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Automated peritoneal dialysis has significant effects on systemic hemodynamics
Nicholas M Selby1, Sally Fonseca, Lisa Hulme
1Department of Renal Medicine, Derby City Hospital, Derby, United Kingdom.
Summary
Automated peritoneal dialysis (APD) causes significant hemodynamic changes, including increased total peripheral resistance and reduced cardiac output. These effects may contribute to the accelerated loss of residual renal function (RRF) in APD patients compared to continuous ambulatory peritoneal dialysis (CAPD).
Area of Science:
- Nephrology
- Cardiovascular Physiology
- Dialysis Technology
Background:
- Residual renal function (RRF) is crucial for outcomes in peritoneal dialysis (PD) patients.
- The impact of automated peritoneal dialysis (APD) on RRF decline versus continuous ambulatory peritoneal dialysis (CAPD) remains debated.
Purpose of the Study:
- To investigate if APD is linked to systemic hemodynamic alterations that could accelerate RRF loss.
- To compare hemodynamic effects of APD with established CAPD practices.
Main Methods:
- Eight CAPD patients underwent a 4-hour APD session with multiple drain/fill cycles using varying glucose concentrations.
- Noninvasive continuous arterial pulse wave analysis monitored blood pressure, heart rate, stroke volume, cardiac output, and total peripheral resistance.
Main Results:
- Blood pressure dropped during fluid drainage and rose upon instillation.
- Total peripheral resistance (TPR) increased by 53.4% (p=0.032).
- Stroke volume and cardiac output decreased by 21.1% (p=0.060) and 22.4% (p=0.037) respectively, despite no significant change in overall blood pressure.
Conclusions:
- APD is associated with significant systemic hemodynamic changes.
- Increased drain/fill cycles and the observed rise in TPR with reduced cardiac output may negatively impact RRF in APD patients.
- Potential cooling effects during APD could also contribute to adverse RRF outcomes.