key words: continuous ambulatory peritoneal dialysis (CAPD), manidipine hydrochloride, intermittent per Three cases of continuous ambulatory peritonea

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1 key words: continuous ambulatory peritoneal dialysis (CAPD), manidipine hydrochloride, intermittent per Three cases of continuous ambulatory peritoneal dialysis with chylous peritoneal dialysate Yoshihiro Fujii, Yasuhiro Horii, Kazumi Kishimoto, Masayuki Iwano, Kazuhiro Dohi First Department of Internal Medicine, Nara Medical University Turbid peritoneal dialysate in patients treated with CAPD is one of the signs predicting infectious peritonitis. We experienced 3 cases with turbid peritoneal dialysate who did not have infectious peritonitis. All three had chylous ascites. The milky white color of chylous ascites was visually indistinguishable from that of infectious peritonitis. No clinical manifestations suggestive of infectious peritonitis were observed. The cell counts of the turbid peritoneal dialysates were under 100/ƒÊl, and dialysate turbidity did not disappear after centrifugation at 3,000rpm for 5 minutes. Analysis of the dialysates revealed elevated triglyceride contents consistent with chylous ascites. The turbid peritoneal dialysate of case 1 developed during the course of IPD, and was suggested to be due to repeated mild trauma to the abdominal lymphatics by movement of the catheter. In case 2, the peritoneal fluid turned milky white after the administration of a calcium channel blocker, manidipine hydrochlor ide, and then cleared after withdrawal of the drug. The turbid peritoneal dialysate of case 3 was present after a high lipid diet and was associated with an increase in CAPD fluid drainage volume. When peritoneal dialysate turns milky white during the course of CAPD, the differentiation between chylous ascites and infectious peritonitis should be made promptly. Moreover, the multiple etiologies of chylous ascites warrant further discussion.

2 The lipoprotein fraction and lipid concen tration of turbid fluid in connecting tube and serum in case 1 Milky white color of turbid dialysate in case 1 is located in ether layer

3 +: turbid dialysate -: clear dialysate ND: nut done +: turbid dialysate -: clear dialysate The course of chylous ascites in case 2

4 The drainage volume in turbid dialy sate and clear dialysate in case 3

5 1) Pomeranz A, Reichenberg Y, Schurr D, Druk ker A: Chyloperitoneum: A rare complica tion of peritoneal dialysis. Perit Dial Bull , ) DePaula A, Jimeno A, Largo ME, Gago P, Diez JL, Bustamante J: Ascitis quilosa; una rara complicacion de la dialisis peritoneal. Rev Clin Esp 139: , ) Humayun HM, Daugirdas JT, Ings TS, Lee hey DJ, Gandhi VC, Popli S: Chylous ascites in a patient treated with intermittent per itoneal dialysis. Artif Organs 8: , ) Roodhooft AM, VanAcker KJ, DeBroe ME: Chylous peritonitis; an infrequent complica tion of peritoneal dialysis. Perit Dial Bull 7: , ) Yoshimoto K, Saima S, Echizen H, Naka mura Y, Ishizaki T: A drug-induced turbid peritoneal dialysate in five patientes with continuous ambulatory peritoneal dialysis. Clin Nephrol 40: , 1993

6 11) McHale NG, Allen JM: The effect of exter nal Ca2+ concentration on the contractility of bovine mesenteric lymphatics. Microvasc Res 26: , ) Barrowman JA: Physiology of the gastrointestinal lymphatic system. p , Cam bridge University Press, Cambridge, 1978

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