LAUSR

The function of a peritoneal dialysis (PD) catheter is crucial for performing high-quality PD. Malfunctioning PD catheter can cause by many aetiologies, including catheter malposition/migration and intraluminal/extraluminal obstructions. 1 Accidental insertion into the urinary bladder is rare, sometimes could be initially undiagnosed and mimic catheter malfunction resulting in ultrafiltration (UF) failure and fungal peritonitis, as demonstrated here. A 93-year-old bed-bound man had initiated haemodialysis for the past 2 months due to fluid overload from the cardiorenal syndrome, albeit having daily residual urine of 800–1,500 mL. Other medical problems included hyperten-sion, atrial fibrillation and dementia. The patient was transferred to PD due to multiple episodes of intradialytic hypotension. A PD catheter was inserted under local anaes-thesia by a mini-explored implantation technique. Success-ful inflow and outflow were achieved after catheter insertion. However, after a 2-week break-in period, rapid flushing with 1 L of PD solution revealed normal inflow and outflow rates; however, only half the amount of infused fluid containing fibrin was drained out. Thus, heparin was administered. A plain film of the kidney-urinary bladder confirmed the proper position of the catheter tip in the small pelvis. Low volume PD (800 mL) was started with negative UF of 100–300 mL each exchange. Due to the patient’s clinical euvolaemia, high residual kidney function was suspected as the cause of negative UF. Then, the fill volume was gradually increased to 1,200 mL, resulting in higher negative UF, cloudy