Fungal peritonitis in peritoneal dialysis: a 5 years retrospective review in Northeast Thailand

Introduction: Peritoneal dialysis (PD) is a widely used renal replacement therapy for end-stage renal disease patients, offering various advantages. However, fungal peritonitis, a rare but life-threatening complication, remains less understood than bacterial peritonitis. Material and methods: This retrospective single-center study included all cases of fungal peritonitis in PD patients at Sakon Nakhon hospital, Northeast Thailand, from October 2017 to September 2022. Data on demographics, co-morbidities, prior antibiotic uses, laboratory values, microbiological features, treatments, and outcomes were collected. Results: The study involved 32 PD patients with fungal peritonitis. Patients were on average 59.0 ± 11.29 years old, with a majority of females (68.8%). Diabetes (62.5%) was the leading cause of chronic kidney disease. Common co-morbidities included hypertension (75.0%) and diabetes (62.5%). Laboratory values showed variations, including elevated serum creatinine, urea levels, and low hemoglobin. Abdominal pain (81.3%) and clouding of dialysate (68.8%) were typical symptoms at presentation. Sepsis was present in 18.8% of patients. Candida species were the most common causative agents, with 100% receiving Amphotericin-B and 87.5% receiving Fluconazole for treatment. Most patients underwent catheter removal (93.8%). In terms of outcomes, 37.5% resumed PD, 43.8% transitioned to permanent hemodialysis, and the overall mortality rate was 15.6%. Conclusions: This study provides valuable insights into fungal peritonitis in PD patients, underlining the significance of regional considerations in clinical management. The findings underscore the need for standardized guidelines for diagnosis and treatment, accounting for local variations in causative agents and outcomes.