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Perit Dial Int 30(1): 19-22
2010
© 2010 International Society for Peritoneal Dialysis
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PD IN THE DEVELOPING WORLD

DESCRIPTION OF AN OUTBREAK OF ACUTE STERILE PERITONITIS IN IRAN

Nader Nouri-Majalan1,2, Iraj Najafi2,3, Hoshang Sanadgol2,4, Mohammad-Reza Ganji3, Shahnaz Atabak5, Monirossadat Hakemi3 and Tayebeh Soleymanian3

Departments of Nephrology, Shahid Sadoughy University of Medical Sciences,1 Yazd; Shafa Research Center2 ; Nephrology Research Center,3 Tehran University of Medical Sciences, Tehran; Nephrology Research Center,4 Zahedan University of Medical Sciences, Zahedan; and Shahid Beheshti Medical University,5 Tehran, Iran

Correspondence to: H. Sanadgol, Department of Nephrology, Zahedan Medical University, Zahedan, Iran. sanadgol{at}yahoo.com

{diamondsuit} Background: Outbreaks of sterile or chemical peritonitis are uncommon and often not well documented. It is therefore important to describe the characteristics of sterile peritonitis in continuous peritoneal dialysis (PD) patients.

{diamondsuit} Methods: Characteristics of acute chemical peritonitis (ACP) are described in 20 patients (5 males, 15 females; mean age 50 ± 15 years; range 29 – 72 years). Cultures and Gram stains were negative for micro-organisms. All patients with symptoms of peritonitis were using glucose bags with the same lot number and resolution of peritonitis occurred only after changing the suspicious bags. The first measurements of dialysate-to-plasma creatinine (D/P creat) and glomerular filtration rate (GFR) before and after ACP were compared in 14 patients with no separate episode of bacterial peritonitis during that time.

{diamondsuit} Results: Cloudy dialysate was observed in 19 patients and 13 experienced abdominal pain. Mean dialysate white blood cell count and percentage neutrophils were 520/mm3 (range 100 – 1600/mm3) and 65% (range 14% – 98%) respectively. Analysis of the unused PD solution showed that endotoxin (0.06 endotoxin unit/mL), 5-hydroxymethyl furaldehyde (8 µg/mL), and acetaldehyde (0.4 µg/mL) concentrations were within acceptable ranges. In 14 patients without episodes of bacterial peritonitis, D/P creat was significantly higher after than before ACP (0.77 ± 0.07 vs 0.55 ± 0.1, p = 0.036), whereas GFR was not (4.5 ± 2.9 vs 4.9 ± 2.53 mL/minute, p = 0.62).

{diamondsuit} Conclusion: Although chemical peritonitis in glucose-based PD solution is uncommon, it should be distinguished from bacterial peritonitis in outbreaks of peritonitis. Facilities to measure glucose degradation products are required, especially in developing countries. Acute chemical peritonitis increases small-molecule transport in the short term.

KEY WORDS: Glucose dialysate; chemical peritonitis; peritoneal transport characteristics.

Received 2 July 2008; accepted 12 January 2009.






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