Reducing intra‐abdominal pressure in peritoneal dialysis patients to avoid transient hemodialysis

Jegatheswaran, Januvi; Warren, James V.; Zimmerman, Deborah

doi:10.1111/sdi.12676

Cited by 15 publications

(9 citation statements)

References 25 publications

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“…However, dialysis modality failed to predict IAH grade II/III in adjusted regression analysis in our study. Increased intra-peritoneal pressure, a surrogate of IAP is a common finding among peritoneal dialysis patients and has been related to several complications such as hernia or dialysate leakage 39 , 40 . Nevertheless, repeated peritoneal dialysis leads to abdominal wall expansion, explaining the lower prevalence of postoperative IAH among these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, repeated peritoneal dialysis leads to abdominal wall expansion, explaining the lower prevalence of postoperative IAH among these patients. Additionally, intra-peritoneal pressure is directly correlated with actual infused volume 40 and recipients are left with a dry abdomen immediately before transplant surgery, thus removing the main driving determinant behind increased intra-peritoneal pressure in this subset of subjects.…”

Section: Discussionmentioning

confidence: 99%

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Impact of intra-abdominal pressure on early kidney transplant outcomes

Coca

Arias-Cabrales

Pérez‐Sáez

et al. 2022

Sci Rep

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Increased intra-abdominal pressure (IAP) is common among post-surgical patients and may cause organ dysfunction. However, its impact after kidney transplantation on early postoperative complications and graft recovery remains unclear. We designed a prospective, observational cohort study to describe the prevalence and determinants of IAP, as well as its effect on delayed graft function, postoperative complications, and graft recovery. IAP was measured in 205 kidney transplant recipients every 8 h during the first 72 h after surgery using the urinary bladder technique. Intra-abdominal hypertension was defined as IAP ≥ 12 mmHg. Patients were followed for 6 months or until graft failure/death. Mean IAP was 12 ± 3.3 mmHg within the first 24 h. 78% of subjects presented with intra-abdominal hypertension during the first 72 h. Increased IAP was associated with higher renal resistive index [r = 0.213; P = 0.003] and lower urine output [r = − 0.237; P < 0.001]. 72 h mean IAP was an independent risk factor for delayed graft function [OR: 1.31; 95% CI: 1.13–1.51], postoperative complications [OR: 1.17; 95% CI: 1.03–1.33], and absence of graft function recovery [HR for graft function recovery: 0.94; 95% CI: 0.88–0.99]. Increased IAP was highly prevalent after transplantation and was independently associated with delayed graft function, postoperative complications, and absence of graft function recovery. Routine IAP monitoring should be considered post-transplantation to facilitate early recognition of relevant complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of intra-abdominal pressure on early kidney transplant outcomes

Coca

Arias-Cabrales

Pérez‐Sáez

et al. 2022

Sci Rep

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“…High PIA has an etiology with complications such as hernias and peritoneal fluid leaks. 20 But more subtle details have barely been examined. 21 Here we show for the first time that PIA controls the rate of extracellular fluid reabsorption from the tissue in a large tissue compartment, the lower limbs.…”

Section: Discussionmentioning

confidence: 99%

Supine equilibration of extracellular fluid in peritoneal dialysis varies with intra-abdominal pressure

et al. 2020

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Background: Increased intra-abdominal pressure (PIA) leads to venous congestion in splanchnic and adjoining circulations. The aim is to examine whether PIA in peritoneal dialysis (PD) affects the mobilization of extracellular fluid from the lower body in supine body position. Methods: Patients were studied during a regular peritoneal equilibration test (PET) in supine body position using multifrequency bioimpedance analysis to determine extracellular resistance and absolute volume overload (AVO) in wrist-to-ankle (W2A) as well as in ankle-to-ankle (A2A) configurations. Measurements were taken at baseline (T0) after draining the peritoneal cavity, at T1 shortly after filling with 2 L of standard dialysate, and at T2 before taking the 2 h PET samples. PIA was measured from the column height in the PD catheter. Extracellular resistance in the lower extremities (RL) was taken as half of the A2A resistance. Results: Eighteen patients (56 ± 15 years, 76 ± 21 kg, body mass index (BMI) 26.4 ± 7 kg/m2, 13 men) were studied. After having assumed a supine body position for the duration of 17, 77, and 155 min, AVO continuously decreased from 1.6 ± 1.3 (T0) to 1.2 ± 1.5 (T1) and 1.0 ± 1.4 L (T2). RL significantly increased from 238 ± 57 (T0) to 254 ± 62 (T1) and 264 ± 67 Ohm (T2). This increase was negatively correlated to BMI and PIA measured at any time point, but not to net ultrafiltration volume. Conclusions: Orthostatic fluid shifts from the lower limbs may take up to 2 h in supine PD patients, especially with high BMI and PIA because of venous congestion in splanchnic and adjoining circulations.

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“…Because it is difficult to ensure comprehensive education in the short-term hospitalization period, establishing a communication bridge between the patient and the hospital is very important (11). Currently, the Internet is gradually replacing traditional follow-up methods and becoming the main platform for management of chronic diseases and home treatment guidance (12).…”

Section: Efficacy Of Clhm Based On An Internet Platform For the Provision Of Good Medical Services For Patients With Pdmentioning

confidence: 99%

Observation of the effect of closed-loop health management based on an internet platform in patients with peritoneal dialysis: a randomized trial

Fen¹,

Wang²,

Shi³

2021

Ann Palliat Med

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Background: Peritoneal dialysis (PD) uses the peritoneum as the dialysis membrane. PD is a simple operation for self-treatment at home, and has become the preferred option for most patients with chronic renal failure (CRF). This study aimed to explore the effect of a closed-loop health management (CLHM) system based on an Internet platform in patients with PD.Methods: A total of 102 patients with PD who were admitted to Xuzhou Central Hospital from May 2019 to May 2020 were selected and randomly divided into two groups (n=51). The control group received routine care, and in the observation group a CLHM based on an Internet platform was introduced. The incidence of complications and changes in disease knowledge, nutritional status, quality of life (QOL) before and after the intervention were compared between groups.Results: The incidences of peritonitis, tunnel entrance infection, poor drainage, and hypokalemia in the observation group were lower than in the control group (P<0.05). The disease-related knowledge mastery scores of the observation group were higher than those in the control group after 3 months of intervention (P<0.05). Malnutrition-inflammation score (MIS) and serum creatinine (SCr) in the observation group were lower than in the control group after 3 months of intervention (P<0.05), and the body mass index (BMI), albumin (ALB), and hemoglobin (Hb) of the observation group were higher than those of the control group (P<0.05). The QOL scores of the observation group were higher than those of the control group after 3 months of intervention (P<0.05). Conclusions:The application of a CLHM system based on an Internet platform to patients with PD could effectively reduce complications, and improve patients' knowledge of disease, nutritional status and QOL.

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Reducing intra‐abdominal pressure in peritoneal dialysis patients to avoid transient hemodialysis

Cited by 15 publications

References 25 publications

Impact of intra-abdominal pressure on early kidney transplant outcomes

Impact of intra-abdominal pressure on early kidney transplant outcomes

Supine equilibration of extracellular fluid in peritoneal dialysis varies with intra-abdominal pressure

Observation of the effect of closed-loop health management based on an internet platform in patients with peritoneal dialysis: a randomized trial

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