Manidipine hydrochloride-induced chyloperitoneum in a patient on continuous ambulatory peritoneal dialysis

A 51-year-old female patient on continuous ambulatory peritoneal dialysis noticed milky effluent 24 hours after her dosage of manidipine hydrochloride had been increased to 40mg/day. She had been on continuous ambulatory peritoneal dialysis since 1990. The dialysate contained 29mg/dl of triglyceride and 25mg/dl of chylomicrons. She was diagnosed as having manidipine hydrochloride-induced chyloperitoneum. The chylous effluent spontaneously disappeared 12 hours after discontinuation of the drug. Chyloperitoneum occurred in association with an increase in drainage volume and the IgG/urea clearance ratio. There was no increase in the dialysate concentration of NO2-, which is an intermediate of nitric oxide, the endothelial-derived relaxing factor. The mechanisms for manidipine hydrochloride-induced chyloperitoneum may be partly related to enhanced permeability to large molecules, especially in peritoneal lymphatics.