Peritonitis, dialysate infusion and lung function in continuous ambulatory peritoneal dialysis (CAPD)

Area of Science:

• Nephrology
• Pulmonology
• Critical Care Medicine

Background:

• Continuous Ambulatory Peritoneal Dialysis (CAPD) is a common treatment for end-stage renal disease.
• Acute peritonitis is a frequent complication of CAPD, potentially affecting systemic functions.
• The impact of peritonitis and CAPD procedures on pulmonary function requires detailed investigation.

Purpose of the Study:

• To assess the effects of acute peritonitis on pulmonary function in CAPD patients.
• To evaluate the immediate and long-term effects of dialysate infusion on lung function in CAPD patients.
• To understand the mechanisms underlying pulmonary changes during CAPD, with and without peritonitis.

Main Methods:

• Pulmonary function tests (PFTs) were conducted on CAPD patients during acute peritonitis and after recovery.
• PFTs were performed on CAPD patients before and after dialysate infusion, with some patients restudied after several months.
• Measurements included vital capacity and arterial oxygen tension (PaO2) in various positions (sitting, supine).

Main Results:

• Peritonitis was associated with a 30% reduction in vital capacity and a significant decrease in PaO2.
• Dialysate infusion alone reduced functional residual capacity (FRC) and PaO2, especially when supine, due to airway closure.
• Long-term follow-up showed persistent FRC reduction with dialysate infusion, but PaO2 normalized, suggesting compensatory mechanisms.

Conclusions:

• Acute peritonitis significantly compromises lung function in CAPD patients, likely due to reduced diaphragmatic mobility leading to atelectasis.
• Dialysate infusion in CAPD patients can cause significant pulmonary changes, particularly affecting FRC and PaO2 in the supine position.
• While initial dialysate infusion impacts gas exchange, compensatory mechanisms develop over time in CAPD patients without peritonitis.