What is a key sign of peritoneal dialysis-related infection?

• A. Clear dialysate; no fever
• B. Vomiting
• C. Hypotension
• D. Cloudy dialysate effluent; fever; abdominal pain

Answer: (D)

In peritoneal dialysis, infection of the peritoneal cavity (peritonitis) presents most clearly with cloudy dialysate effluent accompanied by fever and abdominal pain. The cloudiness comes from white blood cells and bacteria in the dialysate, signaling an inflammatory/infectious process, while fever and abdominal pain reflect systemic and local irritation. The other signs are less specific: clear dialysate with no fever argues against infection; vomiting and hypotension can occur with many conditions and are not defining features of PD-related peritonitis. When this presentation occurs, it’s essential to obtain a dialysate culture and start appropriate treatment promptly.