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Chemical peritonitis associated with high dialysate acetaldehyde concentrations
M Tuncer1, M Sarikaya, T Sezer
1Department of Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey.
Summary
High acetaldehyde levels in peritoneal dialysis solutions may cause sterile peritonitis in patients. This study observed 21 cases linked to a specific lot of PD fluid with elevated glucose degradation products.
Area of Science:
- Nephrology
- Clinical Chemistry
Background:
- Standard heat sterilization of lactate-buffered peritoneal dialysis (PD) solutions generates glucose degradation products (GDPs).
- While GDPs like acetaldehyde are known to cause in vitro cytotoxicity, their effects on the human peritoneum are not well-documented.
Purpose of the Study:
- To investigate a potential link between elevated GDPs in PD solutions and aseptic peritonitis.
- To identify the causative agent in 21 cases of unexplained peritonitis.
Main Methods:
- Case presentation of 21 patients experiencing aseptic peritonitis.
- Analysis of dialysate for white blood cell count and microbial cultures.
- Gas chromatography to assay acetaldehyde levels in PD solution bags from a specific lot.
Main Results:
- All 21 patients presented with symptoms of peritonitis, but cultures were negative for microorganisms.
- Patients used PD solutions from a new domestic plant, with affected individuals using the same lot number.
- PD solutions from the implicated lot showed significantly elevated acetaldehyde levels (17-20 ppm) compared to standard levels (6 ppm).
Conclusions:
- Elevated acetaldehyde levels in PD solutions are hypothesized to be the cause of acute sterile peritonitis.
- Concentrations of acetaldehyde 3-4 times higher than usual may induce peritonitis in CAPD patients.