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and can even facilitate the passage of bacteria from the intestinal lumen&#44; leading to peritonitis&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Constipation can be associated with several different factors&#44; such as a certain degree of intestinal paresis&#44; insufficient mobility&#44; and a diet low in fibre&#44; which is often the result of diets that restrict the intake of fruits&#44; and frequently is a result of the medications administered for concomitant problems&#46; Several treatments administered to dialysis patients can generate or aggravate this situation&#44; such as the resins used for hypercalcaemia and phosphate binders&#46; Lanthanum carbonate is a phosphate binder&#44; without calcium or aluminium&#44; which is effective in controlling hyperphosphataemia&#44; and being a radiopaque compound&#44; results in very characteristic radiological images&#46;<span class="elsevierStyleSup">4</span> However&#44; as is the case in other chelating agents&#44; it can produce constipation that is difficult to treat using conventional measures&#46;<span class="elsevierStyleSup">5</span> A peritoneography can aid in the diagnosis of this type of mechanical issue&#46;</p><p class="elsevierStylePara">We present the case of a patient in which the administration of lanthanum carbonate produced severe constipation and displacement of the catheter to the point where peritoneal dialysis treatment became impossible&#46;</p><p class="elsevierStylePara">Ours was a 47 year-old patient with chronic renal failure from interstitial nephropathy secondary to reflux&#44; who had been on haemodialysis since 1990&#46; He underwent his first kidney transplant in 1991&#44; which was then removed due to chronic dysfunction&#44; and underwent a second transplant in 1999&#44; which was again lost to the same reasons&#46; He returned to haemodialysis in 2010&#46; Due to intolerance to the second kidney&#44; the patient underwent graft embolisation&#46; He was receiving lanthanum carbonate at 750mg&#47;8 hours due to secondary hyperparathyroidism and hyperphosphataemia&#46; Due to several failed vascular accesses&#44; it was suggested that the patient be transferred to peritoneal dialysis&#44; and a straight&#44; double-cuff Tenckhoff catheter was implanted&#46; During training&#44; we detected catheter malfunction with incomplete drainage&#44; so we performed abdominal x-rays &#40;Figure 1&#41; and peritoneography &#40;Figure 2&#41;&#46; In addition to the remnants of the radio-opaque material from the graft embolisation&#44; we observed a large quantity of faecal matter throughout the large intestine&#44; with radiolucent images indicating the presence of lanthanum carbonate&#46; The peritoneal catheter was poorly positioned towards the hepatic flexure of the colon&#44; and the peritoneography dye was completely restricted between the transverse colon and the lower edge of the liver&#44; which was clearly outlined&#44; without disseminating into the rest of the abdominal cavity&#46; Suspension of the lanthanum and intensive laxative treatment progressively resolved the constipation and dye restriction&#44; although it did not resolve the poor positioning of the catheter&#44; which had to be relocated&#46;</p><p class="elsevierStylePara">The radiological images presented show the mechanism of action and the mechanical consequences&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11341&#95;16025&#95;30612&#95;en&#95;f1&#95;1411341&#46;jpg" class="elsevierStyleCrossRefs"><img src="11341_16025_30612_en_f1_1411341.jpg" alt="Simple abdominal x-ray"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Simple abdominal x-ray</p><p class="elsevierStylePara"><a href="grande&#47;11341&#95;16025&#95;30613&#95;en&#95;f2&#95;1411341&#46;jpg" class="elsevierStyleCrossRefs"><img src="11341_16025_30613_en_f2_1411341.jpg" alt="Peritoneography"></img></a></p><p class="elsevierStylePara">Figure 2&#46; 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Lanthanum carbonate and peritoneal catheter dysfunction
Carbonato de lantano y disfunción de catéter peritoneal
José R. Rodríguez-Palomaresa, Gabriel de Arribaa, Liliana Gómeza, Katia Péreza, Mariángeles Basterrecheaa, Beatriz Hernándeza, Serafín Tallóna
a Sección de Nefrología, Hospital Universitario de Guadalajara. Departamento de Medicina. Universidad de Alcalá, Guadalajara,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44;</span></p><p class="elsevierStylePara">Clinicians are frequently faced with relatively banal issues that become factors of diagnostic confusion or can even trigger more severe complications&#46;</p><p class="elsevierStylePara">In patients treated with peritoneal dialysis&#44; constipation can become a very difficult problem&#44; and can even reach the point of completely impeding the drainage function of the peritoneal catheter&#46;<span class="elsevierStyleSup">1</span> This is the result of displacement of the catheter towards the upper abdomen and the fact that&#44; even with a properly positioned catheter&#44; a rigid intestine hinders the recovery of infused peritoneal fluid&#46; Over 50&#37; of catheter dysfunctions are related to constipation&#44; and at times this necessitates intensive laxative treatment&#46;<span class="elsevierStyleSup">2</span> Constipation is also an issue in the development of hernias and complications from pressure on the abdominal wall&#44; and can even facilitate the passage of bacteria from the intestinal lumen&#44; leading to peritonitis&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Constipation can be associated with several different factors&#44; such as a certain degree of intestinal paresis&#44; insufficient mobility&#44; and a diet low in fibre&#44; which is often the result of diets that restrict the intake of fruits&#44; and frequently is a result of the medications administered for concomitant problems&#46; Several treatments administered to dialysis patients can generate or aggravate this situation&#44; such as the resins used for hypercalcaemia and phosphate binders&#46; Lanthanum carbonate is a phosphate binder&#44; without calcium or aluminium&#44; which is effective in controlling hyperphosphataemia&#44; and being a radiopaque compound&#44; results in very characteristic radiological images&#46;<span class="elsevierStyleSup">4</span> However&#44; as is the case in other chelating agents&#44; it can produce constipation that is difficult to treat using conventional measures&#46;<span class="elsevierStyleSup">5</span> A peritoneography can aid in the diagnosis of this type of mechanical issue&#46;</p><p class="elsevierStylePara">We present the case of a patient in which the administration of lanthanum carbonate produced severe constipation and displacement of the catheter to the point where peritoneal dialysis treatment became impossible&#46;</p><p class="elsevierStylePara">Ours was a 47 year-old patient with chronic renal failure from interstitial nephropathy secondary to reflux&#44; who had been on haemodialysis since 1990&#46; He underwent his first kidney transplant in 1991&#44; which was then removed due to chronic dysfunction&#44; and underwent a second transplant in 1999&#44; which was again lost to the same reasons&#46; He returned to haemodialysis in 2010&#46; Due to intolerance to the second kidney&#44; the patient underwent graft embolisation&#46; He was receiving lanthanum carbonate at 750mg&#47;8 hours due to secondary hyperparathyroidism and hyperphosphataemia&#46; Due to several failed vascular accesses&#44; it was suggested that the patient be transferred to peritoneal dialysis&#44; and a straight&#44; double-cuff Tenckhoff catheter was implanted&#46; During training&#44; we detected catheter malfunction with incomplete drainage&#44; so we performed abdominal x-rays &#40;Figure 1&#41; and peritoneography &#40;Figure 2&#41;&#46; In addition to the remnants of the radio-opaque material from the graft embolisation&#44; we observed a large quantity of faecal matter throughout the large intestine&#44; with radiolucent images indicating the presence of lanthanum carbonate&#46; The peritoneal catheter was poorly positioned towards the hepatic flexure of the colon&#44; and the peritoneography dye was completely restricted between the transverse colon and the lower edge of the liver&#44; which was clearly outlined&#44; without disseminating into the rest of the abdominal cavity&#46; Suspension of the lanthanum and intensive laxative treatment progressively resolved the constipation and dye restriction&#44; although it did not resolve the poor positioning of the catheter&#44; which had to be relocated&#46;</p><p class="elsevierStylePara">The radiological images presented show the mechanism of action and the mechanical consequences&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11341&#95;16025&#95;30612&#95;en&#95;f1&#95;1411341&#46;jpg" class="elsevierStyleCrossRefs"><img src="11341_16025_30612_en_f1_1411341.jpg" alt="Simple abdominal x-ray"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Simple abdominal x-ray</p><p class="elsevierStylePara"><a href="grande&#47;11341&#95;16025&#95;30613&#95;en&#95;f2&#95;1411341&#46;jpg" class="elsevierStyleCrossRefs"><img src="11341_16025_30613_en_f2_1411341.jpg" alt="Peritoneography"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Peritoneography</p>"
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