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.

scholarly journals Ten-year experience with fungal peritonitis in peritoneal dialysis patients: antifungal susceptibility patterns in a North-American center

2012 ◽  
Vol 16 (1) ◽  
pp. e41-e43 ◽  
Author(s):  
Jasmin Levallois ◽  
Annie-Claire Nadeau-Fredette ◽  
Annie-Claude Labbé ◽  
Michel Laverdière ◽  
Denis Ouimet ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
North American ◽  
Antifungal Susceptibility ◽  
Dialysis Patients ◽  
Fungal Peritonitis ◽  
Susceptibility Patterns

scholarly journals THE RISK FACTORS AND OUTCOME OF FUNGAL PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

2009 ◽  
Vol 27 (1) ◽  
pp. 59-61
Author(s):  
E Indhumathi ◽  
V Chandrasekaran ◽  
D Jagadeswaran ◽  
M Varadarajan ◽  
G Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Fungal Peritonitis

Mortality and Technique Failure in Peritoneal Dialysis Patients Using Advanced Peritoneal Dialysis Solutions

2009 ◽  
Vol 54 (4) ◽  
pp. 711-720 ◽  
Author(s):  
Seung Hyeok Han ◽  
Song Vogue Ahn ◽  
Jee Young Yun ◽  
Anders Tranaeus ◽  
Dae-Suk Han
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Technique Failure ◽  
Dialysis Solutions ◽  
Peritoneal Dialysis Solutions

Six-minute walk test predicts all-cause mortality and technique failure in ambulatory peritoneal dialysis patients

Nephrology ◽  
2017 ◽  
Vol 22 (2) ◽  
pp. 118-124 ◽  
Author(s):  
Yuanyuan Shi ◽  
Dongxia Zheng ◽  
Lin Zhang ◽  
Zanzhe Yu ◽  
Hao Yan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Walk Test ◽  
Dialysis Patients ◽  
Six Minute Walk Test ◽  
All Cause Mortality ◽  
Technique Failure ◽  
Minute Walk

Treatment of Fungal Peritonitis with a Combination of Intravenous Amphotericin B and Oral Flucytosine, and Delayed Catheter Replacement in Continuous Ambulatory Peritoneal Dialysis

2008 ◽  
Vol 28 (2) ◽  
pp. 155-162 ◽  
Author(s):  
Ping-Nam Wong ◽  
Kin-Yee Lo ◽  
Gensy M.W. Tong ◽  
Shuk-Fan Chan ◽  
Man-Wai Lo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Amphotericin B ◽  
Clinical Course ◽  
Control Group ◽  
Study Group ◽  
Fungal Peritonitis ◽  
Antifungal Chemotherapy ◽  
Intravenous Amphotericin ◽  
Technique Failure ◽  
Catheter Replacement

Background Fungal peritonitis (FP) is associated with significant mortality and high risk of peritoneal failure. The optimum treatment for peritoneal dialysis (PD)-associated FP remains unclear. Since January 2000 we have been treating FP with a combination of intravenous amphotericin B and oral flucytosine, together with deferred catheter replacement. We examined the clinical course and outcome of the FP patients treated with this approach (study group). An outcome comparison was also made to an alternatively treated historic cohort (control group). Methods This was a single-center retrospective study. The clinical course and outcome of 13 consecutive episodes of FP occurring in 13 patients treated between January 2000 and April 2005 with the study approach were examined. The patients were treated with an incremental dose of intravenous amphotericin B to a target dose of 0.75 – 1 mg/kg body weight/day, and oral flucytosine 1 g/day upon a diagnosis of FP at 3.77 ± 0.93 days from presentation. Replacement of the peritoneal catheter was intended after complete clearing of effluent, after which, antifungal chemotherapy was continued for another 1 – 2 weeks. Their outcome was compared with 14 historic controls that were treated between April 1995 and December 1999. Results Mean age of the study group was 58.7 ± 13.2 years; male-to-female ratio was 2:11; 6 (46.1%) were diabetic. All FP were caused by Candida species ( C. albicans, 2; C. parapsilosis, 8; C. glabrata, 3). Two (15.4%) patients died before resolution of the peritonitis. The dialysate effluent cleared in 11 patients (84.6%) after 13.2 ± 3.3 days of treatment, but 2 patients died of acute myocardial infarction before catheter replacement. Nine patients had their catheters replaced at day 26.7 ± 7.7 of treatment; all 9 returned to PD after a total of 31 ± 12.2 days of antifungal chemotherapy. Reversible liver dysfunction was common with this regimen. When compared with the 14 cases in the historic control group ( Candida species, 13; Trichosporon, 1), who were treated with amphotericin B, fluconazole, or a combination of the two, and the majority (78.6%) of whose catheters were removed before day 10 of presentation, the study group appeared to have a lower technique failure rate (30.8% vs 78.6%, p = 0.013) and similar all-cause mortality (30.7% vs 28.5%, p = NS), FP-related mortality (15.4% vs 28.5%, p = NS), and length of hospitalization (48.5 ± 30.2 vs 57.0 ± 37.7 days, p = NS). However, a significantly earlier commencement of antifungal treatment in the study group (3.8 ± 0.9 vs 5.8 ± 2.4 days, p = 0.012) could be an important confounder of outcome. Conclusions Combination of intravenous amphotericin B and oral flucytosine with deferred catheter replacement appears to be associated with a relatively low incidence of PD technique failure, without affecting mortality in patients suffering from FP due to yeasts in this preliminary study. Nonetheless, drug-induced hepatic dysfunction was common; close monitoring during treatment is of paramount importance. The reasons accounting for the observed distinctive outcome remain unclear and further study is required to confirm the results and to investigate for the underlying mechanism.

Higher Eosinophils Predict Death-Censored Technique Failure in Peritoneal Dialysis Patients

2020 ◽  
Vol 181 (10) ◽  
pp. 765-773
Author(s):  
Jiayi Yang ◽  
Jinjin Fan ◽  
Li Fan ◽  
Chunyan Yi ◽  
Jianxiong Lin ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Technique Failure

Four steps to standardize reporting of peritoneal dialysis technique failure: A proposed approach

2020 ◽  
pp. 089686082097693
Author(s):  
Alix Clarke ◽  
Pietro Ravani ◽  
Matthew J Oliver ◽  
Mohamed Mahsin ◽  
Ngan N Lam ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Outcome Measure ◽  
Time Window ◽  
Time Windows ◽  
Dialysis Patients ◽  
Data Set ◽  
The Impact ◽  
Technique Failure ◽  
Standardize Reporting ◽  
Dialysis Technique

Background: Technique failure is an important outcome measure in research and quality improvement in peritoneal dialysis (PD) programs, but there is a lack of consistency in how it is reported. Methods: We used data collected about incident dialysis patients from 10 Canadian dialysis programs between 1 January 2004 and 31 December 2018. We identified four main steps that are required when calculating the risk of technique failure. We changed one variable at a time, and then all steps, simultaneously, to determine the impact on the observed risk of technique failure at 24 months. Results: A total of 1448 patients received PD. Selecting different cohorts of PD patients changed the observed risk of technique failure at 24 months by 2%. More than one-third of patients who switched to hemodialysis returned to PD—90% returned within 180 days. The use of different time windows of observation for a return to PD resulted in risks of technique failure that differed by 16%. The way in which exit events were handled during the time window impacted the risk of technique failure by 4% and choice of statistical method changed results by 4%. Overall, the observed risk of technique failure at 24 months differed by 20%, simply by applying different approaches to the same data set. Conclusions: The approach to reporting technique failure has an important impact on the observed results. We present a robust and transparent methodology to track technique failure over time and to compare performance between programs.

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