1. ¹Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
2. ²Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
3. ³Department of Nephrology and Transplantation Services, University of Adelaide at the Queen Elizabeth Hospital, Adelaide, Australia
4. ⁴Department of Nephrology, Monash Medical Center, Clayton, Victoria, Australia
5. ⁵Renal Department, Middlemore Hospital, Otahuhu, Auckland, New Zealand
6. ⁶University of Melbourne Department of Medicine, St Vincent's Hospital, Fitzroy, Victoria, Australia
7. ⁷Department of Nephrology, Royal Adelaide Hospital, Adelaide, Australia

Correspondence: David W. Johnson, Department of Nephrology, Level 2, ARTS Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane Qld 4102, Australia. E-mail: david_johnson@health.qld.gov.au

Received 2 January 2009; Revised 11 March 2009; Accepted 21 April 2009; Published online 10 June 2009.

Abstract

Fungal peritonitis is a serious complication of peritoneal dialysis but previous reports on this have been limited to small, single-center studies. Using all Australian peritoneal dialysis patients, we measured predictors, treatments, and outcomes of this condition by logistic regression and multilevel, multivariate Poisson regression. This encompassed 66 centers over a 4-year period that included 162 episodes of fungal peritonitis (4.5% of all peritonitis episodes) that occurred in 158 individuals. Candida albicans (25%) and other Candida species (44%) were the most common fungi isolated. Fungal peritonitis was independently predicted by indigenous race and prior treatment of bacterial peritonitis. Peritonitis episodes occurring after 7 and 60 days of treatment for previous bacterial peritonitis decreases in the probability of fungal peritonitis 23 and 6%, respectively. Compared with other organisms, fungal peritonitis was associated with significantly higher rates of hospitalization, catheter removal, transfer to permanent hemodialysis, and death. The risks of repeat fungal peritonitis and death were lowest with catheter removal combined with antifungal therapy when compared to either intervention alone. Our study shows that fungal peritonitis is a serious complication of peritoneal dialysis and should be strongly suspected in the context of recent antibiotic treatment for bacterial peritonitis.