Answer: Peritoneal dialysis (PD), also referred to as CAPD, is a form of home dialysis in which you are taught how to perform the procedure at home. The peritoneal membrane is the covering of the cavity of the abdomen. It also covers or lines other internal organs, such as the liver and intestines. Waste, which builds up in the bloodstream, travels across the blood vessels in this lining into the fluid instilled into the cavity during dialysis. Infection of this membrane is called peritonitis.

The most common cause of peritonitis is bacterial infection. This can happen when bacteria are inadvertently introduced into the peritoneal fluid by improper technique during the connection of the PD bag to the catheter in your stomach. During training, a registered nurse will teach you how to avoid such complications. If a problem should occur, one key symptom is the fluid drained out would appear cloudy instead of clear. Cloudiness is mainly caused by white blood cells that have entered the peritoneal cavity from the bloodstream to fight infection. You may experience mild to severe abdominal pain. Other symptoms include nausea, fever or diarrhea. Examining the fluid in the drainage bag is very important.

Peritonitis needs to be treated immediately. Therefore, you are provided with antibiotics to be stored in your refrigerator. If the abdomen is ‘flushed’ with PD bags, it will help ease pain. The next step would be to inject the antibiotic into the PD bag and fill the abdomen with the medicated fluid. The dosage is predetermined and, since the infection is in the abdomen, this is the most effective treatment. The ‘cloudy’ bag is saved to send to the laboratory for analysis, which is important since bacteria may need to be identified and treated with another antibiotic. At this time, contacting the nurse at the dialysis center is vital. In most cases, PD is continued despite the infection, and there is no interruption in eliminating waste and fluid from the body. Another cause of peritonitis is appendicitis, an infection of the intestine, which is not due to technical failure but from infection within the body. If symptoms are severe or you experience lightheadedness with low blood pressure, you should immediately call the dialysis nurse or your doctor.

The peritoneal membrane takes a few weeks to heal. Pain can be alleviated and fluid cleared with antibiotics. Your doctor will check the fluid periodically to ensure cells in the fluid are decreasing, indicating resolution of infection. However, some infections are severe, or bacteria sticking to the catheter walls can be difficult to eliminate. In those cases, replacing the old catheter can be helpful in eliminating infection. Your doctor will determine if this needs to be done. Repeated infections can undermine the ability of the lining to completely recover and also prevent efficient elimination of waste and water in which case your physician will suggest another form of dialysis.

Answer provided by Quresh Khairullah, MD, Director of CAPD Division of Nephrology and Transplant at St. Clair Specialty Physicians in Detroit.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in the May 2005 issue of aakpRENALIFE, Vol. 20, No. 6.

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