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Symptomatic fluid retention in patients on continuous peritoneal dialysis
A H Tzamaloukas1, M C Saddler, G H Murata
1Albuquerque Veterans Affairs Medical Center, NM 87108, USA.
Journal of the American Society of Nephrology : JASN
|August 1, 1995
Summary
Symptomatic fluid gain (SFR) in continuous ambulatory peritoneal dialysis (CAPD) patients is linked to noncompliance and high solute transport. Management is challenging, impacting prognosis and CAPD continuation.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Peritoneal Dialysis
Background:
- Symptomatic fluid gain (SFR) is a significant complication in patients undergoing continuous peritoneal dialysis (CPD).
- Understanding the predictors and clinical features of SFR is crucial for managing patients on CPD, particularly continuous ambulatory peritoneal dialysis (CAPD).
Purpose of the Study:
- To analyze the clinical features, pathogenesis, management, prognosis, and predictors of symptomatic fluid gain (SFR) in patients on CPD.
- To identify factors contributing to SFR and evaluate the effectiveness of management strategies in CAPD patients.
Main Methods:
- Retrospective analysis of 71 SFR episodes in 66 patients on CPD (94.4% CAPD) compared to 149 control CAPD patients.
- Evaluation of clinical manifestations, patient compliance, peritoneal equilibration tests (PET), and logistic regression for predictor identification.
- Assessment of management responses and outcomes, including hospitalization, CAPD discontinuation, and mortality.
Main Results:
- SFR patients exhibited higher rates of diabetes (64% vs. 46%) and noncompliance with fluid (76% vs. 22%), salt (74% vs. 23%), and dialysis (30% vs. 7%) restrictions.
- Common SFR manifestations included peripheral edema (100%), pulmonary congestion (80%), pleural effusions (76%), and hypertension (systolic 83%, diastolic 66%).
- Independent predictors of SFR were dietary noncompliance, low PET drain volume, and younger age; high peritoneal solute transport was also more frequent (32.2% vs. 2.4%).
Conclusions:
- Symptomatic fluid gain poses serious consequences for CAPD patients, leading to increased hospitalizations, CAPD discontinuation, and mortality.
- Dietary noncompliance, low PET drain volume, and young age are key predictors of SFR.
- Management strategies, particularly short dwell exchanges with hypertonic dialysate in compliant high transporters, showed the most promise but responses were inconsistent.