Discontinuation of CAPD due to low solute clearance

Abstract

Preservation of peritoneal function is of importance in establishing successful chronic peritoneal dialysis. We encountered a 52-year-old male patient on a regular CAPD program representing underdialysis, despite an appropriate CAPD regime. The peritoneal equilibration test (PET) revealed a low solute clearance with normal ultrafiltration capacity, classified as so-called “Low” peritoneum. The peritoneal specimen obtained at the Tenckhoff catheter removal site showed minor abnormalities. Clinically, there was no possibility of a reduced peritoneal surface area or a reduced indwelling volume, thus the reduced solute clearance was essentially attributed to peritoneal dysfunction. Based on the PET results, we ceased CAPD and switched to HD. He has since been well and asymptomatic on HD.
To date, the majority of CAPD drop-out cases due to impaired peritoneal function are characterized by a reduced ultrafiltration capacity, not by a reduced solute clearance. The selective impairment of solute clearance seen in the present case is rare, and is thus of particular interest. Future studies are needed to further clarify the etiology of this disease state.