ABSTRACT Introduction: Fungal peritonitis is an infrequent but serious complication for a patient on home peritoneal dialysis. Objective: To describe a case of fungal peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). Methods: A 53-year-old male patient is reported, with a history of arterial hypertension, 9 years on continuous outpatient peritoneal dialysis, moderate protein-energy malnutrition. During his treatment, he had several episodes of bacterial peritonitis, exit-site infections, and repositioning of a peritoneal catheter with an extruded cuff. We worked with his antecedents, clinical status, etiological agent and treatment. The diagnosis was established by the presence of cloudy peritoneal fluid, cell count higher than 100 leukocytes / ul, and culture with the presence of the filamentous fungus. Results: In December 2017, he was diagnosed with fusarium peritonitis, with no leukocytosis or anemia, he did present hypoalbuminemia. A culture was performed on the wall of the room where the patient had his exchanges and filamentous fungus was found. Initially, treatment started with vancomycin and ceftazidime, followed by amikacin. Finally, after having a culture showed the pathogen, treatment with itraconazole started. Unfortunately the patient died 20 days later. Conclusions: This research analyzes clinical and microbiological aspects of fusarium peritonitis, which are poorly understood in home peritoneal dialysis

RESUMEN Introducción: La peritonitis fúngica es una complicación infrecuente pero grave para un paciente en diálisis peritoneal domiciliaria. Objetivo: Describir un caso de peritonitis fúngica en un paciente en diálisis peritoneal continua ambulatoria (DPCA). Métodos: Se presenta un paciente masculino de 53 años de edad, con antecedentes de hipertensión arterial, 9 años en diálisis peritoneal continua ambulatoria, con una desnutrición proteico energética moderada. Durante su tratamiento presentó varios episodios de peritonitis bacterianas, infecciones del orificio de salida y una recolocación de catéter peritoneal con cuff extruido. Se trabajó con sus antecedentes, cuadro clínico, agente etiológico y tratamiento. El diagnóstico se estableció por la presencia de líquido peritoneal turbio, conteo celular con más de 100 leucocitos/ul y cultivo con la presencia del hongo filamentoso. Resultados: En diciembre de 2017 se le diagnostica una peritonitis por fusarium, sin leucocitosis ni anemia, sí presentaba una hipoalbuminemia, se cultiva además pared de la habitación donde el paciente se realizaba los intercambios y se encuentra hongo filamentoso. En principio se comienza tratamiento con vancomicina y ceftacidima, posteriormente se cambia la ceftazidima por amikacina y finalmente, al tener resultado de cultivo y se muestra el patógeno, se inicia tratamiento con itraconazol, lamentablemente el paciente fallece a los 20 días. Conclusiones: Con esta investigación se analizan aspectos clínicos y microbiológicos de la peritonitis por fusarium, los cuales son poco conocidos en diálisis peritoneal domiciliaria.

ABSTRACT Encapsulating peritoneal sclerosis is a rare but very serious complication of peritoneal dialysis. This complication is associated with high morbidity and mortality rates. Clinical diagnosis is based on the presence of intestinal obstruction or altered gastrointestinal function with pathological and radiological signs of intestinal encapsulation. The pathognomonic diagnosis is achieved only by performing peritoneal biopsy. The exact pathogenic mechanism of this entity remains unknown, although it is strongly associated with the duration of the patient with peritoneal dialysis. We report a clinical case of encapsulating peritoneal sclerosis and the clinical manifestations, diagnosis, treatment, prognosis and prevention are analyzed.

RESUMEN La esclerosis peritoneal encapsulante es una complicación poco común, pero muy grave, de la diálisis peritoneal. Esta complicación está asociada con altas tasas de morbilidad y mortalidad. El diagnóstico clínico requiere la presencia de obstrucción intestinal o función gastrointestinal alterada con signos patológicos y radiológicos de encapsulamiento intestinal. El diagnóstico patognomónico es solo con la realización de una biopsia peritoneal. El mecanismo patogénico exacto de esta entidad sigue siendo desconocido, aunque se asocia firmemente con el tiempo de duración del paciente en el tratamiento con diálisis peritoneal. Se presenta un caso clínico de esclerosis peritoneal encapsulante y se analizan las manifestaciones clínicas, diagnóstico, tratamiento, pronóstico y prevención.

INTRODUCTION Peritoneal dialysis is a maintenance therapy option for patients with end-stage renal disease. Continuous ambulatory peritoneal dialysis in Cuba was introduced in December 2007, and automated peritoneal dialysis one year later. This paper presents the outcomes attained with this blood purification technique, enabling an assessment to decide on scaling up its use in Cuba. OBJECTIVES Describe the clinical course of patients in the first five years of the Home Peritoneal Dialysis Program at Havana’s Nephrology Institute. METHODS An observational, descriptive study with a retrospective cohort was conducted. The universe comprised the 40 Nephrology Institute patients who underwent treatment with home peritoneal dialysis from December 20, 2007 to December 20, 2012. Relative and absolute frequencies were calculated for the study variables and the Kaplan-Meier method was used for survival curves for patients and for the peritoneum as dialysis membrane. RESULTS Of the 40 patients in the program, 23 were men and 17 were women, primarily aged 40 to 59 years. The most frequent causes of chronic kidney failure were hypertension (42.5%), glomerulopathies (22.5%), and diabetes mellitus (22.5%). A total of 103 complications occurred, both infectious (68, 66%) and non-infectious (35, 34%). The most common infectious complication was peritonitis (45, 66.2%); the most frequent non-infectious complication was catheter displacement (13, 37.1%). Seven patients left the peritoneal dialysis program. Of these, three died, two lost function of the peritoneum as a dialysis membrane, one received a kidney transplant and one recovered kidney function. Survival was 100% at one year, 97% at 2 years, 93.2% at 3 and 4 years, and 92% at 5 years. However, the peritoneal membrane was functional in 100% of patients during the first 2 years, decreasing to 96% at 3 and 4 years and to 88.6% at 5 years. CONCLUSIONS In our setting, peritoneal dialysis attained outcomes similar to those obtained internationally, which supports its usefulness as a renal replacement therapy method in Cuban patients with endstage renal disease.

Introduction: in Cuba the peritoneal dialysis was introduced at the end of the 60s; the peritonitis the was the more fearsome complication. Objective: to determine the incidence rate of peritonitis in a program of peritoneal dialysis at home. Methods: a prospective, descriptive and observational study was conducted in a universe including 30 patients from December, 2007 to May, 2011. Authors analyzed the demographic variables and the peritonitis presence. The distribution of frequency analysis was used as well as the Kaplan Meier for the time of the peritonitis-free survival. Results: from the total of patients, 17 had one episode of peritonitis, 6 had a second episode whereas only one had a third event for a total of 24 episodes of peritonitis; similar to an episode each 32 months/patient, these events occurred in 12 male patients and in 5 female patients; mean age was of 46,2 years. Conclusions: although the incidence of peritonitis became decreasing in past years, it remains as the leading complication of this therapeutical procedure.

Introducción: en Cuba se introdujo la diálisis peritoneal a finales de los años 60, la peritonitis es la complicación más temida. Objetivo: determinar la frecuencia y la tasa de peritonitis en un programa de diálisis peritoneal domiciliaria. Métodos: se realizó un estudio observacional, descriptivo y prospectivo desde diciembre de 2007 hasta mayo de 2011. El universo estuvo constituido por 30 pacientes. Se analizaron las variables demográficas y la presencia de peritonitis. Se utilizó el análisis de distribución de frecuencias, además el Kaplan Meier para el tiempo de supervivencia libre de peritonitis. Resultados: del total de pacientes, 17 presentaron 1 episodio de peritonitis, 6 tuvieron un segundo episodio, mientras solo 1, sufrió un tercer evento para un total de 24 episodios de peritonitis; equivalente a un episodio cada 32 meses/paciente, estos se presentaron en 12 enfermos masculinos y 5 femeninos; la edad promedio fue de 46,2 años. Conclusiones: aunque la incidencia de peritonitis ha venido descendiendo en los últimos años, continúa siendo la principal complicación de este proceder terapéutico.

All the patients who received urgent hemodialysis at the intensive care unit of the Nephrology Institute «Dr Abelardo Buch» in the period of March 1st to September 30th 2010 were studied through out an observational descriptive method of transversal cut. Every medical history and nursing register related to these urgent hemodialysis were carefully studied in order to determine the causes that provoked them and their ulterior behavior. It was used the statistical technique of analysis of frequency distributions and the absolute and relative frequencies were calculated. This technique came to show that of 44 patients most of them were female of white race with an age between 40 and 69 years. The most frequent base illness was hypertension. Hypervolemia and Hyperazoemia were the most suggesting causes for urgent hemodialysis. There were not significant complications.

En situaciones de urgencia, la hemodiálisis es la técnica más empleada en pacientes portadores de Insuficiencia Renal Crónica, Insuficiencia Renal Crónica Agudizada y en Insuficiencia Renal Aguda Se realizó un estudio observacional descriptivo de corte transversal. Fueron estudiados todos los pacientes que requirieron hemodiálisis de urgencia en la Unidad de Terapia Intensiva del Instituto de Nefrología Dr. Abelardo Buch, en el período del 1ro. de marzo al 30 de septiembre del 2010, para determinar las causas y para comportamiento de las mismas fueron revisadas todas las historias clínicas y los registros de Enfermería. Se utilizó la técnica estadística de análisis de distribución de frecuencias; absolutas y relativas. De un total de 44 pacientes, predominó el sexo femenino con 54,5%, la edad mayor de 40 años, 95,5%, entre 60-69 años, y mayores de 69 años con 25% respectivamente; la enfermedad de base más frecuente fue la hipertensión arterial. Las causas de indicación de hemodiálisis de urgencia que prevalecieron fueron la hipervolemia (52,2%) y la hiperazoemia (27,3%). El 92,9% de los hemodializados de urgencia no presentaron ninguna complicación durante el proceder. Los resultados expuestos demuestran la experiencia acumulada y calidad de los cuidados que se brindan a estos pacientes en la realización de hemodiálisis de urgencia en nuestro Centro.