Chyloperitoneum secondary to calcium channel blockers in a peritoneal dialysis patient

A case report.

Abstract

Introduction: Hypertension is one of the most prevalent diseases worldwide, particularly in patients with end-stage renal disease undergoing renal replacement therapy. Antihypertensive treatment in this group typically involves pharmacological combinations including calcium channel blockers; although effective, these may be associated with adverse effects such as chyloperitoneum.

Case report: We present the case of a 45-year-old female with a history of hypertension and stage V chronic kidney disease on continuous ambulatory peritoneal dialysis. Following adjustments to her antihypertensive regimen, lercanidipine was added in combination with valsartan. Subsequently, she presented thick, cloudy, and low-volume effluent. High triglyceride levels were identified in the peritoneal fluid sample. The drug was discontinued, resulting in clinical improvement over the following days.

Discussion: Chyloperitoneum is a rare clinical entity, with an estimated incidence of up to 1 in 20,000 cases, characterized by the accumulation of milky peritoneal fluid with triglyceride levels exceeding 200 mg/dL. Its pathogenesis is linked to lymphatic drainage dysfunction, which can be exacerbated by calcium channel blockers such as lercanidipine, which increase lymphatic pressure via vasodilation. Unlike infectious peritonitis, this condition lacks inflammatory criteria or positive cultures, as evidenced in our patient (triglycerides: 264 mg/dL). Fundamental management consists of immediate discontinuation of the offending drug, typically resulting in clinical and analytical resolution within 24 to 72 hours.

Conclusion: Chyloperitoneum induced by calcium channel blockers is an infrequent entity, often misdiagnosed as peritonitis. Definitive diagnosis through biochemical and cellular analysis of the peritoneal fluid enables resolution upon drug withdrawal. Correct identification avoids invasive procedures, unnecessary treatments, and additional costs, ensuring efficient and safe clinical management for the patient.