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Bloody peritoneal dialysate (hemoperitoneum)

Anthony Bleyer, MD, MS
John M Burkart, MD
Section Editor
Thomas A Golper, MD
Deputy Editor
Alice M Sheridan, MD


Bloody peritoneal dialysate (hemoperitoneum) in the peritoneal dialysis patient is an uncommon occurrence. The etiology, diagnosis, and treatment of this problem will be reviewed here. Other abdominal disorders in dialysis patients, including abnormalities requiring immediate surgical therapy, are discussed separately. (See "Unique aspects of gastrointestinal disease in dialysis patients".)


The incidence of hemoperitoneum varies from 6 percent overall to as high as 57 percent in premenopausal women [1,2]. Bloody peritoneal dialysate may be related to the peritoneal dialysis catheter, the peritoneal dialysis procedure, the underlying renal disease (such as polycystic renal disease or acquired cystic changes), or may be due to factors unrelated to renal disease. Performance of peritoneal dialysis exchanges allows early detection of intra-abdominal bleeding, including benign cases in patients not on peritoneal dialysis, in whom this finding would be otherwise clinically silent.

Causes of hemoperitoneum were reviewed in a single-center series of 424 patients; 26 patients (6 percent) developed one or more episodes of hemoperitoneum [1]. Based upon severity and cause of bleeding, patients could be divided into different groups:

In the largest group (n = 21) of cases, bleeding was mild, asymptomatic, and resulted in pinkish or red discoloration of the fluid. These patients were treated conservatively and did not receive extensive evaluation. Menstrual bleeding was believed responsible in seven cases, while a bleeding diathesis (use of warfarin or thrombocytopenia) was responsible in four patients.

Peritoneal bleeding after transplant nephrectomy, increased physical activity, catheter repositioning, and femoral hematoma were responsible for single cases.

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Literature review current through: Oct 2017. | This topic last updated: Apr 08, 2016.
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