Changes in the Progression of Chronic Kidney Disease in Patients Undergoing Fecal Microbiota Transplantation.

Chronic kidney disease (CKD) is a progressive loss of renal function in which gut dysbiosis is involved. Fecal microbiota transplantation (FMT) may be a promising alternative for restoring gut microbiota and treating CKD. This study evaluated the changes in CKD progression in patients treated with FMT. Patients with diabetes and/or hypertension with CKD clinical stages 2, 3, and 4 in this single-center, double-blind, randomized, placebo-controlled clinical trial (NCT04361097) were randomly assigned to receive either FMT or placebo capsules for 6 months. Laboratory and stool metagenomic analyses were performed. A total of 28 patients were included (15 FMT and 13 placebo). Regardless of CKD stages, patients responded similarly to FMT treatment. More patients (53.8%) from the placebo group progressed to CKD than the FMT group (13.3%). The FMT group maintained stable renal function parameters (serum creatinine and urea nitrogen) compared to the placebo group. Adverse events after FMT treatment were mild or moderate gastrointestinal symptoms. The abundance of Firmicutes and Actinobacteria decreased whereas Bacteroidetes, Proteobacteria and Roseburia spp. increased in the FMT group. CKD patients showed less disease progression after FMT administration. The administration of oral FMT in patients with CKD is a safe strategy, does not represent a risk, and has potential benefits.

Candida tropicalis in Peritoneal Dialysis-related Peritonitis Diagnosed by Matrix-assisted Laser Desorption/ionization Time-of-flight Mass Spectrometry.

Fungal peritonitis (FP) is a rare complication of peritoneal dialysis (PD). Candida tropicalis infections are rarely reported in literature. The authors present the first case of FP with peritoneal abscess due to C. tropicalis in a 22-year-old woman admitted to our hospital with septic shock. Abdominal tomography demonstrated an abscess in peritoneal space and intraluminal bubble appearance in femoral venous and arterial circulation. PD fluid specimens and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) analysis revealed fungus growth of C. tropicalis. Fluconazole therapy was administered accompanied by catheter removal and mechanical ventilation with vasopressor support. The patient recovered after 23 days of hospitalization and was discharged. FP represents high mobility and mortality unless infection source control and appropriate antimicrobial therapy are implemented accompanied by PD catheter removal. The use of MALDI-TOF MS for PD-related peritonitis pathogen identification can promote early identification and appropriate antibiotic therapy, especially in C. tropicalis infection.