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Related Experiment Videos

High volume, low frequency continuous ambulatory peritoneal dialysis.

Z J Twardowski, B F Prowant, K D Nolph

    Kidney International
    |January 1, 1983
    PubMed
    Summary

    Intra-abdominal pressure (IAP) and dialysis fluid volume affect lung function in peritoneal dialysis patients. Optimizing exchange volume and position is crucial for maintaining pulmonary capacity.

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    Area of Science:

    • Nephrology
    • Pulmonary Physiology
    • Medical Engineering

    Background:

    • Continuous ambulatory peritoneal dialysis (CAPD) involves infusing dialysis solutions, potentially impacting intra-abdominal pressure (IAP) and respiratory mechanics.
    • Understanding the relationship between intraperitoneal volume (IPV), patient position, and pulmonary function is essential for optimizing CAPD therapy.

    Purpose of the Study:

    • To investigate the effects of varying intraperitoneal volumes (IPV) and patient positions (supine, sitting, upright) on intra-abdominal pressure (IAP), forced vital capacity (FVC), and forced expiratory volume at 1 second (FEV1) in CAPD patients.
    • To determine the impact of different dialysis fluid exchange volumes on pulmonary function and identify tolerance limits.

    Main Methods:

    • Measurements of IAP, FVC, and FEV1 were conducted in 18 stable CAPD patients across supine, sitting, and upright positions.

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  • Dialysis solutions were infused incrementally up to 4 liters, with patients categorized based on their routine 3-liter exchange usage (RUT-0, RUT-1, RUT-2).
  • Abdominal girth was measured to correlate with IPV.

    • Main Results:

    • IAP increased linearly with IPV, with higher increases noted in sitting and upright positions compared to supine.
    • Significant deterioration in FVC and FEV1 was observed in the supine position with IPV exceeding 2 liters, particularly in patients not using 3-liter exchanges (RUT-0).
    • Pulmonary function decline was noted in supine and sitting positions with larger IPVs, while upright position showed less significant impact up to 4.6 liters IPV.

    Conclusions:

    • Individualizing exchange volume and patient position is critical in CAPD to mitigate pulmonary function compromise.
    • The upright position appears more favorable for maintaining pulmonary function during larger IPV infusions.
    • A significant portion of patients could increase daily dialysate volume while reducing exchange frequency, suggesting potential for optimized treatment regimens.