Cloudy Peritoneal Dialysate: It’s not Always Infection

Background/Aims: Turbid peritoneal dialysate is most commonly due to bacterial peritonitis. However, not all instances of cloudy dialysate are due to infection. This paper will review the various non-infectious causes of cloudy dialysate fluid. Methods: Literature review and synthesis. Results: Cloudy dialysate may be due to pathologic increases of either cellular or non-cellular constituents of peritoneal fluid. Polymorphonuclear leukocytes may be increased due to either intra- or juxtaperitoneal inflammation or drug-induced chemical peritonitis. Increased eosinophils often represent a response to intraperitoneal air or an allergy to a component of the dialysis system. Red blood cells may be present due to one of many causes. Monocytes or malignant cells are relatively uncommon. The differential for the non-cellular causes of culture-negative cloudy dialysate is limited to elevated fibrin or triglycerides. The latter may be due to lymphatic obstruction, pancreatitis, catheter trauma, dihydropyridine calcium channel blockers, or the superior vena cava syndrome. Conclusion: After ruling out atypical infectious etiologies, a diverse set of aseptic causes remains in the differential diagnosis. Use of an organizational scheme based upon identification of the cellular or non-cellular constituent producing dialysate turbidity facilitates appropriate diagnostic and therapeutic interventions.