Journal Article

Chemical peritonitis associated with high dialysate acetaldehyde concentrations

Murat Tuncer, Metin Sarıkaya, Tugˇrul Sezer, Sadife Özcan, Gültekin Süleymanlar, Gülşen Yakupogˇlu and F. Fevzi Ersoy

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 15, issue 12, pages 2037-2040
Published in print December 2000 | ISSN: 0931-0509
Published online December 2000 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/15.12.2037
Chemical peritonitis associated with high dialysate acetaldehyde concentrations

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Background. During the standard heat sterilization process of lactate‐buffered peritoneal dialysis (PD) solutions, glucose degrades to form compounds called glucose degradation products such as acetaldehyde, formaldehyde, or glyoxal. Despite evidence that these products may be responsible for some in vitro cytotoxic effects induced by commercially available PD fluids, data on their acute or chronic effects on the human peritoneum is scarce.

Subjects and methods. This case presentation is based on an observation of 21 aseptic peritonitis cases of unknown aetiology. All cases appeared within one month in a university hospital PD unit that had a peritonitis rate of 1 episode/26 patient months and 55 active patients on CAPD. Acetaldehyde level in the bags was assayed by gas chromatography.

Results. Twenty‐one patients presented with signs of peritonitis including cloudy dialysate and abdominal tenderness with additional abdominal pain in 11 patients and vomiting in one. In all cases, cultures and Gram stains were negative for micro‐organisms. Fever was not observed in any patient. Average dialysate white blood cell count was 1795/mm3. All patients were free of intraperitoneal medication when symptoms appeared. Patients were using PD solutions from a newly established domestic production plant. Apparently all patients with symptoms of peritonitis used bags with the same lot number and the solution in the bags appeared to be darker in colour than that in bags with other lot numbers. Chemical analysis of the unused PD solution samples revealed acetaldehyde levels of 17–20 p.p.m. in bags containing darker solution, which is very high compared with the usual acetaldehyde level of 6 p.p.m. in heat‐sterilized PD solutions.

Conclusions. Based on the above findings, we hypothesize that higher levels of acetaldehyde and possibly other glucose degradation products may have been an aetiological factor in these 21 cases of chemical peritonitis. Our observation suggests that acetaldehyde, in concentrations 3–4 times higher than the usual level in commercially available PD solutions, may induce acute sterile peritonitis in CAPD patients.

Keywords: acetaldehyde; chemical peritonitis; dark dialysate; glucose degradation products; peritoneal dialysis

Journal Article.  2248 words. 

Subjects: Nephrology

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