Peritoneal dialysis–associated eosinophilic peritonitis

Abstract

Eosinophilic peritonitis (EP) is a non-infectious complication associated with the peritoneal dialysis (PD) process, with a reported incidence ranging from 16 to 60%. It is defined by the presence of >100 eosinophils/mm3 or >10% eosinophils in the total non-erythrocyte count of the PD effluent; in the presence of negative peritoneal fluid cultures and evidence suggestive of peritonitis (such as abdominal pain, fever, and cloudy dialysate), which are generally mild. The etiopathogenesis of PD-associated PD is not completely clear. In principle, it is considered a hypersensitivity reaction of the peritoneal membrane to mechanical and chemical stimuli associated with the PD process (idiopathic eosinophilic peritonitis), although it can also develop after episodes of culture-positive peritonitis (eosinophilic peritonitis associated with infection). PD is usually benign, self-limited; and tends to resolve spontaneously after removal of the offending agent. Severe or persistent cases may require supportive therapy, especially with corticosteroids. It is an atypical entity, often overlooked or confused with bacterial peritonitis (which is the most common cause of cloudiness in PD effluents), leading to inappropriate management.