No abstract

Introduction: A national program of continuous ambulatory peritoneal dialysis (CAPD) has only recently been established in Sudan. In the head center of this national program, six of the 67 peritonitis episodes that were diagnosed during its 30 months of function were fungal in origin (9% of all episodes, 0.12 episode per year at risk). Here we describe the clinical features, predisposing factors, and outcomes of these six cases. Case series: Clinical presentation of fungal peritonitis did not differ from other cases of peritonitis. Among the six cases that were diagnosed in our center, five cases were due to Candida species and only one was due to Aspergillus. All patients had received antibiotic therapy within one month of diagnosing fungal peritonitis; five of them had received intraperitoneal (IP) antibiotics for a previous episode of bacterial peritonitis and one patient had received a course of oral antibiotics for exit site infection. Two of the patients were diabetic. All patients were treated with oral fluconazole, 200 mg daily, for three weeks, and all had their dialysis catheter removed. One patient died, and the others were transferred permanently to hemodialysis (HD). Two patients developed encysted intra-abdominal fluid collections 15 and 48 days after catheter removal. Conclusion: Fugal peritonitis complicating CAPD is not uncommon in our center, which serves a major portion of the CAPD population in the Sudan. Most patients responded to oral fluconazole treatment and catheter removal, but two of them suffered from late complications.

Introduction: Diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) are more prone to fluid overload than non-diabetic patients, but the use of hypertonic glucose solutions to improve their ultrafiltration (UF) may hamper their glycemic control.Maintaining euvolemia in such patients may be tricky and needs special care.Case report: A 72 year old diabetic and hypertensive patient presented with severe fluid overload shortly after initiation of CAPD despite producing more than one liter of urine per day. He only achieved modest ultrafiltration (UF) during the day, and had a negative UF during the long hypertonic night dwell. Peritoneal equilibration tests (PET) confirmed that he was a high transporter, and his weekly Kt/V was found to be 1.36. Since automated peritoneal dialysis (APD) is not yet available in Sudan, the PD prescription was modified to comprise five short cycles during the day, including two short hypertonic daytime dwells, and a dry abdomen at night. This approach succeeded in improving his fluid status, but required the addition of intra-peritoneal soluble insulin to his regular subcutaneous insulin in order to achieve acceptable blood sugar control. After 8 months his residual renal function (RRF) had declined remarkably and he began to suffer from intermittent fluid overload of variable degrees. Nevertheless, we managed to maintain him satisfactorily on CAPD for 14 months. Conclusion:Simple measures such as omitting the night dwell and using five short cycles during the day, including two short hypertonic dwells, can be effective in controlling fluid overload in diabetic patients who have a high transporter status.