Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Single-Centre Experience in India

Ram, R; Swarnalatha, G; Neela, P.; Murty, K V Dakshina

doi:10.1159/000167867

Cited by 39 publications

(59 citation statements)

References 14 publications

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“…The rate of fungal peritonitis is highly variable between countries, ranging from 1 to 15% [44,45,46,47]. However, in certain countries like India the rate can be as high as 14.3-23.9% [48,49]. Yeast, especially Candida species, dominated all fungal peritonitis.…”

Section: Issues Related To Peritoneal Dialysis In Asian Countriesmentioning

confidence: 99%

Peritoneal Dialysis in Asia

Kwong¹,

Li²

2015

Kidney Dis

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Background: There is a growing demand of dialysis in Asia for end-stage renal failure patients. Diabetes mellitus is the leading cause of end-stage renal failure in many countries in Asia. Summary: The growth of peritoneal dialysis (PD) in Asia is significant and seeing a good trend. With the enhanced practices of PD, the quality of care in PD in Asia is also improved. Overall, PD and hemodialysis (HD) are comparable in clinical outcome. There is a global trend in the reduction of peritonitis rates and Asian countries also witness such improvement. The socio-economic benefits of PD for end-stage renal failure patients in both urban and rural areas in the developed and developing regions of Asia are an important consideration. This can help to reduce the financial burden of renal failure in addressing the growing demand of patients on dialysis. Initiatives should be considered to further drive down the cost of PD in Asia. Key Messages: Growing demand for dialysis by an increasing number of end-stage renal failure patients requires the use of a cost-effective quality dialysis modality. PD is found to be comparable to HD in outcome and quality. In most countries in Asia, PD should be more cost-effective than HD. A ‘PD-first' or a ‘PD as first considered therapy' policy can be an overall strategy in many countries in Asia in managing renal failure patients, taking the examples of Hong Kong and Thailand. Facts from East and West: (1) PD is cheaper than HD and provides a better quality of life worldwide, but its prevalence is significantly lower than that of HD in all countries, with the exception of Hong Kong. Allowing reimbursement of PD but not HD has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over the last years. In the Western world, however, HD is still promoted, and the proportion of patients treated with PD decreases. Japan remains an exception in Asia where PD penetration is very low. Lack of adequate education of practitioners and information of patients might as well be reasons for the low penetration of PD in both the East and West. (2) Patient survival of PD varies between and within countries but is globally similar to HD. (3) Peritonitis remains the main cause of morbidity in PD patients. South Asian countries face specific issues such as high tuberculosis and mycobacterial infections, which are rare in developed Asian and Western countries. The infection rate is affected by climatic and socio-economic factors and is higher in hot, humid and rural areas. (4) Nevertheless, the promotion of a PD-first policy might be beneficial particularly for remote populations in emerging countries where the end-stage renal disease rate is increasing dramatically.

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Section: Issues Related To Peritoneal Dialysis In Asian Countriesmentioning

confidence: 99%

Peritoneal Dialysis in Asia

Kwong¹,

Li²

2015

Kidney Dis

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“…[1] Indian studies have reported incidence of FP rates varying from 14.3%[13] to 23.88%, respectively. [14] In our study, FP accounted for 14% of all peritonitis episodes.…”

Section: Discussionmentioning

confidence: 61%

Fungal peritonitis in continuous ambulatory peritoneal dialysis: The impact of antifungal prophylaxis on patient and technique outcomes

et al. 2014

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Fungal peritonitis (FP) is a rare, but serious complication of peritoneal dialysis. We analyzed the incidence of FP, associated risk factors and outcome of patients with FP and evaluated the role of prophylactic antifungal agent in reducing its incidence. We studied all patients with FP from January 2005 to January 2012. Study period was divided into two parts, period I (January 2005 to January 2010), when prophylactic antifungal was not used and period II (January 2010 to January 2012), when prophylactic antifungal (fluconazole) was used. A total of 142 episodes of peritonitis were documented during this period of which 20 (14%) were FP. During the study period I, 18 of 102 episodes of peritonitis (17.6%) and in the study period II (with antifungal prophylaxis), only 2 of 40 episodes of peritonitis (5%) were due to fungal infection (P = 0.04). Nine out of 20 patients (45%) had prior exposure to antibiotics. Fungal isolates were Candida albicans in 65%, non-albicans Candida in 25%, Rhizopus species in 5% and Alternaria in 5% of the patients. While 12 out of 20 patients (60%) recovered completely and were re-initiated on continuous ambulatory peritoneal dialysis (CAPD), 4 of them expired (20%) and 4 others (20%) were shifted to hemodialysis. Use of prophylactic antifungal agent significantly reduced the incidence of FP (P = 0.04). We conclude that - fluconazole when used as a prophylactic agent in the setting of bacterial peritonitis significantly reduces the incidence of subsequent FP in CAPD patients.

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“…In an Indian study, fungal peritonitis accounted for 23.88% of all peritonitis episodes. 4 Three factors appeared to predict mortality: the presence of non-Candida species, the catheter being left in situ and a serum albumin level 53 g/dL. 4 As peritoneal biopsy is rarely done in clinical practice unless it is a protocol procedure, a significant proportion of information on morphology is unavailable to the treating physician to predict the outcome.…”

Section: Discussionmentioning

confidence: 99%