The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis.
| Autor: | Motta Guimarães MG; Division of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil. Electronic address: gabrielaguimar@hotmail.com., Pinheiro Martin Tapioca F; Division of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil; Bahiana School of Medicine, Salvador, Bahia, Brazil; Medicine and Health Program, Federal University of Bahia, Salvador, Bahia, Brazil., Costa Neves F; Division of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil; Bahiana School of Medicine, Salvador, Bahia, Brazil., Nunes Freitas Teixeira S; Division of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil., Santana Passos LC; Medicine and Health Program, Federal University of Bahia, Salvador, Bahia, Brazil; Division of Cardiology, Ana Nery Hospital, Salvador, Bahia, Brazil. |
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| Jazyk: | angličtina |
| Zdroj: | Nefrologia [Nefrologia (Engl Ed)] 2024 Mar-Apr; Vol. 44 (2), pp. 173-179. |
| DOI: | 10.1016/j.nefroe.2024.04.002 |
| Abstrakt: | Introduction and Objectives: The efficacy of fluconazole as a prophylactic strategy in patients with chronic kidney disease (CKD) on peritoneal dialysis (PD) with prior antibiotic exposure is controversial in the current literature. This study aimed to compare a strategy of fluconazole prophylaxis versus no-prophylaxis for patients in PD on antibiotics for previous episodes of peritonitis. Materials and Methods: We performed a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) comparing fluconazole prophylaxis with no prophylaxis for PD-related peritonitis. The search was conducted on PubMed, EMBASE, and Cochrane Central in January 23, 2023. The outcome of interest was the occurrence of fungal peritonitis (FP). Results: We included six studies (1 RCT, 5 observational) with 4515 occurrences of peritonitis, of which 1098 (24.8%) received fluconazole prophylaxis in variable doses, whereas 3417 (75.6%) did not receive prophylaxis during peritonitis episodes. Overall, fluconazole prophylaxis was associated with a lower incidence of FP (OR 0.22; 95% CI 0.12-0.41; p<0.001; I 2 =0%). Subgroup analysis of studies that administered daily doses of fluconazole also demonstrated a reduced incidence of FP in patients who received antifungal prophylaxis (OR 0.31; CI 0.14-0.69; p=0.004; I 2 =0%). Conclusions: In this meta-analysis of 4515 episodes of PD-related peritonitis, prophylaxis with fluconazole significantly reduced episodes of FP as compared with no antifungal prophylaxis. (Copyright © 2023 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.) |
| Databáze: | MEDLINE |
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