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Clinical |
Department of Renal Medicine,1 Derby City Hospital, Derby; Centre for Integrated Systems Biology and Medicine,2 University of Nottingham, United Kingdom
Correspondence to: C.W. McIntyre, Department of Renal Medicine, Derby City Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.Chris.McIntyre{at}derbyhospitals.nhs.uk
Objectives: Maintenance of residual renal function (RRF)
is an important determinant of outcome in peritoneal dialysis patients. It
remains contentious as to whether automated peritoneal dialysis (APD) leads to
an increased rate of decline of RRF compared with continuous ambulatory
peritoneal dialysis (CAPD). We studied whether APD was associated with
significant systemic hemodynamic changes that may play a role in the
accelerated loss of RRF. Methods: As a follow-on from a previous study, 8
well-established CAPD patients underwent a 4-hour APD treatment consisting of
3 drain/fill cycles using 2 x 2.5 L 1.36% glucose and 1 x 3.86%
glucose dialysate. Each dwell phase lasted 76 minutes. Blood pressure (BP) and
a full range of hemodynamic variables, including pulse (HR), stroke volume
(SV), cardiac output (CO), and total peripheral resistance (TPR), were
measured noninvasively using continuous arterial pulse wave analysis. Results: BP fell during 2 of the 3 drain/fill periods when
dialysate was drained from the peritoneal cavity, but then rose upon
instillation of dialysate fluid. The fall in BP was associated with a fall in
TPR, matched by an inadequate rise in SV and CO. Over the entire study period,
TPR progressively rose to +53.4% above baseline (p = 0.032). Both SV
and CO fell over the same period, to -21.1% (p = 0.060) and -22.4%
from baseline (p = 0.037) respectively. This did not result in any
significant difference between start and end BP. Conclusions: This study demonstrates that APD is
associated with significant systemic hemodynamic effects. The increased number
of drain/fill cycles compared to CAPD, or the progressive rise in TPR and
reduction in CO (possibly due to a cooling effect), may potentially be factors
that adversely affect RRF in APD patients.
KEY WORDS: Automated peritoneal dialysis; blood pressure; hemodynamics; pulse wave analysis; residual renal function.
Received 11 July 2005; accepted 19 September 2005.
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N. M. Selby, J. Fialova, J. O. Burton, and C. W. McIntyre The haemodynamic and metabolic effects of hypertonic-glucose and amino-acid-based peritoneal dialysis fluids Nephrol. Dial. Transplant., March 1, 2007; 22(3): 870 - 879. [Abstract] [Full Text] [PDF]
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