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Cloudy peritoneal dialysate: it's not always infection

Isaac Teitelbaum1

  • 1Division of Renal Disease and Hypertension, Department of Internal Medicine, University of Colorado Health Sciences Center, Denver, Colo., USA.

Contributions to Nephrology
|May 25, 2006
PubMed
Abstract

Insights

Cloudy peritoneal dialysate can stem from non-infectious causes beyond bacterial peritonitis. Identifying cellular or non-cellular constituents in the fluid aids diagnosis and treatment of aseptic causes.

Area of Science:

  • Nephrology
  • Peritoneal Dialysis
  • Internal Medicine

Background:

  • Turbid peritoneal dialysate is often attributed to bacterial peritonitis.
  • However, non-infectious etiologies can also lead to cloudy dialysate fluid.

Purpose of the Study:

  • To review and synthesize the various non-infectious causes of cloudy dialysate fluid.
  • To provide an organizational scheme for diagnosing aseptic causes of dialysate turbidity.

Main Methods:

  • Literature review and synthesis of existing studies.

Main Results:

  • Cloudy dialysate can result from increased cellular components (polymorphonuclear leukocytes, eosinophils, red blood cells, monocytes, malignant cells) or non-cellular components (fibrin, triglycerides).
  • Non-cellular causes include lymphatic obstruction, pancreatitis, catheter trauma, dihydropyridine calcium channel blockers, and superior vena cava syndrome.
  • Increased leukocytes may indicate inflammation or drug-induced chemical peritonitis; increased eosinophils suggest intraperitoneal air or allergy.

Conclusions:

  • A diverse range of aseptic causes should be considered in the differential diagnosis of cloudy dialysate after ruling out infection.
  • Classifying turbidity based on cellular or non-cellular constituents aids in diagnosis and therapeutic interventions.

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