Abstract: SA-PO630
Incidence of Fungal Peritonitis and Exit Site Infections Among Peritoneal Dialysis Patients in a Mid-Sized Dialysis Provider
Session Information
- Home Dialysis - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
- Neumann, Joanna, Satellite Healthcare, San Jose, California, United States
- Abra, Graham E., Satellite Healthcare, San Jose, California, United States
Background
Fungal infections are a relatively rare complication of peritoneal dialysis (PD). These infections include fungal peritonitis, an especially serious complication, and fungal growth at the catheter exit site. Surprisingly little is known about the epidemiology of fungal infections among PD patients in the United States. We estimated the incidence of fungal peritonitis and exit site infection (ESI) in a multi-center cohort of PD patients.
Methods
We analyzed the electronic health records of Satellite Healthcare, a mid-sized, not-for-profit dialysis provider. We identified patients who initiated PD between January 1, 2011, and March 31, 2023, and retained those that initiated PD during the first year after diagnosis of end stage kidney disease. Patents were followed until the earliest of first fungal infection (either peritonitis or ESI), death, conversion to hemodialysis, kidney transplantation, recovery of function, or April 30, 2023. We estimated the cumulative incidence of each of fungal peritonitis and ESI, and used Cox regression to estimate associations of age, sex, diabetes, and time-varying modality subtype (continuous ambulatory, automated) with the risk of fungal infection.
Results
The cohort included 5743 patients. Overall, 135 patients experienced a fungal infection: 94 patients experienced peritonitis at a mean of 27.9 months after PD initiation, 43 patients experienced an ESI at a mean of 32.0 months after PD initiation, and 2 patients experienced both complications. The cumulative incidence of fungal peritonitis was 0.9% at 2 years after PD initiation and 1.7% at 4 years. No associations with fungal peritonitis were statistically significant, although age of 18-44 years, relative to 45-64 years, and continuous ambulatory PD were associated with lower hazard. At 3 months after fungal peritonitis, the cumulative incidence of conversion to hemodialysis was 80.4%. The cumulative incidence of fungal ESI was 0.4% at 2 years after PD initiation and 0.7% at 4 years. At 3 months after fungal ESI, the cumulative incidence of conversion to hemodialysis was 18.6%.
Conclusion
Fungal infection is a rare event in PD patients, with little overlap between fungal peritonitis and ESI. Fungal infection tends to occur late in the course of PD. Fungal peritonitis is highly likely to be followed by PD discontinuation in the short run.