Increase in wbc counts

i am 30 years old and am on capd past 8 months , however my wbc counts have been steadily increasing although the culture reports of the peritoneal fluid are negative. when i take antibiotics the counts reduce , but again within a week they shoot up. Right now they have increased to 16000.i wonder if any one else is also facing such a problem!!!

Another problem is that of rapid weight gain. i am doing 5 cycles of 2.5 . i am exercisng going for walks etc but still my weight has increased by 16kgs in these 8 months.

hi in october i will be completing two yrs on dialysis and apart from excess weight gain , i have no problems on it. haemo was a night mare for me but pd is like a boon, hope i continue doing well .

I hope you continue to do well, too, unregistered.

Tasnimkapasi, I’m trying to figure out how it was possible to not see your post, when I check these boards several times a day! I’m really sorry about that. We try to make certain that everyone gets answers quickly, and don’t like to see a delay like this happen.

Have you found a reason yet for your high WBC counts? If your peritoneum isn’t the focus of an infection, I guess I’d start to wonder about:
– Your PD catheter (a tunnel infection, possibly)
– A previous HD graft or fistula infection
– A dental abscess

Weight gain can be a side effect of PD, and five exchanges per day of 2.5% is a lot of 2.5%. Each bag contains 25 grams of dextrose (sugar) @ 3.4 calories (85 calories), but luckily only 75% of the sugar is absorbed. Still, that adds up to 63.75 calories x 5 exchanges/day = an extra 318 calories per day. It takes an extra 3500 calories to gain one pound, so if you don’t cut back on other calories, you could gain one pound every 10 days or so with five 2.5% bags/day, or about 3 lbs./mo, 36 lbs./year. (1.5% bags only have 38.25 absorbable calories).

Starches are a good place to cut back–grains (wheat, rice, corn, oatmeal…) and potatoes. You need protein, and fruits and vegetables have important micronutrients. The body actually has zero carb requirements, and there is no “necessary” quantity of starches–we’re just used to them and tend to like them.

There are many possible causes of “sterile peritonitis” which may be what you have with a high WBC, tenderness, cloudy bags, but no growth. Here’s a 2005 article on sterile peritonitis:

Here are International Society for Peritoneal Dialysis guidelines on how to treat infections. There is a discussion of sterile peritonitis here too:

So far as your weight gain is concerned, here’s a booklet describing peritoneal dialysis that might help you come up with questions to ask your doctor or nurse:

Here’s a fact sheet that explains peritoneal dialysis dose and adequacy. Do you know if you’re a slow or fast transporter? The test to determine this is described in the brochure above and the fact sheet linked below. If you’re a fast transporter you could be absorbing the fluid and glucose in the dialysis solution while the solution sits in your peritoneal cavity before it’s time for you to drain it out. Most of the time people who are fast transporters do better with shorter dwell times and many use a cycler machine to do PD overnight while they sleep instead of doing 4-5 exchanges during the day and a long dwell overnight while they sleep. Some doctors suggest doing an exchange in the middle of the night so the dialysis solution doesn’t dwell all night if a cycler isn’t available.

thank you so much for replying to my mail. well my wbc counts are still high at around 12000 and they keep on fluctuating every month, my nephrologist has told me to ignore it as she says you are asymptomatic and hence there is no need to worry.

well when i got my PET test done i was told i belonged to the higher average category.
previously i was doing my cycles 5 times a day by getting up at 4 o clock in the morning each dwell time being of 4-5 hours, but it was becoming extremely strenuous for me and my financial capacity did not allow me to go in for cycler. but still the output at 4 oclock used to come positive, which meant my fluid was getting absorbed at night,so inspite of doing dialysis 5 times a day I had swellings on my face( on top of that i was keeping a complete restriction on my fluids too) ,i hat gotten very frustrated as inspite of keeping a strict restriction on intake of fluid my body was indirectly absorbing peritoneal fluid at night, while i was thirsty all the time!.finally i suggested my doctor that i keep nights dry.
she hesitated in the beginning but i was quite adamant in experimenting it out. so she finally agreed. and since then my output has increased to a great extent. i now get an output of around 1100. please note that i have zero urine output.but the bad news is that in this one year and 11mnths i have gained 20kgs.still i am happy that apart from this there are no other serious problems.
thanks again for replying to my mails.

Hi Unregistered (tasnimkapasi, I presume? ;-)),

Some things that you’re saying don’t seem to fit together. First, you shouldn’t need to have any more money to have a cycler than to do manual exchanges. The clinic provides a cycler; you don’t have to pay for it. Ask your clinic social worker about this–if you want a cycler, you should be able to get one.

I’m also a bit perplexed by your absorbing fluid and being so thirsty, and needing a fluid limit on PD. Staying dry at night means you’re losing out on the best time to be dialyzing. Did you try all three fluid strengths and have problems with them all?

I’ve forwarded your question to a PD expert, and will let you know when/if I hear back with some questions for you to ask your doctor about.

As Dori said, if you’re in the U.S., the Medicare reimbursement for CCPD (machine) or CAPD (manual PD) are equivalent to in-center HD. Some dialysis clinics don’t offer every treatment option, but you should be able to find a clinic near you using the “Find a dialysis clinic near you” database from the Home Dialysis Central home page.

What dialysis solutions do you use for your exchanges – 1.5%, 2.5%, 4.25%? The 1.5% has the least amount of glucose; the 4.25% has the most. More sugar in the dialysate may make you thirsty.

Has anyone checked your blood sugar since you’ve been on PD. Because the PD solution has glucose. it can raise blood sugar if your body is not able to break down the sugar. If you blood sugar is high blood, that could make you thirsty. If you are diabetic, you may need medication (oral or injectible) to control your blood sugar to protect your organs, nerves, eyes, and to help you be less thirsty. Sometimes people who must inject insulin are allowed and trained to inject insulin into their bags to avoid giving themselves shots.

I can understand why you might want to stay dry at night if you’re absorbing the fluid and the sugar. Another option would be to do an exchange every 4 hours 24 hours a day, including midway through your sleep cycler. Would your doctor be willing to let you try this? If so, you’d likely be getting the best possible dialysis. You might need to use different glucose concentrations for different exchanges. Limit use of the 4.25% solution which has been known to scar the peritoneal membrane.

Tasnimkapasi, I heard back from the PD doctor I emailed (an international expert), and she is concerned. She would like you to have your doctor email her directly. If you private message me, I will give you the email address to share with your doctor.