scholarly journals Prescription Patterns in Dialysis Patients: Differences Between Hemodialysis and Peritoneal Dialysis Patients and Opportunities for Deprescription

2020 ◽  
Vol 7 ◽  
pp. 205435812091265 ◽  
Author(s):  
Judith G. Marin ◽  
Laura Beresford ◽  
Clifford Lo ◽  
Alexander Pai ◽  
Gabriela Espino-Hernandez ◽  
...  
Keyword(s):  
British Columbia ◽  
Peritoneal Dialysis ◽  
Statistical Tests ◽  
Prescribing Patterns ◽  
Dialysis Patients ◽  
Renal Complications ◽  
Dialysis Vintage ◽  
The Mean ◽  
Maintenance Dialysis ◽  
Chi Square Analysis

Background: Patients treated with maintenance dialysis are at high risk of polypharmacy given their many comorbidities as well as complications from their disease state and treatment. The prescribing patterns and burden of polypharmacy in patients treated with maintenance dialysis, and specifically the difference between hemodialysis (HD) and peritoneal dialysis (PD) prescribing, are not well characterized. Objectives: The objectives of this study were to review the prescribing patterns for patients treated with maintenance dialysis, to compare prescribing pattern between HD and PD, and to identify opportunities for deprescription. Design: This is a retrospective cohort study. Setting: This study was conducted in all dialysis centers in British Columbia, Canada. Patients: Patients who were receiving chronic dialysis (>120 days on the same dialysis modality) between June 3 and October 1, 2015, and registered in the British Columbia (BC) Renal Patient Records and Outcomes Management Information System. Measurements: Patient demographics as well as both prescription and non-prescription medications were collected. Comparison of discrete and continuous variables was made by chi-square analysis and independent t test, respectively. All statistical tests were 2-sided, and a P value of <.05 was considered statistically significant. Methods: Medications were classified by indication: (1) management of renal complications, (2) cardiovascular (CV) medications, (3) diabetes medications, or (4) management of symptoms, and then classified as to whether they were a “potentially inappropriate medication” (PIM) or not. Ethics approval was granted from the University of British Columbia Research and Ethics Board. Results: In total, 3017 patients met inclusion criteria (2243 HD, 774 PD). The mean age was 66.2 ± 14.8 years. The HD group had more patients over 80 years old (22.1% vs 12.5%) and more patients with diabetes and CV disease. The mean number (standard deviation [SD]) of discrete prescribed medications was 17.71 (5.72) overall with more medications in the HD group versus the PD group. The mean number of medications increased with dialysis vintage in both groups. HD patients were on more medications for renal complications and management of symptoms than PD patients. Of the total number of medications prescribed, 5.02 (2.78) were classified as a PIM, with the number of PIMs higher in HD vs PD patients: 5.37 (2.83) versus 4.02 (2.37). Limitations: In BC, some of the medications are prescribed through standardized protocols and may not be comparable with other Canadian provinces. We report here prescribing patterns, not utilization patterns, as we are not able to ascertain actual consumption of prescribed medication. Conclusion: This study reviews and characterizes both the prescription and non-prescription medication prescribed to HD patients and PD patients in BC. Pill burden in both groups is high, as is the prescription of PIMs. Patients receiving maintenance HD receive more overall medications and more PIMs. These results highlight areas of opportunities for future systematic and patient-informed deprescription initiatives in both patient groups.

scholarly journals Association of Serum Sclerostin Level, Coronary Artery Calcification, and Patient Outcomes in Maintenance Dialysis Patients

2021 ◽  
pp. 1-10
Author(s):  
Yifei Ge ◽  
Buyun Wu ◽  
Xiangbao Yu ◽  
Ningning Wang ◽  
Xueqiang Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Coronary Artery ◽  
Patient Outcomes ◽  
Coronary Artery Calcification ◽  
Dialysis Patients ◽  
Survival Group ◽  
Dialysis Vintage ◽  
Maintenance Dialysis

<b><i>Objective:</i></b> The objective of this study is to investigate the association between the serum sclerostin, the coronary artery calcification (CAC), and patient outcomes in maintenance dialysis patients. <b><i>Methods:</i></b> We performed a prospective cohort study of 65 maintenance dialysis patients in 2014, including 39 patients on peritoneal dialysis and 26 on hemodialysis, and followed up for 5 years. Parameters of mineral metabolism including bone-specific alkaline phosphatase, fibroblast growth factor 23, sclerostin, and other biochemical factors were determined at the baseline. Meanwhile, the CAC score was analyzed by cardiac computed tomography. <b><i>Results:</i></b> Serum sclerostin in hemodialysis patients was significantly higher than that in peritoneal dialysis patients (632.35 ± 369.18 vs. 228.85 ± 188.92, <i>p</i> &#x3c; 0.001). The patients with CAC were older, receiving hemodialysis, lower Kt/V, and had longer dialysis vintage, as well as higher levels of serum 25-(OH)-vit D and sclerostin. In multivariate logistic regression analysis, older age and lower Kt/V were risk factors for CAC. The area under the receiver operating characteristic curves for prediction of CAC by sclerostin was 0.74 (95% confidence interval 0.605–0.878, <i>p</i> = 0.03), and the cutoff value of sclerostin is 217.55 pg/mL with the sensitivity 0.829 and specificity 0.619. After 5 years of follow-up, 51 patients survived. The patients in the survival group had significantly lower age, sclerostin levels, and low CAC scores than the nonsurvival group. Old age (≥60 years, <i>p</i> &#x3c; 0.001) and high CAC score (≥50 Agatston unit, <i>p</i> = 0.031) were significant risk factors for the patient survival. <b><i>Conclusions:</i></b> Sclerostin is significantly elevated in dialysis patients with CAC. But sclerostin is not a risk factor for CAC. After 5 years of follow-up, patients in the survival group are younger and have lower sclerostin levels and CAC scores. But sclerostin levels are not independent risk factors for high mortality in dialysis patients.

Hemodialysis versus peritoneal dialysis: an observational study in two international centers

2017 ◽  
Vol 41 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Renhua Lu ◽  
Carla Estremadoyro ◽  
Xiaohuan Chen ◽  
Mingli Zhu ◽  
Leonardo C. Ribeiro ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lipid Metabolism ◽  
Vascular Disease ◽  
Cause Of Death ◽  
Patient Survival ◽  
Dialysis Patients ◽  
Cerebral Vascular Disease ◽  
Kaplan Meier ◽  
Dialysis Vintage ◽  
Maintenance Dialysis

Introduction: Given that it is difficult to randomize end-stage renal disease (ESRD) patients to either hemodialysis (HD) or peritoneal dialysis (PD), differences between these renal replacement therapy (RRT) modalities are of major interest and remain controversial. Methods: All data on maintenance dialysis patients during 2009 to 2013 in the Renji Hospital in Shanghai, China and in the San Bortolo Hospital in Vicenza, Italy were selected. Patients who changed their therapy from HD to PD or PD to HD during this study were excluded. Results: 919 maintenance dialysis patients were included in the present study, including 509 patients on HD and 410 on PD. During the 5-year follow-up, mean arterial pressure (MAP) was higher in HD patients. The level of serum HCO3- was significantly better in PD patients than in HD patients. Phosphate was significantly higher in HD patients than in PD patients. With respect to lipid metabolism, triglyceride, total cholesterol and LDL were significantly higher in PD patients. Serum protein and albumin were higher in HD patients than in PD patients. Overall, 236 patients died (25.7%); 150 (16.3%) on HD and 86 (9.4%) on PD. The main cause of death in HD and PD patients was cerebral vascular disease and infection, respectively. After adjusting for dialysis vintage, the Kaplan-Meier patient survival was similar between HD and PD patients. Conclusions: Based on 5 years of data, we demonstrate that lipid metabolism and nutritional status were better in HD patients. However, blood pressure control, acid-base balance, phosphate (P) control were better in PD patients. The main cause of death in HD and PD was cerebral vascular disease and infection, respectively. Considering the dialysis vintage, the Kaplan-Meier patient survival was similar between HD and PD patients.

Overview of blood purification in uremia

1980 ◽  
Vol 3 (4) ◽  
pp. 203-208
Author(s):  
B.T. Burton
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Rejection Rate ◽  
Blood Purification ◽  
Maintenance Hemodialysis ◽  
Dialysis Patients ◽  
Transplant Patients ◽  
Maintenance Dialysis ◽  
Transplanted Kidneys

Today, management of irreversible renal failure is based primarily on maintenance hemodialysis and renal transplantation with a growing minority of patients treated by peritoneal dialysis. With regard to renal transplantation — the early promise of renal transplantation in the mid 1960's has given way to the realities of the late 1970's. There have been no major changes in the rejection rate of transplanted kidneys in recent years though today's mortality of transplant patients is considerably reduced over what it used to be. Moreover, universally the lack of availability of a sufficient number of organs for transplantation poses a formidable problem. It is all too apparent that current methods of blood purification in uremia are far from optimal. Even though the mortality in maintenance dialysis is relatively low, hemodialysis is characterized by a variety of complications and most maintenance dialysis patients are not optimally rehabilitated.

scholarly journals Maintaining the Uptake of Peritoneal Dialysis During the COVID-19 Pandemic: A Research Letter

2021 ◽  
Vol 8 ◽  
pp. 205435812098626
Author(s):  
Mark Canney ◽  
Lee Er ◽  
John Antonsen ◽  
Michael Copland ◽  
Rajinder Suneet Singh ◽  
...  
Keyword(s):  
British Columbia ◽  
Peritoneal Dialysis ◽  
Confidence Interval ◽  
Clinical Information System ◽  
Clinical Information ◽  
Catheter Insertion ◽  
Peritoneal Dialysis Catheter ◽  
Time Period ◽  
Hospital Patients ◽  
Maintenance Dialysis

Background: Due to inherent challenges in maintaining physical distancing in hemodialysis units, the Canadian Society of Nephrology has recommended peritoneal dialysis as the preferred modality for patients requiring maintenance dialysis during the coronavirus disease 19 (COVID-19) pandemic. However, pursuing peritoneal dialysis is not without risk due to the requirement for in-person contact during catheter insertion and training, and there is a paucity of data regarding the experience of peritoneal dialysis during the early phases of the pandemic. Objective: To examine the incidence and outcomes of peritoneal dialysis between March 17 and June 01, 2020 compared to the same time period in preceding years. Design: Retrospective observational study. Setting: British Columbia, Canada. After the pandemic was declared on March 17, 2020, patients continued to be trained in peritoneal dialysis. In an effort to limit time spent in hospital, patients were preferentially trained in continuous ambulatory peritoneal dialysis, training times were truncated for some patients, and peritoneal dialysis catheters were inserted by a physician at the bedside whenever feasible. Patients: All patients aged >18 years who started chronic maintenance dialysis during the period March 17 to June 01 in the years 2018 to 2020 inclusive. The time period was extended to include the years 2010 to 2020 inclusive to evaluate longer term trends in dialysis incidence. Measurements: A provincial clinical information system was used to capture the date of commencing dialysis, dialysis modality, and complications including peritonitis. Overall uptake of peritoneal dialysis included new starts and transitions to peritoneal dialysis from in-center hemodialysis during the observation period. Methods: The incidence of dialysis during the specified time period, overall and by modality, was calculated per million population using census figures for the population at risk. Patients were followed for a minimum of 30 days from the start of peritoneal dialysis to capture episodes of peritonitis and COVID-19. Results: A total of 211 patients started maintenance dialysis between March 17 and June 01, 2020. The incidence dialysis rate (41.3 per million population) was lower than that expected based on the 10-year trend from 2010 to 2019 inclusive (expected rate 45.7 per million population, 95% confidence interval 41.7 to 50.1). A total of 93 patients started peritoneal dialysis, including 32 patients who transitioned from in-center hemodialysis, contributing to a higher overall uptake of peritoneal dialysis compared to preceding years. The incidence rate for peritoneal dialysis of 18.2 per million population was higher than that expected (16.3 per million population, 95% confidence interval 14.0 to 19.0). Half of patients (48%) underwent a bedside peritoneal dialysis catheter insertion by a physician. During 30 days of follow-up, 2 (2.2%) patients experienced peritonitis and no patients were diagnosed with COVID-19. Limitations: Results are short term and generalizable only to regions with similarly low community rates of transmission of severe acute respiratory syndrome coronavirus 2. Conclusions: These preliminary findings indicate that peritoneal dialysis can be safely started and perhaps expanded as a means of mitigating the anticipated surge in in-center hemodialysis during the COVID-19 pandemic. Important contributors to the uptake of peritoneal dialysis in British Columbia were bedside catheter insertions and expediting transitions from in-center hemodialysis to peritoneal dialysis.

scholarly journals The Diagnosis of Protein Energy Wasting in Chronic Peritoneal Dialysis Patients Is Influenced by the Method of Calculating Muscle Mass. A Prospective, Multicenter Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Cristina Techy Roth-Stefanski ◽  
Naiane Rodrigues de Almeida ◽  
Gilson Biagini ◽  
Natália K. Scatone ◽  
Fabiana B. Nerbass ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Muscle Mass ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Multifrequency Bioimpedance ◽  
Study Population ◽  
The Mean ◽  
Main Factor

Objective: To analyze the concordance and agreement between bioimpedance spectroscopy (BIS) and anthropometry for the diagnosis of protein energy wasting (PEW) in chronic peritoneal dialysis patients.Methods: Prospective, multi-center, observational study using multifrequency bioimpedance device (Body Composition Monitor -BCM®- Fresenius Medical Care) and anthropometry for the diagnosis of PEW as recommended by the International Society of Renal Nutrition and Metabolism (ISRNM). Cohen's kappa was the main test used to analyze concordance and a Bland-Altmann curve was built to evaluate the agreement between both methods.Results: We included 137 patients from three PD clinics. The mean age of the study population was 57.7 ± 14.9, 47.8% had diabetes, and 52.2% were male. We calculated the scores for PEW diagnosis at 3 and 6 months after the first collection (T3 and T6) and on average 40% of the study population were diagnosed with PEW. The concordance in the diagnosis of PEW was only moderate between anthropometry and BIS at both T3 and T6. The main factor responsible for our results was a low to moderate correlation for muscle mass in kilograms, with an r-squared (R2) of 0.35. The agreement was poor, with a difference of more than 10 kg of muscle mass on average and with more than a quarter of all cases beyond the limits of agreements.Conclusion: Current diagnosis of PEW may differ depending on the tools used to measure muscle mass in peritoneal dialysis patients.

Association of Carnitine Deficiency in Indian Continuous Ambulatory Peritoneal Dialysis Patients with Anemia, Erythropoietin Use, Residual Renal Function, and Diabetes Mellitus

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 235-238
Author(s):  
S. Ramalakshmi ◽  
Bjoe Baben ◽  
Ben S. Ashok ◽  
V. Jayanthi ◽  
Nancy Leslie ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Dialysis Patients ◽  
Carnitine Level ◽  
Daily Urine ◽  
The Mean ◽  
Daily Urine Output

♦ In the present study, we aimed to determine levels of free carnitine in hemodialysis (HD) and peritoneal dialysis (PD) patients in India and to correlate carnitine deficiency with various clinical parameters. ♦ Patients on HD and PD at two tertiary care centers were selected for the study. Baseline data were obtained, and a free carnitine analysis was performed. Carnitine deficiency was defined as a free carnitine level of less than 40 μmol/L. ♦ The total number of study patients was 96 (77 on HD, 19 on PD). In the PD group, the mean age was 56 years, with 26.3% of the patients being vegan, 47.4% having diabetes, and 57.9% having a daily urine output of <500 mL. The mean carnitine level in that group was 38.9 μmol/L, and 68.4% of the patients had a carnitine deficiency. A Pearson correlation test failed to show any association of carnitine level with parameters such as anemia, use of erythropoietin, non-vegetarian diet, diabetes, and hypertension. In the HD group, the mean age was 45 years, with 22% of the patients being vegan, 23% having diabetes, and 45.5% having a daily urine output of <500 mL. The mean carnitine level in the group was 38.2 μmol/L, and 64.3% of the patients had a carnitine deficiency. Residual renal function and duration of dialysis were different in HD patients with and without carnitine deficiency. Carnitine levels in the HD group correlated positively and statistically significantly with the presence of diabetes and hypertension. ♦ Conclusion This study is the first demonstration that Indian dialysis patients have carnitine deficiency.

Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

2002 ◽  
Vol 22 (3) ◽  
pp. 371-379 ◽  
Author(s):  
◽  
Michael V. Rocco ◽  
Diane L. Frankenfield ◽  
Barbara Prowant ◽  
Pamela Frederick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

scholarly journals Long QT, alteration of calcium-phosphate product, prevalence of ventricular arrhythmias and sudden death in peritoneal dialysis patients: a Holter study

2013 ◽  
pp. 99-104
Author(s):  
Pierluigi Di Loreto ◽  
Claudio Ronco ◽  
Giorgio Vescovo
Keyword(s):  
Peritoneal Dialysis ◽  
Plasma Levels ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Holter Monitoring ◽  
Dialysis Patients ◽  
Premature Ventricular Contractions ◽  
Phosphate Product ◽  
The Mean ◽  
Monitoring And Measurement

Materials and methods We studied 79 patients on peritoneal dialysis. Each underwent 24-h electrocardiography (Holter monitoring) and measurement of the rate-corrected QT interval (QTc). We analyzed the correlation between QTc and plasma levels of Ca++, PO4−, K+, Na+, Mg++, and parathyroid hormone (PTH). Results The mean QTc was 0.445 ± 0.04 s. In 55 patients, the QTc was prolonged (> 0.45 s). Mean laboratory values for the group were: PTH 344 ± 25 pg/mL, Ca++ 9.27 ± 0.11 mg/dL, PO4− 5.5 ± 1.5 mg/dL, Na+ 139.6 ± 3.4 mmol/L, K+ 4.04 ± 0.64 mmol/L, and Mg++ 2.52 ± 0.43 mg/dL. Holter monitoring revealed complex premature ventricular contractions in 44 patients, monomorphic premature ventricular contractions in 16, and nonsustained ventricular tachycardia (NSVT) in 10. The QTc was significantly correlated with plasma levels of PO4− (r = 0.045, p < 0.05), PTH (r = 0.077, p < 0.02), and Ca++ (r = 0.076, p < 0.02). Eleven patients had Lown class 4a or 4b ventricular arrhythmias, and their mean QTc was 465 ± 0.02 ms. Ten had NSVT and their QTc was 464 ± 0.03 ms. Eleven patients died suddenly (mean QTc 465 ± 0.03 ms); all 11 had either NSTV or Lown class 4 ventricular arrhythmias. Conclusions Long QTc seems to be associated with an increased prevalence of ventricular arrhythmias that may be the cause of sudden cardiac death.

Hematocrit Values in the CAPD/CCPO Population: A Report of the National CAPO Registry

1990 ◽  
Vol 10 (4) ◽  
pp. 275-278 ◽  
Author(s):  
Anne s. Lindblad ◽  
Karl D. Nolph
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Random Sample ◽  
Recombinant Erythropoietin ◽  
Hematocrit Level ◽  
Polycystic Kidney ◽  
Dialysis Patients ◽  
Population Information ◽  
The Mean ◽  
Anephric Patients

A survey of the National CAPD Registry population was conducted to assess the distribution of hematocrit levels in a large group of peritoneal dialysis patients, to characterize the anemia of the population, and identify factors which relate to variation in hematocrit levels. A random sample of 812 patients was selected from the Registry population. Information was provided on 608 patients. Characteristics of sampled patients were similar to the Registry population as a whole. The mean hematocrit level in this cohort was 29.4% and the median was 29%. Recent peritonitis, time on CAPD, folate therapy, androgen therapy, and iron therapy had no obvious influence on hematocrit distributions. Significantly higher hematocrits were seen in males, whites, and patients with polycystic kidney disease. Significantly lower hematocrits were seen in surgically anephric patients and in patients who had received transfusions 60 days before the survey. Eighty-nine percent of patients had not received a transfusion 60 days prior to the survey. Some patients, especially those with hematocrits below the median, might benefit from recombinant erythropoietin therapy.

scholarly journals Characteristics and Outcomes of Fungal Peritonitis in a Modern North American Cohort

2015 ◽  
Vol 35 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Annie-Claire Nadeau-Fredette ◽  
Joanne M Bargman
Keyword(s):  
Peritoneal Dialysis ◽  
North American ◽  
Significant Proportion ◽  
Dialysis Patients ◽  
Fungal Peritonitis ◽  
Risk Of Death ◽  
Dialysis Vintage ◽  
Unit Increase ◽  
Wbc Count ◽  
Technique Failure

IntroductionPeritonitis remains a common complication of peritoneal dialysis (PD). Although representing only 1 – 12% of overall peritonitis in dialysis patients, fungal peritonitis (FP) is associated with serious complications, including technique failure and death. Only scarce data have been published regarding FP outcomes in modern cohorts in North America. In this study we evaluated the rates, characteristics and outcomes of FP in a major North American PD center.MethodsWe conducted a retrospective cohort study including all fungal peritonitis episodes among peritoneal dialysis patients followed in a large PD center between January 2000 and February 2013. Our pre-specified end-points included rates of FP, characteristics, outcomes and determinants of death.ResultsThirty-six episodes of FP were identified during the follow-up period (one episode per 671 patient-months), representing 4.5% of the total peritonitis events. Patients’ mean age and peritoneal dialysis vintage were 61.3 ± 15.5 and 2.9 (1.5 – 4.8) years, respectively. Of the 36 episodes of FP, seven (19%) resulted in death and 17 (47%) led to technique failure with permanent transfer to hemodialysis. Surprisingly, PD was eventually resumed in 33% of cases with a median delay of 15 weeks (interquartile range 8 – 23) between FP and catheter reinsertion. In a univariable analysis, a higher Charlson comorbidity index (Odds ratio [OR] 3.25 per unit increase, 95% confidence interval [CI] 1.23 – 8.58) and PD fluid white blood cell (WBC) count greater than 3,000/mm3at presentation (OR 6.56, 95% CI 1.05 – 40.95) predicted death.ConclusionWhile fungal peritonitis is still associated with a high frequency of death and technique failure, one-third of our patients eventually returned to PD. Patients with a high burden of comorbidities appear at higher risk of death. We postulate that the high mortality associated with FP is partially related to the severity of comorbidity among patients with F P, rather than the infection per se. Importantly, PD can be resumed in a significant proportion of cases.

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