Sclerosing peritonitis complicating continuous ambulatory peritoneal dialysis with the use of chlorhexidine in...

Sclerosing peritonitis (SP) is an uncommon but serious complication of CAPD with various suggested etiology. We have documented 14 cases of SP in 18 CAPD patients using chlorhexidine in alcohol (ChA) in the connection procedure; 13 died. Nine of the 14 patients had been transferred to haemodialysis or renal transplantation, yet all still developed symptoms of SP within a few months after transfer even though 5 of them were originally asymptomatic. The main symptoms of SP were peritoneal ultrafiltration failure, exudative bloody ascites and intestinal obstruction. They present at around 5 years (30-80 months) after commencement of CAPD. Four other patients with a comparable duration of ChA exposure were continued on CAPD with a Travenol Spike System (TSS) without further exposure to ChA. They were all asymptomatic of SP after 9-12 months. Comparing the 2 groups of asymptomatic patients at 9 months after transfer, those transferred to TSS have a much better outcome than those transferred to HD or renal transplantation (P = 0.0476). We concluded that ChA is the main cause of SP in our patients and continuing CAPD without further exposure to ChA is a better alternative than stopping CAPD in preventing the progression of SP.