A drug-induced turbid peritoneal dialysate in five patients treated with continuous ambulatory peritoneal dialysis

Turbid peritoneal dialysate is one of the heralding signs for infective peritonitis in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Peritoneal dialysate drained from 5 out of 8 patients undergoing CAPD became turbid within 24 h after the administration of a new dihydropyridine type of calcium channel blocker, manidipine hydrochloride (10 or 20 mg/day). Although the dialysate was visually indistinguishable from that observed during infective peritonitis, no clinical manifestations being suggestive of infective peritonitis were observed. The turbid dialysate contained normal leukocyte counts (< 10 mm-3), and the bacterial (aerobic and anaerobic) and fungal cultures of the dialysate failed to produce organisms. Cytology of the dialysate showed no malignant cells. Biochemical analysis of the dialysate revealed that the fluid contained an elevated triglyceride concentration [range: 12 to 32 mg/100 ml (0.14 to 0.37 mmol/l], while the clear dialysate obtained from 9 uncomplicated CAPD-patients contained less than the detection limit of the assay for triglyceride [< 5 mg/100 ml (0.06 mmol/l)]. All patients were found to consume a nutritionally balanced diet consisting of 1800 to 2400 Kcal/day during the manidipine therapy. No appreciable change was observed in the mean (+/- SD) fasting serum triglyceride concentrations determined before and 24 h after the withdrawal of the manidipine therapy (194 +/- 84 and 186 +/- 106 mg/100 ml, respectively) in the 5 CAPD-patients with turbid peritoneal dialysate. Within 24 h after the withdrawal of the manidipine therapy the peritoneal dialysate became clear spontaneously and the triglyceride concentration in the dialysate was normalized in all of them.(ABSTRACT TRUNCATED AT 250 WORDS)