dihydropyridines and Peritonitis

Topics: Chylous Ascites; Dihydropyridines; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Renal Insufficiency, Chronic

Topics: Adult; Antihypertensive Agents; Ascitic Fluid; Calcium Channel Blockers; Cardiovascular Agents; Chylous Ascites; Diagnosis, Differential; Dihydropyridines; Drug Therapy, Combination; Female; Glomerulonephritis, Membranoproliferative; Humans; Kidney Failure, Chronic; Nifedipine; Nitrobenzenes; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Piperazines; Retrospective Studies; Triglycerides

We previously reported that manidipine, a new dihydropyridine type calcium channel blocker, produced chylous peritoneal dialysate being visually indistinguishable from infective peritonitis in 5 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) [Yoshimoto et al. 1993]. To study whether such an adverse drug reaction would also be elicited by other commonly prescribed calcium channel blockers in CAPD patients, we have conducted postal inquiry to 15 collaborating hospitals and an institutional survey in International Medical Center of Japan as to the possible occurrence of calcium channel blocker-associated non-infective, turbid peritoneal dialysate in CAPD patients. Our diagnostic criteria for drug-induced turbidity of dialysate as a) it developed within 48 h after the administration of a newly introduced calcium channel blocker to the therapeutic regimen, b) absence of clinical symptoms of peritoneal inflammation (i.e., pyrexia, abdominal pain, nausea or vomiting), c) the fluid containing normal leukocyte counts and being negative for bacterial and fungal culture of the fluid, and d) it disappeared shortly after the withdrawal of the assumed causative agent. Results showed that 19 out of 251 CAPD patients given one of the calcium channel blockers developed non-infective turbid peritoneal dialysis that fulfilled all the above criteria. Four calcium channel blockers were suspected to be associated with the events: benidipine [2 out of 2 (100%) patients given the drug], manidipine [15 out of 36 (42%) patients], nisoldipine [1 out of 11 (9%) patients] and nifedipine [1 out of 159 (0.6%)] in descending order of frequency. None of the patients who received nicardipine, nilvadipine, nitrendipine, barnidipine and diltiazem (25, 7, 2, 1 and 8 patients, respectively) exhibited turbid dialysate. In conclusion, we consider that certain dihydropyridine type calcium channel blockers would cause turbid peritoneal dialysate being similar to that observed in patients developing infective peritonitis. To avoid unnecessary antibiotic therapy the possibility of this adverse reaction should be ruled out whenever a CAPD patient receiving a dihydropyridine type calcium channel blocker develops turbid dialysate.

Topics: Calcium Channel Blockers; Chylous Ascites; Data Collection; Diagnosis, Differential; Dialysis Solutions; Dihydropyridines; Female; Humans; Japan; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Turbid peritoneal dialysate is one of the heralding signs for infective peritonitis in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Peritoneal dialysate drained from 5 out of 8 patients undergoing CAPD became turbid within 24 h after the administration of a new dihydropyridine type of calcium channel blocker, manidipine hydrochloride (10 or 20 mg/day). Although the dialysate was visually indistinguishable from that observed during infective peritonitis, no clinical manifestations being suggestive of infective peritonitis were observed. The turbid dialysate contained normal leukocyte counts (< 10 mm-3), and the bacterial (aerobic and anaerobic) and fungal cultures of the dialysate failed to produce organisms. Cytology of the dialysate showed no malignant cells. Biochemical analysis of the dialysate revealed that the fluid contained an elevated triglyceride concentration [range: 12 to 32 mg/100 ml (0.14 to 0.37 mmol/l], while the clear dialysate obtained from 9 uncomplicated CAPD-patients contained less than the detection limit of the assay for triglyceride [< 5 mg/100 ml (0.06 mmol/l)]. All patients were found to consume a nutritionally balanced diet consisting of 1800 to 2400 Kcal/day during the manidipine therapy. No appreciable change was observed in the mean (+/- SD) fasting serum triglyceride concentrations determined before and 24 h after the withdrawal of the manidipine therapy (194 +/- 84 and 186 +/- 106 mg/100 ml, respectively) in the 5 CAPD-patients with turbid peritoneal dialysate. Within 24 h after the withdrawal of the manidipine therapy the peritoneal dialysate became clear spontaneously and the triglyceride concentration in the dialysate was normalized in all of them.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Ascitic Fluid; Calcium Channel Blockers; Diagnosis, Differential; Dialysis Solutions; Dihydropyridines; Female; Humans; Male; Middle Aged; Nitrobenzenes; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Piperazines; Triglycerides