Evidence for a Role of Plasticizers in ‘Eosinophilic’ Peritonitis in Continuous Ambulatory Peritoneal Dialysis

Characterization of Eosinophils in a Continuous Ambulatory Peritoneal Dialysis Patient with Eosinophilic Peritonitis

“…Plastic and plasticizers in dialysate bags and tubing have been implicated. When glass bottles were used to replace plastic dialysate bags in 1 case, eosinophilia resolved and later reappeared when plastic bags were reintro duced [12], Specific plasticizers, such as phthalate compounds, have been found in dialysis solutions and have been implicated in eosinophilic peritonitis [11]. However, our patient remained on identical plastic dialysate bags and tubing, and her eosinophila re solved spontaneously.…”

“…Several hypotheses for the cause of eosinophilic peritonitis have been discussed [2,11,12]. Plastic and plasticizers in dialysate bags and tubing have been implicated.…”

Pathophysiology of Peritoneal Fluid Eosinophilia in Peritoneal Dialysis Patients

“…Mechanical trauma during insertion of catheter, hypersensitivity reaction to ethylene oxide and other sterilants used in the preparation of dialysate bags [20, 21], plasticizers, additives, impurities, decomposition products and reaction products, still unidentified compounds released from polyvinyl chloride bags and iodine solution used for continuous ambulatory peritoneal dialysis with possible exposure of the peritoneal membrane to iodine, and mechanical irritant action of large volumes of fluid on the peritoneum have all been implicated in the induction of peritoneal fluid eosinophilia [22]. Saline lavage alone has been shown to be a sufficient stimulus for peritoneal eosinophil production in animal models [23].…”

Composition of Peritoneal Dialysis Solutions: Potential Hazards

“…Peritoneal adhesions have also been described [68]. Solary et al [69] have implicated plasticisers in the development of eosinophilic peritonitis.…”