title: Description of an outbreak of acute sterile peritonitis in Iran.
abstract: BACKGROUND
  Outbreaks of sterile or chemical peritonitis are uncommon and often not well documented. It is therefore important to describe the characteristics of sterile peritonitis in continuous peritoneal dialysis (PD) patients.
  
  
  METHODS
  Characteristics of acute chemical peritonitis (ACP) are described in 20 patients (5 males, 15 females; mean age 50 +/- 15 years; range 29 - 72 years). Cultures and Gram stains were negative for micro-organisms. All patients with symptoms of peritonitis were using glucose bags with the same lot number and resolution of peritonitis occurred only after changing the suspicious bags. The first measurements of dialysate-to-plasma creatinine (D/P creat) and glomerular filtration rate (GFR) before and after ACP were compared in 14 patients with no separate episode of bacterial peritonitis during that time.
  
  
  RESULTS
  Cloudy dialysate was observed in 19 patients and 13 experienced abdominal pain. Mean dialysate white blood cell count and percentage neutrophils were 520/mm(3) (range 100 - 1600/mm(3)) and 65% (range 14% - 98%) respectively. Analysis of the unused PD solution showed that endotoxin (0.06 endotoxin unit/mL), 5-hydroxymethyl furaldehyde (8 microg/mL), and acetaldehyde (0.4 microg/mL) concentrations were within acceptable ranges. In 14 patients without episodes of bacterial peritonitis, D/P creat was significantly higher after than before ACP (0.77 +/- 0.07 vs 0.55 +/- 0.1, p = 0.036), whereas GFR was not (4.5 +/- 2.9 vs 4.9 +/- 2.53 mL/minute, p = 0.62).
  
  
  CONCLUSIONS
  Although chemical peritonitis in glucose-based PD solution is uncommon, it should be distinguished from bacterial peritonitis in outbreaks of peritonitis. Facilities to measure glucose degradation products are required, especially in developing countries. Acute chemical peritonitis increases small-molecule transport in the short term.
authors.affiliation: Department of Nephrology, Shahid Sadoughy University of Medical Sciences, Yazd, Iran.
authors.forename: Nader
authors.initials: N
authors.lastname: Nouri-Majalan
authors.forename: Iraj
authors.initials: I
authors.lastname: Najafi
authors.forename: Hoshang
authors.initials: H
authors.lastname: Sanadgol
authors.forename: Mohammad-Reza
authors.initials: MR
authors.lastname: Ganji
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Atabak
authors.forename: Monirossadat
authors.initials: M
authors.lastname: Hakemi
authors.forename: Tayebeh
authors.initials: T
authors.lastname: Soleymanian
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D004196:Disease Outbreaks; D005260:Female; D005947:Glucose / Q000009:adverse effects; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000453:epidemiology* / Q000209:etiology*
chemical_list: D005947:Glucose