.05 is considered a statistically significant difference.

1. General information: During the observation period, there were 501 hospitalizations for PD-related peritonitis, of which 29 were FP, accounting for 5.79%. FP occurred most frequently in August (20.70%) and April (20.70%). Among the 29 FP cases, 12 were male and 17 were female, with an average age of 51.79±12.70 years, and an average age of peritoneal dialysis of 36.66±29.15 months, of which 7 cases (24.14%) had been on dialysis for more than 60 months. The primary diseases were as follows: 9 cases with unknown cause, 9 cases with chronic glomerulonephritis, 8 cases with diabetic nephropathy, 1 case each of gouty nephropathy, ANCA-associated vasculitis renal damage, and lupus nephritis.
2. Clinical data: 15 cases were first diagnosed in our hospital. Fourteen cases had been treated in other hospitals, of which 5 cases had been cultured as fungi and 2 cases had been cultured as bacteria. Fifteen patients had a history of peritonitis, and 7 patients had used antibiotics 4 weeks before the onset of illness. Three patients were diagnosed with FP after the transudate turned clear and then became turbid again during treatment. All 29 patients had abdominal pain at onset, 9 patients had diarrhea at onset, 12 patients had fever at onset, and 3 cases developed sepsis during the course of the disease. The number of nucleated cells in the dialysate was 960 (255.50, 2176.25) cells/mm3, hemoglobin was less than 110g/L in 24 cases (82.76%), albumin was less than 30g/L in 26 cases (89.66%), and serum potassium was less than 3.5mmol/L in 15 cases (51.70%). The median ferritin was 768.05 (183.15, 1500.00) ug/L, and the median procalcitonin was 2.16 (0.97, 4.92) ng/ml. A total of 8 patients completed the serum G/GM test, and 4 patients had G test >100pg/ml (2 cases of Candida albicans infection, 2 cases of Candida tropicalis infection), and all GM test results were normal.
3. Etiological results: Among the 29 FP patients, 12 were Candida parapsilosis, 5 were Candida albicans, 3 were Candida tropicalis, 2 were Candida glabrata and Candida guilliermomdii, 1 case each of Cryptococcus neoformans, yeast-like fungi, leucosporium parvum, Candida norvegensis and Rodydium longsporum. There were 2 cases of fungi combined with bacteria, Enterococcus faecium and Klebsiella pneumoniae respectively.
4. Treatment and prognosis: All 29 patients had their peritoneal dialysis tubes removed. Four cases of abdominal abscess and one case of infectious peritoneal effusion occurred during the course of the disease, and peritoneal puncture and drainage were performed in all cases. Intestinal obstruction occurred in 5 patients and intestinal perforation in 1 patient. All 29 patients received antifungal therapy, 16 of which were intravenous and 13 of which were oral. Among them, 9 cases were voriconazole, 19 cases were fluconazole, and 1 case was amphotericin. The median time from admission to extubation for extubated patients was 6.0 (3.3, 13.0) days, and the median hospital stay was 18.5(14.0, 29.0) days. Two patients' condition worsened and died, 25 patients were switched to hemodialysis, one patient was re-cannulated for PD after 6 months, and one patient was lost to follow-up.

FP is a serious complication of PD, with long disease course and hospitalization time, high PD withdrawal rate, and poor prognosis. Our center mainly deals with Candida parapsilosis and Candida albicans, which are more common in women.