ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

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.