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NDT Advance Access published online on June 21, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh946
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received February 10, 2005
Accepted May 11, 2005

Original Articles

Hypertonic glucose-based peritoneal dialysate is associated with higher blood pressure and adverse haemodynamics as compared with icodextrin

Nicholas M. Selby 1, Sally Fonseca 1, Lisa Hulme 1, Richard J. Fluck 1, Maarten W. Taal 1, and Christopher W. McIntyre 2*

1 Department of Renal Medicine, Derby City Hospital, UK
2 Department of Renal Medicine, Derby City Hospital, UK; Centre for Integrated Systems Biology and Medicine, University of Nottingham, UK

* To whom correspondence should be addressed.
Christopher W. McIntyre, E-mail: Chris.McIntyre{at}derbyhospitals.nhs.uk



  Abstract

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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