Lercanidipine-Induced Chyloperitoneum in Patients on Peritoneal Dialysis

Abstract

Objective Lercanidipine is a lipophilic calcium channel blocker and a widely used antihypertensive agent. However, it can cause chyloperitoneum in patients receiving peritoneal dialysis (PD). The incidence, pathophysiology, and clinical impact of these adverse events are not known. Design Retrospective study. Method Patients were screened for use of antihypertensive agents. Those that had taken lercanidipine were identified and dialysate cholesterol (Chol) and triglyceride (TG) levels were checked. Serum levels were taken from the routine biochemistry record closest to the time of the dialysate levels. Dialysate Chol and TG from patients on other antihypertensives and with matched serum lipid profiles were compared. Patients 14 of 222 patients had taken lercanidipine during February 2005 to January 2006, accounting for 12% of all patients on calcium channel blockers in our PD center. Results Of 14 patients prescribed lercanidipine, 8 (57%) developed chyloperitoneum. None had peritonitis and the dialysate was clear under microscopic examination. Mean dialysate TG was 128.4 ± 133.0 mg/dL and mean dialysate Chol was 18.2 ± 24.9 mg/dL in patients that developed chyloperitoneum. These patients were also noted to have higher blood TG and Chol than patients that did not develop chyloperitoneum. In contrast, patients on other antihypertensive agents with matched blood TG and Chol levels had low dialysate TG levels and zero dialysate Chol. Conclusion Lercanidipine frequently causes chyloperitoneum in Taiwanese PD patients. The risk of developing this adverse event seems to be related to the blood lipid profile. The mechanism of this phenomenon is worthy of further investigation.