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Kidney Week

Abstract: PO0981

Chylous Peritoneal Fluid in a Patient on Peritoneal Dialysis Taking Nifedipine

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Macaraeg, Lauren Eillen, University of California San Diego, La Jolla, California, United States
  • Rifkin, Dena E., University of California San Diego, La Jolla, California, United States
  • Woodell, Tyler, University of California San Diego, La Jolla, California, United States
  • Potok, O. Alison, University of California San Diego, La Jolla, California, United States
Introduction

Chylous fluid in peritoneal dialysis (PD) patients may appear with lymphatic system disruption. This can be due to lymphatic obstruction, exudation through vessels, or via a lymphoperitoneal fistula.

Case Description

A 78 year-old man with ESKD due to diabetic nephropathy, transitioned five weeks prior from HD to PD, presented with newly cloudy PD fluid. His past medical history included hypertension, coronary artery disease, and monoclonal gammopathy of undetermined significance. He reported a newly cloudy white initial drain with lower abdominal pain, but denied fever, vomiting or diarrhea. He denied a breach in sterile technique. Medications included hydralazine, cinacalcet, furosemide, nifedipine, omeprazole, calcium acetate and darbepoietin. He was hemodynamically stable and had no abdominal tenderness. Laboratory results revealed a leukocytosis of 11.7 /cm3. Peritoneal fluid was milky (figure 1a) with 101 white blood cells (4% neutrophils); gram stain and culture were negative. Triglycerides were 96 and 62 mg/dL in the PD fluid and serum, respectively. Etiologic work-up was negative for malignancy, pancreatitis, cirrhosis, trauma and tuberculosis. Chylous nature of the PD fluid resolved within a day of nifedipine discontinuation (figure 1b). The patient self-resumed nifedipine weeks later and the milky fluid recurred the following day before again subsiding after its repeat cessation.

Discussion

This patient had the onset of chylous PD fluid 5 weeks after initiating PD, which resolved with cessation and recurred with reinitation of his long-term nifedipine. The mechanism of calcium channel blockers (CCB) – related chylous ascites is not well established. Some have suggested it may be related to the lipophilic nature of CCB. Patients on PD with higher peritoneal membrane transport may be at higher risk. Genetic factors may predispose to this phenomenon. Nephrologists should be aware of this rare complication of CCB use in PD patients. More research is needed to better understand the underlying pathophysiology of this rare condition.