Re: Fungal peritonitis in Iranian children on continuous ambulatory peritoneal dialysis: a national experience. Prompt removal of catheter in fungal peritonitis.

Sir, Congratulations to you and your colleagues on launching the Iranian Journal of Kidney Diseases. I am sure that this journal will bring the Iranian nephrological community together and will help the new generation of Iranian nephrologists. Hopefully, through this journal, you will be able to show the International nephrological community your achievements and contributions in our field. The Web page [www.ijkd.org] was very user friendly. I perused the contents of the first issue and I was impressed with the variety of issues addressed. I was impressed with the findings of the paper by Pour-Reza-Gholi and associates on the use of doxepin for the treatment of uremic pruritus in patients on hemodialysis,1 and definitely, I will try it in my patients on peritoneal dialysis. Pruritus is a very annoying problem in patients on maintenance dialysis. Staphylococcus aureus colonization in patients who receive dialysis is a cause of serious morbidity and mortality in both peritoneal dialysis and hemodialysis patients, as emphasized by Ghazvini and colleagues.2 In our hemodialysis unit, following a randomized prospective controlled trial that showed lower morbidity and mortality in those using polysporin ointment at the exit site, we introduced it as a routine procedure in all patients using a line as an access. In our patients on hemodialysis, we are using mupirocin at the exit site and we have found a substantial decrease in the frequency of S aureus infections. I agree with the conclusions of the paper by Hooman and colleagues on fungal peritonitis.3 Unfortunately, the only available treatment is catheter removal immediately after the fungus has been identified. Prevention of fungal peritonitis remains our main hope. Though the results are controversial, use of nystatin by mouth, whenever these patients are exposed to antibiotics for any reason, seems to be a safe policy. Again congratulations on your efforts and best wishes for your success.