Changing Pattern of Peritoneal Dialysis-Related Fungal Peritonitis: A 21-Year Single-Center Experience.

Rationale & Objective: Fungal peritonitis (FP) in peritoneal dialysis is rare but associated with catastrophic outcomes. This study evaluated the longitudinal evolution of FP incidence during 2004-2024, with particular interest in the effects of antifungal prophylaxis, which was introduced in 2016, on the development of FP and the risk factors for FP-associated death. Study Design: Retrospective cohort study. Setting & Participants: Sixty-two episodes of FP in 62 patients undergoing peritoneal dialysis who experienced FP at our center between January 2004 and December 2024. Exposure: Antifungal prophylaxis with oral fluconazole 100 mg/d. Outcomes: Incidences of overall, secondary, and primary FP; risk factors for FP-associated death. Analytical Approach: Linear by linear association; Poisson regression; logistic regression. Results: The average FP rate was 0.0065 episodes/patient-year. The annual FP rates significantly decreased over the 21 years ( Limitations: Single-center, observational study. Conclusions: Incidences of overall FP and secondary FP declined at our center, advocating the effectiveness of antifungal prophylaxis in programs with a low baseline FP rate. Primary FP represented the major subtype after implementation of antifungal prophylaxis, and high mortality remained an issue. A greater comorbid condition burden, as well as certain species of causative fungi, were associated with risks of death.