Chylous Ascites Following Peritoneal Dialysis Catheter Placement: A Case Report

Chylous ascites is a rare complication of peritoneal dialysis (PD) that can mimic peritonitis and pose diagnostic challenges. We present a 72-year-old man with stage IV chronic kidney disease who developed milky dialysis effluent 20 days after uncomplicated PD catheter placement. He remained asymptomatic, with no signs of infection. Dialysate triglycerides were markedly elevated (653–874 mg/dL), and cultures were negative, confirming chylous ascites. Antibiotics were not initiated, and PD was continued. Although his calcium channel blocker was discontinued, the effluent began clearing before cessation, with complete resolution within one month. Recent catheter placement suggested iatrogenic lymphatic injury as the most likely etiology, although calcium channel blockers have also been implicated. Diagnosis is supported by milky fluid with triglycerides >200 mg/dL. In clinically stable patients, conservative management and continued dialysis may be sufficient. After excluding secondary causes, catheter-related lymphatic injury should be considered in PD-associated chylous ascites.