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


CONCLUSIONS
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.
Department of Renal Medicine, Derby City Hospital, Uttoxeter Road, Derby DE22 3NE, UK.
Nicholas M
NM
Selby
Sally
S
Fonseca
Lisa
L
Hulme
Richard J
RJ
Fluck
Maarten W
MW
Taal
Christopher W
CW
McIntyre
D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000145:classification; D005260:Female; D005936:Glucans; D005947:Glucose; D015312:Hemodialysis Solutions; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*
D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D005947:Glucose