Increasing fill volume reduces cardiac performance in peritoneal dialysis

Ivarsen, Per; Povlsen, Johan V.; Jensen, Jens Dam

doi:10.1093/ndt/gfm284

Cited by 21 publications

(21 citation statements)

References 18 publications

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“…APD uses higher fill volumes than CAPD, and the conditions of prescription (frequent short cycles, more intensive ultrafiltration) during the night session are relatively aggressive. These two factors have been shown to result in hemodynamic disturbances, including significant oscillations in cardiac output and peripheral resistance [20,21]. These changes may accelerate the decay of RKF.…”

Section: Discussionmentioning

confidence: 99%

Compared Decline of Residual Kidney Function in Patients Treated with Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis: A Multicenter Study

Fontán

Rodríguez²,

Sans³

et al. 2015

Nephron Clin Pract

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Background: There is controversy concerning the compared rates of decline of residual kidney function (RKF) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Objectives and Method: Following an observational, multicenter design, we studied 493 patients initiating peritoneal dialysis (PD) in four different Spanish units. We explored the effect of the PD modality on the rate of decline of RKF and the probability of anuria during follow-up. We applied logistic regression for intention-to-treat analyses, and linear mixed models to explore time-dependent variables, excluding those affected by indication bias. Main Results: Patients started on APD were younger and less comorbid than those initiated on CAPD. Baseline RKF was similar in both groups (p = 0.50). Eighty-seven patients changed their PD modality during follow-up. The following variables predicted a faster decline of RKF: higher (rate of decline) or lower (anuria) baseline RKF, younger age, proteinuria, nonprimary PD, use of PD solutions rich in glucose degradation products, higher blood pressure, and suffering peritonitis or cardiovascular events during follow-up. Overall, APD was not associated with a fast decline of RKF, but stratified analysis disclosed that patients with lower baseline RKF had an increased risk for this outcome when treated with this technique (HR: 2.26, 95% CI: 1.09-4.82, p = 0.023). Moreover, the probability of anuria during follow-up was overtly higher in APD patients (HR: 3.22, 95% CI: 1.25-6.69, p = 0.002). Conclusions: Starting PD patients directly on APD is associated with a faster decline of RKF and a higher risk of developing anuria than doing so on CAPD. This detrimental effect is more marked in patients initiating PD with lower levels of RKF.

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Section: Discussionmentioning

confidence: 99%

Compared Decline of Residual Kidney Function in Patients Treated with Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis: A Multicenter Study

Fontán

Rodríguez²,

Sans³

et al. 2015

Nephron Clin Pract

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“…Although lower intraperitoneal pressure in the supine position could have a salutary impact on the ultrafiltration volume with consequent enhanced SR, that study was performed in children; future studies are needed to confirm the results in adults. In a randomized controlled trial, increasing fill volumes from 2 to 3 L in the supine position was followed by an impairment in cardiac performance (i.e., reduction in cardiac output and stroke volume coupled with rise in peripheral systemic resistance) [26]. The impaired cardiac function was already present after a 2-L fill in the upright position and did not change further by increasing volumes.…”

Section: Ultrafiltration Volume and Posturementioning

confidence: 99%

Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

2019

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Background: Peritoneal dialysis (PD) has emerged as a mechanistically relevant therapeutic option for patients with heart failure (HF), volume overload, and varying degrees of renal dysfunction (i.e., chronic cardiorenal syndrome). Congestion has been identified as a potent ominous prognostic factor in this patient population, outperforming a number of established risk factors. As such, excess fluid removal is recognized as a relevant therapeutic target in this setting. Methods: Accumulating evidence points to the importance of sodium removal as part of any decongestive strategy because extraction of sodium-free water has little or no impact on the outcomes of these patients. Hence, optimization of sodium removal by PD should be the primary focus in the setting of HF and cardiorenal syndrome, especially if PD is started when the patient still has adequate residual renal function for clearance of waste products. Results: Herein, we provide an overview of approaches that can tailor PD treatment to the patients’ characteristics and clinical needs (e.g., choice of PD modality) to fully exploit its decongestive properties. Other methods that could prove helpful in the future will also be briefly discussed. Conclusion: While these strategies could help with efficient sodium extraction and volume optimization, future studies are needed to evaluate their impact on the outcomes of this specific patient population.

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“…Ivarsen et al [6] analyzed the evolution of cardiac output using foreign gas rebreathing in 15 PD patients, following the instillation of 2 to 3 liters of PD fluid, and this in the supine and upright position. In the supine position, no effect of a 2 liter infusion was observed.…”

Section: Acute Hemodynamic Effects Of Dialysismentioning

confidence: 99%

Noninvasive evaluation of large artery function and structure in dialysis patients: Clinical applications

Verbeke

Biesen

Vanholder

et al. 2010

ARTRES

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Non-invasive evaluation of large artery function and structure may improve cardiovascular risk stratification. Specific treatments in renal failure can affect arterial function/structure.For example, in peritoneal dialysis, a dialysis fluid exchange causes acute central hemodynamic effects due to the instilled volume, and in hemodialyzed patients, anemia has a flow-independent negative impact on endothelial function that can be corrected by erythopoietin administration.Arterial calcification is a common feature in renal failure. In a multicentre European study of 1084 dialysis patients abdominal aortic calcification (AAC) was scored from a plain lateral abdominal radiograph. AAC increased significantly from L1 to L4 and was related to carotid-femoral pulse wave velocity (PWV), independent of age, blood pressure and

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Increasing fill volume reduces cardiac performance in peritoneal dialysis

Cited by 21 publications

References 18 publications

Compared Decline of Residual Kidney Function in Patients Treated with Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis: A Multicenter Study

Compared Decline of Residual Kidney Function in Patients Treated with Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis: A Multicenter Study

Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

Noninvasive evaluation of large artery function and structure in dialysis patients: Clinical applications

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