A review with commentary on the title research of Gupta et. al (2012). This article describes the patient with end-stage renal disease and calcific uremic arteriopathy who developed chem. peritonitis after i.p. administration of sodium thiosulfate. Because peritoneal fluid and blood cultures showed no bacterial growth, a diagnosis of chem. peritonitis secondary to sodium thiosulfate was suggested. The introduction of particulate matter into the peritoneum during peritoneal dialysis has been associated with the development of diffuse peritonitis with granuloma formation.