Document Detail

Effects of peritoneal dialysis fluid biocompatibility on baroreflex sensitivity.
MedLine Citation:
PMID:  18379534     Owner:  NLM     Status:  MEDLINE    
Conventional low biocompatibility peritoneal dialysis (PD) fluid composition has been driven by manufacturing expediency and cost limitations. PD is associated with significant acute changes in cardiovascular functional parameters, at least in part influenced by fluid composition. Short-term control of blood pressure (BP) is under control of the baroreflex arc. The aim of this study was to investigate the effects of PD fluid biocompatibility on baroreflex sensitivity (BRS). We studied 10 non-diabetic established continuous ambulatory PD patients, in a randomized crossover trial comparing conventional and biocompatible PD fluids. Systemic hemodynamics were continuously monitored using digital pulse-wave analysis. Plasma glucose and insulin were assessed during treatment with both 1.36% and 3.86% glucose-containing fluids. BRS was calculated offline from continuous BP and interbeat interval data. BRS was significantly higher with conventional PD fluid during both 1.36% (P<0.001) and 3.86% (P<0.001) dwells. Systolic BP was higher; heart rate, stroke volume, and cardiac output were lower; and total peripheral resistance increased during exposure to either fluid. There were significant differences between fluids with respect to the magnitude of these responses. Plasma glucose and insulin concentrations, and ultrafiltration volumes were significantly higher during the 3.86% dwell than the 1.36% dwell, but there were no differences between standard and biocompatible fluids. We have demonstrated for the first time that PD fluid biocompatibility rapidly affects BRS. These changes occur against a background of cardiovascular variability, hyperinsulinemia, and hyperglycemia. Further research is needed to explore the mechanism and, more importantly, the consequences of these findings.
S G John; N M Selby; C W McIntyre
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Kidney international. Supplement     Volume:  -     ISSN:  0098-6577     ISO Abbreviation:  Kidney Int. Suppl.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-04-01     Completed Date:  2008-05-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7508622     Medline TA:  Kidney Int Suppl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S119-24     Citation Subset:  IM    
Department of Renal Medicine, Derby Hospitals NHS, Foundation Trust, Derby, UK.
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MeSH Terms
Baroreflex / drug effects*
Biocompatible Materials / pharmacology*
Blood Glucose / metabolism
Blood Pressure / drug effects
Cardiac Output / drug effects
Cross-Over Studies
Dialysis Solutions / pharmacology*
Heart Rate / drug effects
Insulin / blood
Kidney Failure, Chronic / physiopathology,  therapy
Middle Aged
Peritoneal Dialysis / methods*
Prospective Studies
Sensitivity and Specificity
Stroke Volume / drug effects
Reg. No./Substance:
0/Biocompatible Materials; 0/Blood Glucose; 0/Dialysis Solutions; 11061-68-0/Insulin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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