NDT Advance Access originally published online on June 21, 2005
Nephrology Dialysis Transplantation 2005 20(9):1848-1853; doi:10.1093/ndt/gfh946
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Hypertonic glucose-based peritoneal dialysate is associated with higher blood pressure and adverse haemodynamics as compared with icodextrin
1 Department of Renal Medicine, Derby City Hospital and 2 Centre for Integrated Systems Biology and Medicine, University of Nottingham, UK
Correspondence and offprint requests to: Dr C. McIntyre, Department of Renal Medicine, Derby City Hospital, Uttoxeter Road, Derby DE22 3NE, UK. Email: Chris.McIntyre{at}derbyhospitals.nhs.uk
Background. Little is known about the haemodynamic effects of continuous ambulatory peritoneal dialysis (CAPD) despite its widespread use in the management of end-stage renal failure. We undertook a study to delineate the haemodynamic effects of CAPD using glucose-containing fluids (1.36 and 3.86% glucose) and icodextrin.
Methods. Eight CAPD patients were recruited for a prospective crossover study. Patients attended for two investigatory days (in random order). CAPD was carried out using 1.36% followed by 3.86% glucose (buffered with lactate/bicarbonate, Physioneal®) on one study day and 1.36% glucose followed by 7.5% icodextrin (Extraneal®) on the other day. Dwell times were 150 min. Blood pressure (BP) and a full range of haemodynamic variables including pulse (HR), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were measured non-invasively using continuous arterial pulse wave analysis.
Results. BP was significantly higher during 3.86% glucose dwells as compared with 1.36% glucose or icodextrin dwells (P<0.0001). TPR during all three dwells was similar; the higher blood pressure was due to an increased HR, SV and, therefore, CO during 3.86% glucose dwells. The higher blood pressure during the 3.86% glucose dwells was present despite the highest ultrafiltration volume and sodium removal.
Conclusion. This study demonstrates large magnitude haemodynamic changes in response to CAPD. In addition to the well-recognized adverse effects on blood glucose and long-term peritoneal membrane viability, CAPD fluids containing high glucose concentrations may also exert undesirable effects on systemic haemodynamics, with potential long-term consequences for patient outcomes.
Keywords: glucose-based dialysate; haemodynamics; icodextrin; peritoneal dialysis; pulse wave analysis
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