In vitro thyroid function tests were performed on clinically euthyroid patients undergoing regular hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). The mean serum total thyroxine (TT4) and total triiodothyronine (TT3) values measured before HD were significantly subnormal. Similarly, CAPD subjects had reduced TT3 concentrations with low normal TT4 levels. Free thyroxine measurements, estimated by two different methods were aberrant in CAPD patients. Low normal reverse triiodothyronine (rT3) values were found in HD, in contrast to high normal rT3 levels in CAPD. Thyroid stimulating hormone determinations were normal, corresponding with the euthyroid status in both patient groups.
We have encountered a sporadic form of aseptic peritonitis, not previously described, that we refer to as acute sterile peritonitis (ASP). This syndrome, which occurs with a frequency of 0.1% of dialyses, begins abruptly during peritoneal dialysis with abdominal pain, fever, and occasionally chills and vomiting. Coincident with the onset of symptoms, the dialysate return becomes cloudy with many white blood cells. Cultures are negative and resolution occurs within hours with continued dialysis. In this report we detail the clinical features of this new syndrome.
Thyroid function tests were performed in nine clinically euthyroid, chronic-renal-failure (CRF) patients on continuous ambulatory peritoneal dialysis (CAPD), and the results were compared with similar tests performed on normal controls and eight patients on maintenance hemodialysis (HD). As reported earlier in untreated patients with CRF and those maintained on HD, our patients on CAPD had markedly reduced total tri-iodothyronine (T3) concentration. Levels of serum thyroxine (T4), and serum free T4 estimated by the microencapsulated antibody technique were reduced in both groups of patients but were in the hypothyroid range only in the HD group. However, in keeping with the clinically euthyroid status of these patients, thyroid stimulating hormone levels were within normal limits. Finally, both groups of patients had low normal reverse T3 levels. These data confirm the presence of abnormalities in in vivo thyroid function tests in patients with CRF maintained by different modes of dialysis. The significance and mechanism of these abnormalities remains speculative.
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