This study demonstrates large magnitude haemodynamic changes in response to CAPD. In addition to the well-recognized adverse effects on blood glucose and long-term peritoneal membrane viability, CAPD fluids containing high glucose concentrations may also exert undesirable effects on systemic haemodynamics, with potential long-term consequences for patient outcomes.
Objectives Maintenance of residual renal function (RRF) is an important determinant of outcome in peritoneal dialysis patients. It remains contentious as to whether automated peritoneal dialysis (APD) leads to an increased rate of decline of RRF compared with continuous ambulatory peritoneal dialysis (CAPD). We studied whether APD was associated with significant systemic hemodynamic changes that may play a role in the accelerated loss of RRF. Methods As a follow-on from a previous study, 8 well-established CAPD patients underwent a 4-hour APD treatment consisting of 3 drain/fill cycles using 2 x 2.5 L 1.36% glucose and 1 x 3.86% glucose dialysate. Each dwell phase lasted 76 minutes. Blood pressure (BP) and a full range of hemodynamic variables, including pulse (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR), were measured noninvasively using continuous arterial pulse wave analysis. Results BP fell during 2 of the 3 drain/fill periods when dialysate was drained from the peritoneal cavity, but then rose upon instillation of dialysate fluid. The fall in BP was associated with a fall in TPR, matched by an inadequate rise in SV and CO. Over the entire study period, TPR progressively rose to +53.4% above baseline ( p = 0.032). Both SV and CO fell over the same period, to -21.1% ( p = 0.060) and -22.4% from baseline ( p = 0.037) respectively. This did not result in any significant difference between start and end BP. Conclusions This study demonstrates that APD is associated with significant systemic hemodynamic effects. The increased number of drain/fill cycles compared to CAPD, or the progressive rise in TPR and reduction in CO (possibly due to a cooling effect), may potentially be factors that adversely affect RRF in APD patients.
♦ Background and Objectives: The extent to which hemo globin (Hb) cycling occurs in peritoneal dialysis (PD) patients is unclear. It is also uncertain whether different types of erythropoiesisstimulating agents (ESAs) affect such cycling. We performed a retrospective cohort study of our PD population before and after the entire program was switched from epoetin beta (NeoRecormon: HoffmanLaRoche, Basel, Switzerland) to continuous erythropoietin receptor activator [CERA (Mircera: Hoffman-LaRoche)]. ♦ Design, Setting, Participants, and Measurements: The study included 79 patients receiving PD for endstage renal failure and being treated with an ESA. Hemoglobin concentrations were measured monthly, and each study period ran for 12 months. Patient demographics and details of intercurrent illness and hospital admission were collected. ♦ Results: There was a trend to fewer patients on CERA (26 patients, 68.4%) than on epoetin beta (36 patients, 87.8%, p = 0.054) experiencing Hb excursions. The CERA group also required fewer dose changes. However, there was no differ ence in the proportion of patients experiencing complete Hb cycles. On logistic regression, the factors associated with Hb cycling were ESA dose increase or decrease and hospital admission. We also observed a positive correla tion between the delta ESA dose and the amplitude of Hb excursion, suggesting that the dose changes were causal, rather than reactive. ♦ Conclusions: Hemoglobin cycling occurs in PD patients and is largely a consequence of current practice in ESA dos ing, plus the effects of intercurrent illness. The longer half life of CERA may offer a small advantage in reducing the degree of Hb variability, possibly because of fewer dose changes per patient.
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