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Abstract: FR-PO658

Intraperitoneal Filling Transiently Decreases Hepato-Splanchnic Perfusion During Regular Peritoneal Dialysis

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Ribitsch, Werner, Medical University of Graz, Graz, Austria
  • Lehner, Thomas Alexander, Medical University of Graz, Graz, Austria
  • Sauseng, Notburga, Medical University of Graz, Graz, Austria
  • Rosenkranz, Alexander R., Medical University of Graz, Graz, Austria
  • Schneditz, Daniel, Medical University of Graz, Graz, Austria
Background

Peritoneal dialysis (PD) is considered a hemodynamic more tolerable treatment mode compared to hemodialysis (HD). However, during PD intra-abdominal pressure (IAP) reaches values close to intra-abdominal hypertension (IAH, defined as IAP>12 mmHg) known to cause local venous congestion. It was the aim to investigate whether a standardized PD filling reduced hepato-splanchnic blood flow (Qh).

Methods

Measurements were done during a peritoneal equilibration test (PET) with 2L of 2.27% glucose dialysate. Subjects remained fasting and assumed a supine body position throughout the duration of the study. Data were obtained in the drained state at baseline (T0), immediately after instillation of dialysate (T1), as well as 2 h after instillation (T2). IAP was measured by Durand’s approach. Qh was determined from kinetics of indocyanine-green (ICG) dye venously injected and transcutaneously measured by pulse-dye-densitometry (DDG-2001, Nihon-Kohden, Japan). Mean arterial pressure (MAP) and total peripheral resistance (TPR) were derived from continuous arterial pulse analysis (Finometer, Finapres Medical Systems, The Netherlands). Plasma glucose (G) and insulin (I) concentrations were measured by standard techniques. Variables obtained at T0, T1, and T2 were compared by non-parametric Friedman-test.

Results

Ten patients (58.6±14.8 years; 87.5±18.8 kg dry body mass; 172±9 cm; 8 male; 8 non-diabetics) were studied after a 13.9±4.3 h fasting period. IAP increased after filling and remained elevated (Tab. 1). Qh fell by about 13.4±17.6% at T1 but returned close to baseline values at T2. MAP increased at T1 and T2. TPR (in peripheral resistance units, PRU) remained unaffected.

Conclusion

The increase in IAP during PD causes a small and transient decrease in Qh. The subsequent rebound coincides with the absorption of glucose and is likely due to the vasodilatory effects of glucose and insulin which appears to compensate for the pressure induced flow congestion in the splanchnic circulation.

Table 1
 IAP, mmHgQh, L/minMAP, mmHgTPR, PRUG, mmoL/LI, mU/L
T06.9±3.21.25±0.57106.2±17.71.13±0.335.8±1.513.9±17.3
T110.2±3.1***1.05±0.38*111.9±20.5*1.07±0.26--
T210.6±3.0***1.21±0.48*110.1±17.7*1.08±0.256.9±2.2**16.5±18.2**

*p<0.05, **p<0.01, ***p<0.001