High volume, low frequency continuous ambulatory peritoneal dialysis

Abstract

Intra-abdominal pressure (IAP), forced vital capacity (FVC), and forced expiratory volume at 1 sec (FEV1) were measured in 18 stable continuous ambulatory peritoneal dialysis (CAPD) patients maintained on 2-liter exchanges, in the supine, sitting, and upright positions after infusing dialysis solutions in 0.5-liter increments up to 4 liters as tolerated. Thereafter, five patients did not increase to 3-liter volumes (RUT-0), four used 3-liter volumes occasionally (RUT-1), and nine chose 3-liter volumes for routine dialysis (RUT-2). IAP was similar in all groups and dependent on the intraperitoneal volume (IPV). The mean IAP increased 2.0, 2.7, and 2.8 cm H2O/liter of IPV in the supine, upright, and sitting positions, respectively. The patients of the RUT-0 group had dramatic deterioration (up to 42%) of FVC and FEV1 in the supine position with IPV above 2 liters. The patients with the greatest deterioration of pulmonary functions could not continue the measurements above 3 liters of IPV. Two of these patients were switched to 1-liter overnight exchanges. Even in patients who tolerated up to 4 liters, FVC and FEV1 decreased significantly in the supine and sitting positions, with IPV greater than 3 or 4 liters, respectively. In the upright position, the values did not decrease significantly below those with the empty abdomen up to 4.6 liters of IPV. Each liter of IPV increased the abdominal girth by 2.1 cm. Exchange volume and frequency should be individualized. In our studies, 50% of the patients could increase daily dialysate volume from 8 to 9 liters while decreasing daily exchanges from 4 to 3.

Resistance of Tumor Interstitial Pressure to the Penetration of Intraperitoneally Delivered Antibodies into Metastatic Ovarian Tumors

“…35). The maximum pressure which can be sustained for more than a few minutes in a supine, anesthetized rat who is not intubated and ventilated is 8 mm Hg (37). Figure 7 also displays the tumor mean values from Fig.…”

Correlating structure with solute and water transport in a chronic model of peritoneal inflammation

“…Scaling from 2,000 ml in a 70-kg human to a 275-g rat, the volume would be 41.4 ml, which produces similar intraperitoneal (ip) pressures to that observed in humans (5,12,27). The volume is completely absorbed in 18 -24 h. At no time after injection did the animal display any signs of distress with the use of this volume.…”

“…Protein losses were significantly less with the NAG than the glucose group. Volumes recovered were not different in either group; however, injection of 30 ml into 324-to 447-g rats was likely insufficient to bring ip pressures to the typical 4 -6 cmH 2 O, which is observed in patients (27) and used in our experiments to test for hydraulic flow. Glucose concentration, on the other hand, dissipated more rapidly in the NAG-treated animals during the first hour of experimental dialysis.…”

“…The volumes were scaled on the basis of (body weight) 0.7 {[x kg/70 kg] 0.7 ϫ 2,000 ml} (5), which produces pressures that are the same as those observed in humans (12,27). The sterile solutions were as follows.…”

The Occurrence of Increased Intraperitoneal Volume Events in Automated Peritoneal Dialysis in the US: Role of Programming, Patient/User Actions and Ultrafiltration

“…More serious infrequent complications in adults and children include severe respiratory distress, hydrothorax (7)(8), and pericardial effusions (9). PD patients with pre-existing cardiac disease or compromised pulmonary function may be more susceptible to the physiologic effects of IIPV or IPP since increases in either parameter are associated with decreased cardiac output (10)(11), elevated blood pressure (12), decreased pulmonary compliance, hypoxia and hypercapnia (13), and decreased pulmonary volumes (14).…”