Turbid acellular peritoneal fluid and the use of calcium antagonists in peritoneal dialysis

Turbid acellular peritoneal fluid of a non-infectious aetiology is an uncommon entity in peritoneal dialysis and is characterised by a high concentration of triglycerides in the peritoneal fluid. The most common causes include cancer, lymphatic obstructions, pancreatitis, trauma, and even the use of certain medications such as calcium antagonists. The largest studies concerning this entity have been carried out in patients of Asian descent. We recently diagnosed 4 cases of turbid acellular peritoneal fluid at our institution in relation to the use of calcium antagonists. We reviewed the primary characteristics of these cases and examined the relationship between the use of calcium antagonists and triglyceride levels in the peritoneal fluid of stable patients on peritoneal dialysis during 2010. Of the four patients with turbid acellular peritoneal fluid, 75% were male and 75% were on treatment with manidipine; in all cases, the issue was resolved by suspending medication. Mean triglyceride levels were 314 mg/dl. Mean triglyceride levels in 36 stable patients on peritoneal dialysis were 8.1mg/dl, with a range of 1-35 mg/dl. Mean triglyceride levels in patients with and without calcium antagonist treatment were very similar, at 7.81 mg/dl and 8.6 mg/dl, respectively. We did not observe significant differences in terms of the type of calcium antagonist prescribed. In our experience, we believe that calcium antagonists should be considered as a cause of turbid acellular peritoneal fluid in patients on peritoneal dialysis, in particular manidipine. We do not find it useful to determine triglyceride levels in the peritoneal fluid of asymptomatic patients on treatment with calcium antagonists.