La transferencia a hemodiálisis tras una peritonitis fúngica.¿Es la opción definitiva?

Abstract

Peritonitis is one of the most serious and frequent complications in patients undergoing renal replacement therapy by means of peritoneal dialysis (PD), especially in the modality of continuous ambulatory peritoneal dialysis (CAPD)¹ . Bacterial aetiology is responsible for episodes of peritonitis in 80% of cases, but in contrast, fungal infection only in 4.6%, although it has a worse prognosis since it is associated with high morbidity-mortality². The guidelines of the Spanish Society of Nephrology4 (SEN) recommend immediate removal of the catheter, with the impossibility of continuing the PD programme. The most common pathogens in bacterial peritonitis are Coagulase negative Staphylococcus and Staphylococcus aureus. In contrast, in fungal peritonitis, the usual pathogen is Candida albacans, although currently a higher incidence of Candida parapsilosis has been observed². The most common risk factors are previous episodes of bacterial peritonitis and treatment with high-spectrum antibiotics^1,2. Below we describe our experience in a case of fungal peritonitis, the uniqueness of which lies in its resolution; despite the severity of the case and complications arising after transfer to haemodialysis (HD), the patient was able to return to PD.