Peritoneal Dialysis International, Vol. 28, pp. 142–148 Printed in Canada. All rights reserved. 0896-8608/08 $3.00 + .00 Copyright © 2008 International Society for Peritoneal Dialysis 142 ACUTE CENTRAL HEMODYNAMIC EFFECTS OF A VOLUME EXCHANGE IN PERITONEAL DIALYSIS Francis Verbeke, 1 Wim Van Biesen, 1 Anneleen Pletinck, 1 Luc M. Van Bortel, 2 and Raymond Vanholder 1 Nephrology Section, 1 Department of Internal Medicine, Ghent University Hospital; Heymans Institute of Pharmacology, 2 Ghent University, Ghent, Belgium Correspondence to: F. Verbeke, Nephrology Section, Depart- ment of Internal Medicine, University Hospital Ghent, De Pintelaan 185, B-9000 Ghent, Belgium. francis.verbeke@ugent.be Received 11 April 2007; accepted 5 September 2007. ♦ Background: Although peritoneal dialysis is considered to offer more hemodynamic stability than hemodialysis, the acute hemodynamic effects of peritoneal dialysis have only been investigated scarcely. The present study assesses the central hemodynamic impact of volume infusion using pH- adjusted icodextrin, thus avoiding interference of glucose, pH, and osmolarity. ♦ Methods: Patients were randomized to 3 different start- ing volumes (A: 1000 mL, B: 1500 mL, and C: 2500 mL) of icodextrin, followed by addition (A and B) or drainage (C) of 200 mL every 10 minutes for 50 minutes. Local carotid systolic blood pressure (BP; as a surrogate for central BP), augmentation index, and augmentation pressure were mea- sured by applanation tonometry before and after infusion of the starting volumes and after each volume change. ♦ Results: We included 13 patients (median age 57 years). Baseline brachial BP was 126/77 mmHg. After infusion of the starting volume, carotid systolic BP and augmentation pressure increased by 4.7 mmHg (p = 0.006) and 3.1 mmHg (p = 0.015). Augmentation index increased by 5.7% (p = 0.04) and heart rate decreased by 2.6/minute (p = 0.006). Intraperitoneal pressure increased by 2.3 cm H 2 O (p = 0.03). No additional hemodynamic changes except for a rise in di- astolic BP with increasing volume (p = 0.004) were observed after subsequent addition or removal of volumes. ♦ Conclusions: Infusion of peritoneal dialysis fluids causes an acute increase in carotid systolic BP, followed by a pro- gressive rise in diastolic BP. These effects persist until com- plete drainage of the abdomen and may be due to an enhanced preload, resulting from intraperitoneal venous compression, and/or increased wave reflection. Perit Dial Int 2008; 28:142–148 www.PDIConnect.com KEY WORDS: Hemodynamic; central blood pressure; tonometry; volume. H emodynamic alterations such as volume overload contribute to the accelerated progression of cardio- vascular disease in dialysis patients (1,2). Removal of this volume excess by hemodialysis causes fluctuations in blood pressure (BP), and sometimes leads to symptom- atic acute hypotension when the ultrafiltration rate ex- ceeds the adaptive capacity of the cardiovascular system. Peritoneal dialysis (PD) has the theoretical advantage of being a continuous technique, which has led to the common conviction that no acute hemodynamic changes are provoked by this technique (3). Some recent studies (4–6), however, demonstrated an increase in peripheral BP during PD, possibly resulting from (a) changes in intra-abdominal volume and/or pressure during the fluid exchange (3), (b) substantial rapid ultrafiltration, and/or (c) the metabolic effects of glucose absorption during dwell time (7). However, these studies lacked the possibility of distinguishing the pathophysiologic causes of the observed changes, as in none of these studies was there used a solution that at the same time avoided glu- cose, low pH, and osmolarity. Also, conclusions are ham- pered by the use of insensitive methodology that measured only peripheral BP; therefore, confirmation of the hemodynamic changes using more appropriate and accurate methods is warranted. The SphygmoCor system ORIGINAL ARTICLES