Volume status and fluid overload in peritoneal dialysis By Yousaf khan Renal Dialysis Lecturer IPMS-KMU Peshawar

1. Volume status and fluid
overload in peritoneal dialysis
Yousaf khan
Lecturer Renal dialysis
IPMS- KMU

2. Introduction
 Fluid overload can manifest in obvious fashion as hypertension or
edema in PD patients.
 Making it difficult to diagnose clinically chronic hypervolemia can
lead to LVH.
 Major contributor to cardiovascular disease, in PD patient with
attendant morbidity and mortality.
 Fluid overload with peritoneal membrane dysfunction is a common
cause for technique failure.
 Assessment of fluid status
 Mechanism of fluid overload
 Diagnosis of ultrafiltration failure ( UFF)

3. 1: Assessment of fluid status:
 Clinical examination
 Laboratory investigation have so far not proven clinically useful
 Target body weight for PD is that which gives a well tolerated
normotensive and edema free state
2: Mechanisms of fluid overload:
 Fluid overload reflects a combination of inappropriate
prescription, noncompliance, loss of residual renal function,
mechanical problems and peritoneal membrane dysfunction.
3: Diagnosis of Ultra filtration failure (UFF):
 High transporter with UFF (type I)
 Low transporter with UFF (type II)

4. Diagnosis of Ultra filtration failure (UFF):
High transporter with UFF (type I)
 In this situation the dialysate dextrose concentration falls rapidly
after infusion, resulting in loss of the concentration gradient that
drives fluid removal.
 Most common cause and is often called type I UFF
 Develops after 3 or more years on PD.
 Its reflect an increase membrane vascularity that occurs with time
on PD, to a greater extent in some patients
 Cause of increase effective surface area may include cumulative
exposure of the membrane to high glucose loads.
Low transporter with UFF (type II)
 Group of patients has reduced small solute clearance.
 A normal or reduce glucose absorption profile and reduce fluid
removal
 Called type II UFF
 Much less common
 Its reflects decrease membrane surface and is most often due to
adhesions and scarring after a severe peritonitis or other intra
abdominal complication.

5. Causes of fluid overload in PD patients
 Inappropriate bag selection
 Inappropriate prescription for membrane transport status
long, dextrose – containing daytime or nocturnal dwells
Failure to optimize APD regimen for transport status
Failure to use icodextrin – containing solutions
 Noncompliance with PD prescription
 Noncompliance with salt and water restriction
 Loss of residual renal function
 Abdominal leak
 Catheter malfunction
 Poor blood glucose control
 Peritoneal membrane dysfunction

6. Management of fluid overload
 Sodium restriction
 Patient education regarding when to select higher dextrose
solutions
 Good blood glucose control
 Preserve residual renal function
 Abdominal leak
 Catheter malfunction
 Preservation of peritoneal membrane function

7. Hypertension and Hypotension in PD
Hypertension:
 PD providing better blood pressure control than hemodialysis b/c
of its continuous nature.
 More recently concern has been raised about blood pressure
control with CAPD
 It has been demonstrate that antihypertensive medication
requirements with increase duration on CAPD, as compare
hemodialysis
 Sodium sieving and removal
Management:
 Initially volume control and antihypertensive should be introduce
only if his approach has been unsuccessful.
 Preference should be given to agent that have a beneficial effect
on residual renal function, such as loop diuretics, ACE inhibitors
and ARB

8. Hypotension
 Hypotension is not uncommon in PD population
 Cause of hypotension is sometimes unclear but
approximately 20% of cases are secondary to heart failure.
 40% may due to hypovolemia

9. Thank