Acute central hemodynamic effects of a volume exchange in peritoneal dialysis

Although peritoneal dialysis is considered to offer more hemodynamic stability than hemodialysis, the acute hemodynamic effects of peritoneal dialysis have only been investigated scarcely. The present study assesses the central hemodynamic impact of volume infusion using pH-adjusted icodextrin, thus avoiding interference of glucose, pH, and osmolarity.

Patients were randomized to 3 different starting volumes (A: 1000 mL, B: 1500 mL, and C: 2500 mL) of icodextrin, followed by addition (A and B) or drainage (C) of 200 mL every 10 minutes for 50 minutes. Local carotid systolic blood pressure (BP; as a surrogate for central BP), augmentation index, and augmentation pressure were measured by applanation tonometry before and after infusion of the starting volumes and after each volume change.

We included 13 patients (median age 57 years). Baseline brachial BP was 126/77 mmHg. After infusion of the starting volume, carotid systolic BP and augmentation pressure increased by 4.7 mmHg (p = 0.006) and 3.1 mmHg (p = 0.015). Augmentation index increased by 5.7% (p = 0.04) and heart rate decreased by 2.6/minute (p = 0.006). Intraperitoneal pressure increased by 2.3 cm H(2)O (p = 0.03). No additional hemodynamic changes except for a rise in diastolic BP with increasing volume (p = 0.004) were observed after subsequent addition or removal of volumes.

Infusion of peritoneal dialysis fluids causes an acute increase in carotid systolic BP, followed by a progressive rise in diastolic BP. These effects persist until complete drainage of the abdomen and may be due to an enhanced preload, resulting from intraperitoneal venous compression, and/or increased wave reflection.