Clinical Relevance of Intraperitoneal Pressure in Peritoneal Dialysis Patients.

INTRODUCTION: Intraperitoneal pressure (IPP) in peritoneal dialysis (PD) increases in sitting and upright positions and is related to some individual characteristics. Adverse effects can appear with IPP > 20 cm H2O. Few studies about peritoneal transport or abdominal wall problems have directly measured IPP. We measured IPP in our prevalent PD patients to identify the clinical factors related to its variability and its possible association with peritoneal transport and abdominal wall complications. METHODS: We performed a retrospective, observational study of our stable PD patients. Intraperitoneal pressure was measured using the Durand's method in supine, sitting, and upright position. RESULTS: Forty-nine patients were included, 70% males, mean age 61.1 ± 15 years, body mass index (BMI) 27.9 ± 5.2 kg/m2. The mean of supine IPP was 18.0 ± 4.4 cm H2O. Intraperitoneal pressure in sitting and upright positions were similar and higher than in supine. Supine IPP showed a positive correlation with BMI (p < 0.0005) and comorbidity (p < 0.05). A multivariate linear regression analysis showed that BMI and comorbidity (p < 0.005) had a positive correlation with IPP; time on PD and daily total ultrafiltration (UF) (p < 0.005) showed a negative correlation. Patients with an IPP ≥ 20 cm H2O had more hernias (35% vs 17%) and leakages (21% vs 8%) without statistical significance. CONCLUSION: Our supine IPPs were higher than others published in adults. Intraperitoneal pressure has an individual value associated with body size. Greater IPP was correlated with lower daily total UF and more hernias and leakages. The measurement of IPP is a simple technique and can help with PD prescription, especially in obese patients.

The safety of phosphate binders.

Disturbances of mineral metabolism occur during the early stages of chronic kidney disease. As renal function worsens, excess dietary phosphorus accumulates and blood levels increase, that can be clearly seen when the glomerular filtration rate has fallen below 30 ml/min/1.73 m2. In patients with end stage renal disease, standard dialysis (three times/week) falls far short of removing adequate amounts of absorbed phosphorus; therefore, hyperphosphataemia is found in the majority of these patients. Hyperphosphataemia has long been associated with progression of secondary hyperparathyroidism and renal osteodystrophy, it can also lead to soft-tissue and vascular calcification. Recent observational data have associated hyperphosphataemia with increased cardiovascular mortality among dialysis patients. Adequate control of serum phosphorus remains a cornerstone in the clinical management and, despite the growing amount of available therapeutic options, achievement of NFK/KDOQI targets for mineral metabolism remain poor. Several reasons may explain the failure to adequately treat hyperphosphataemia: poor compliance with diet and phosphate binder prescriptions are common causes. Also, factors related with cost, tolerance, palatability, safety and efficacy are important. In this article, the authors review the advantages and drawbacks of conventional and emerging therapies in phosphorous binding.