The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis

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 v...

Full description

Bibliographic Details
Main Authors: Maria Gabriela Motta Guimarães, Fernanda Pinheiro Martin Tapioca, Felipe Costa Neves, Sheila Nunes Freitas Teixeira, Luiz Carlos Santana Passos
Format: Article
Language:Spanish
Published: Elsevier 2024-03-01
Series:Nefrología
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S0211699523001376
_version_ 1797277345971699712
author Maria Gabriela Motta Guimarães
Fernanda Pinheiro Martin Tapioca
Felipe Costa Neves
Sheila Nunes Freitas Teixeira
Luiz Carlos Santana Passos
author_facet Maria Gabriela Motta Guimarães
Fernanda Pinheiro Martin Tapioca
Felipe Costa Neves
Sheila Nunes Freitas Teixeira
Luiz Carlos Santana Passos
author_sort Maria Gabriela Motta Guimarães
collection DOAJ
description 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; I2 = 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; I2 = 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. Resumen: Introducción y objetivos: La eficacia de fluconazol como estrategia profiláctica en los pacientes con enfermedad renal crónica (ERC) sometidos a diálisis peritoneal (DP) con exposición antibiótica previa es controvertida en la literatura actual. El objetivo de este estudio fue comparar la estrategia de profilaxis con fluconazol frente a no profilaxis para los pacientes de DP con régimen antibiótico por episodios previos de peritonitis. Materiales y métodos: Realizamos una revisión sistemática y metaanálisis de estudios observacionales y ensayos controlados aleatorizados (ECA), comparando la profilaxis con fluconazol y la no profilaxis para la peritonitis relacionada con DP. Dicha búsqueda se realizó en PubMed, EMBASE y Cochrane Central el 23 de enero de 2023. El resultado de interés fue la aparición de peritonitis fúngica (PF). Resultados: Incluimos seis estudios (1 ECA, 5 observacionales) con 4.515 episodios de peritonitis, de los cuales 1.098 (24,8%) recibieron profilaxis de fluconazol en dosis variables, mientras que 3.417 (75,6%) no recibieron profilaxis durante los episodios de peritonitis. En general, la profilaxis de fluconazol estuvo asociada a una menor incidencia de PF (OR: 0,22; IC 95%: 0,12-0,41; p < 0,001; I2 = 0%). El análisis de subgrupo de los estudios que administraron dosis diarias de fluconazol también demostró una incidencia reducida de PF en los pacientes que recibieron profilaxis antifúngica (OR: 0,31; IC 95%: 0,14-0,69; p = 0,004, I2 = 0%). Conclusiones: En este metaanálisis de 4.515 episodios de peritonitis relacionada con DP, la profilaxis con fluconazol redujo significativamente los episodios de PF, en comparación con la no profilaxis antifúngica.
first_indexed 2024-03-07T15:47:20Z
format Article
id doaj.art-4291643318b74eb89aa66f4ca26fe6bf
institution Directory Open Access Journal
issn 0211-6995
language Spanish
last_indexed 2024-03-07T15:47:20Z
publishDate 2024-03-01
publisher Elsevier
record_format Article
series Nefrología
spelling doaj.art-4291643318b74eb89aa66f4ca26fe6bf2024-03-05T04:29:30ZspaElsevierNefrología0211-69952024-03-01442173179The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysisMaria Gabriela Motta Guimarães0Fernanda Pinheiro Martin Tapioca1Felipe Costa Neves2Sheila Nunes Freitas Teixeira3Luiz Carlos Santana Passos4Division of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil; Corresponding author.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, BrazilDivision of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil; Bahiana School of Medicine, Salvador, Bahia, BrazilDivision of Nephrology, Ana Nery Hospital, Salvador, Bahia, BrazilMedicine and Health Program, Federal University of Bahia, Salvador, Bahia, Brazil; Division of Cardiology, Ana Nery Hospital, Salvador, Bahia, BrazilIntroduction 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; I2 = 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; I2 = 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. Resumen: Introducción y objetivos: La eficacia de fluconazol como estrategia profiláctica en los pacientes con enfermedad renal crónica (ERC) sometidos a diálisis peritoneal (DP) con exposición antibiótica previa es controvertida en la literatura actual. El objetivo de este estudio fue comparar la estrategia de profilaxis con fluconazol frente a no profilaxis para los pacientes de DP con régimen antibiótico por episodios previos de peritonitis. Materiales y métodos: Realizamos una revisión sistemática y metaanálisis de estudios observacionales y ensayos controlados aleatorizados (ECA), comparando la profilaxis con fluconazol y la no profilaxis para la peritonitis relacionada con DP. Dicha búsqueda se realizó en PubMed, EMBASE y Cochrane Central el 23 de enero de 2023. El resultado de interés fue la aparición de peritonitis fúngica (PF). Resultados: Incluimos seis estudios (1 ECA, 5 observacionales) con 4.515 episodios de peritonitis, de los cuales 1.098 (24,8%) recibieron profilaxis de fluconazol en dosis variables, mientras que 3.417 (75,6%) no recibieron profilaxis durante los episodios de peritonitis. En general, la profilaxis de fluconazol estuvo asociada a una menor incidencia de PF (OR: 0,22; IC 95%: 0,12-0,41; p < 0,001; I2 = 0%). El análisis de subgrupo de los estudios que administraron dosis diarias de fluconazol también demostró una incidencia reducida de PF en los pacientes que recibieron profilaxis antifúngica (OR: 0,31; IC 95%: 0,14-0,69; p = 0,004, I2 = 0%). Conclusiones: En este metaanálisis de 4.515 episodios de peritonitis relacionada con DP, la profilaxis con fluconazol redujo significativamente los episodios de PF, en comparación con la no profilaxis antifúngica.http://www.sciencedirect.com/science/article/pii/S0211699523001376Diálisis peritonealPeritonitis fúngicaFluconazolProfilaxis antifúngica
spellingShingle Maria Gabriela Motta Guimarães
Fernanda Pinheiro Martin Tapioca
Felipe Costa Neves
Sheila Nunes Freitas Teixeira
Luiz Carlos Santana Passos
The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis
Nefrología
Diálisis peritoneal
Peritonitis fúngica
Fluconazol
Profilaxis antifúngica
title The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis
title_full The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis
title_fullStr The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis
title_full_unstemmed The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis
title_short The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis
title_sort efficacy of fluconazole for anti fungal prophylaxis in peritoneal dialysis patients a systematic review and meta analysis
topic Diálisis peritoneal
Peritonitis fúngica
Fluconazol
Profilaxis antifúngica
url http://www.sciencedirect.com/science/article/pii/S0211699523001376
work_keys_str_mv AT mariagabrielamottaguimaraes theefficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis
AT fernandapinheiromartintapioca theefficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis
AT felipecostaneves theefficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis
AT sheilanunesfreitasteixeira theefficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis
AT luizcarlossantanapassos theefficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis
AT mariagabrielamottaguimaraes efficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis
AT fernandapinheiromartintapioca efficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis
AT felipecostaneves efficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis
AT sheilanunesfreitasteixeira efficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis
AT luizcarlossantanapassos efficacyoffluconazoleforantifungalprophylaxisinperitonealdialysispatientsasystematicreviewandmetaanalysis