Which sign best indicates peritoneal dialysis–associated peritonitis?

• A. Cloudy dialysis effluent
• B. Clear dialysis effluent
• C. Normal white blood cell count
• D. Decreased tenderness in the abdomen

Answer: (A)

Cloudy dialysis effluent is the clearest clue that peritoneal dialysis–associated peritonitis is present. When infection sets in, inflammatory cells, especially neutrophils, flood the peritoneal cavity and spill into the dialysate, turning it turbid. This change is routinely observed during exchanges and is often the first sign clinicians notice. In contrast, clear effluent argues against infection; a normal white blood cell count in the dialysate suggests no inflammatory process, and peritonitis typically causes abdominal tenderness or worsening pain, not a decrease in tenderness. So the cloudy effluent directly reflects the inflammatory response within the peritoneal cavity and is the best indicator of this condition.