P.085 Acute Effect of Volume Exchange on Central Hemodynamics in Peritoneal Dialysis

Abstract

Introduction

Although peritoneal dialysis (PD) is considered favorable regarding hemodynamic stability, little is known on potential acute effects of fluid exchange. We aimed to assess central hemodynamic changes during infusion and dwell time.

Methods

Patients were randomized to 3 different starting volumes (1000, 1500 and 2500 mL) of the non-glucose containing icodextrin, followed by addition or drainage of 200 mL every 10 minutes for 50 minutes. Hemodynamic parameters were studied using the SphygmoCor, before and after infusion of the starting volumes and after each volume change. Local carotid systolic blood pressure (BP), augmentation index (AI) and central augmentation pressure (AP) and were used as central measures.

Results

We included 13 patients (9 male, 4 female) on PD aged 57 years (range: 40–82) and with a median BP of 126/77 mmHg (range: 94–200/51–94 mmHg). After infusion of the starting volume, central systolic BP and central AP increased by 4.7 mmHg (p = 0.006) and 2.8 mmHg (p = 0.005). AI increased by 5.7% (p = 0.04) and heart rate decreased by 2.6 bpm (p = 0.006). The difference in heart rate adjusted AI was not significant. Intraperitoneal pressure increased by 2.3 cm H₂O (p = 0.03). No significant changes were observed on subsequent addition or drainage of volumes.

Conclusions

Infusion of PD fluids causes a significant acute increase in central systolic BP that persists for at least one hour and is associated with a slight decrease in heart rate. This may be due to an enhanced preload from intraperitoneal venous compression and/or to an increased wave reflection.