A 49-year-old female patient received peritoneal dialysis (PD) for six years but has switched to hemodialysis for two years due to poor peritoneal ultrafiltration. She was admitted because of nausea, vomiting, anorexia, abdominal fullness, and hemoperitoneum (observed when flushing the catheter once a week) for three months. Abdominal physical examination revealed hard lumps in the lower abdomen (enlarged intestines) and hypoactive bowel sounds (two movements per minute). Her intact parathyroid hormone (iPTH) varied from 470 to 836 pg/mL, calcium varied from 2.21 to 2.47 mmol/L, and phosphate varied from 1.36 to 1.88 mmol/L in the past four years.
