Clinical Relevance of Intraperitoneal Pressure in Peritoneal Dialysis Patients

Abstract

Our supine IPPs were higher than others published in adults. Intraperitoneal pressure has an individual value associated with body size. Greater IPP was correlated with lower daily total UF and more hernias and leakages. The measurement of IPP is a simple technique and can help with PD prescription, especially in obese patients.

Intraperitoneal Pressure in Polycystic and Non-Polycystic Kidney Disease Patients, Treated by Peritoneal Dialysis

“…This relationship is also confirmed when IPV is normalized with BMI and when PD population is divided according to IPP in high and lIPP groups (17 cm H 2 O cut off). These results are similar to those previously described by Dejardin et al [9] and more recently by 2 other papers published by Outerelo et al [5] and Castellanos et al [10]. Similar to our data, in all these studies relationship between IPP and BSA is only weak or absent.…”

“…Adults have less variation in BSA compared to BMI, which is mostly affected by visceral fat. In this context, it is not surprising that in some studies, waist circumference significantly correlated with IPP [10]. This differs in paediatric population, where visceral fat is less relevant and BSA truly reflects the growth of the children, so that for a given IPV, small children with small BSA develop more IPP than those with higher BSA [19].…”

“…This comes from studies conducted among the paediatric population, where BSA is commonly used to individualize therapy [18]. However, in adult population, BMI seems to be stronger associated with IPP than BSA and we probably should individualize IPV prescription according to BMI [9,10]. BSA and BMI may reflect different body structure especially in the extreme range, such as thin and tall or fat and short patients may have the same BSA, but different BMI.…”

“…Beside its effect on respiratory indices, it is believed that IPP may contribute to some mechanical complications, commonly referred to as "pressure driven," such as hernia, pleural-peritoneal communication, pericatheter leaks and gastrointestinal reflux. Even if there are no definitive proves that confirm the causal relationship between such mechanical complications and increased IPP [5,[9][10][11], prescription of IPV cannot be done regardless of correspondent IPP. There-fore, all factors affecting IPP need to be analysed before a PD prescription is done.…”

“…It raises passing from supine to upright position and can reach value of 200 mm Hg during coughing. Factors such as gender, dialytic age, and anthropometric variables (body surface area [BSA] and body mass index [BMI]), may also have an effect on IPP for a fixed IPV, which are responsible for the great variability of IPP across PD population [8][9][10].…”