Kidney Week

Abstract: PUB070

Fibrinous Peritoneal Dialysate Mimicking Peritonitis

Session Information

• Publication Only

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Ahmed, Ahmed Khalafalla Mohamed, University of Illinois Chicago, Chicago, Illinois, United States

Ahmed Khalafalla Mohamed Ahmed, MD, MS

• Aladham, Ahmed, University of Illinois Chicago, Chicago, Illinois, United States

Ahmed Aladham, DO

• Ahmad, Fayzan, University of Illinois Chicago, Chicago, Illinois, United States

Fayzan Ahmad, MD

• Amtul, Raheem Raazia, University of Illinois Chicago, Chicago, Illinois, United States

Raheem Raazia Amtul, MBBS

• Amarah, Amatur R., University of Illinois Chicago, Chicago, Illinois, United States

Amatur R. Amarah, MD

Introduction

Cloudy or abnormal-appearing peritoneal dialysate in patients on peritoneal dialysis (PD) often raises concern for PD-associated peritonitis. However, noninfectious etiologies such as fibrin formation may present similarly and lead to unnecessary antimicrobial treatment if not recognized promptly.

Case Description

An 80-year-old man with ESRD on chronic PD developed cloudy effluent with large amounts of whitish, cheesy material and slow drainage. He denied abdominal pain, fever, nausea, or vomiting, and exam showed a soft, non-tender abdomen with a clean PD exit site.

Peritoneal fluid studies showed no leukocytosis, a negative Gram stain, and negative cultures. Despite the atypical appearance, fibrin was suspected, and intraperitoneal heparin was added. The material resolved completely, and PD exchanges resumed without further issues.

Discussion

Fibrin in PD effluent is an important noninfectious mimic of PD-associated peritonitis. It may result from peritoneal inflammation or irritation and can present as cloudy dialysate or visible fibrin, often appearing as strands or cotton-wool-like material. Recognizing this entity is important to avoid unnecessary antibiotics and PD interruptions. Intraperitoneal heparin is a simple, effective treatment that improves catheter patency and helps resolve fibrin accumulation.

PD drain bag showing cloudy dialysate with whitish fibrinous material suspended within the effluent (hollow arrow).

Extracted whitish fibrinous material collected from the PD effluent