RESUMO
Intraperitoneal pressure (IPP) is gaining consideration as a relevant parameter of peritoneal dialysis (PD) in adults, although many of its aspects are still pending clarification. We address here its stability over time and the validity of the usual method of clinical measurement, as proposed by Durand in 1992 but never specifically validated. We performed this validation by comparing Durand's method and direct measurements with a central venous pressure system. We performed a total of 250 measurement pairs in 50 patients with different intraperitoneal volumes plus in-vitro measurements with a simulated peritoneum. Absolute differences between the two systems in vivo were 0.87 ± 0.91 cmH2O (range 0-5 cmH2O); only 6.4% of them were ≥3 cmH2O. In vitro results for both methods were identical. We also compared IPP measurements in the same patient separated by 1-4 h (514 measurement pairs in 136 patients), 1 week (92 pairs in 92 patients), and 2 years (34 pairs in 17 patients). Net differences of measurements separated by hours or 1 week were close to 0 cmH2O, with oscillations of 1.5 cmH2O in hours and 2.3 cmH2O in 1 week. IPP measured 2 years apart presented a net decrease of 2.5 ± 4.9 cmH2O, without correlation with body mass index changes or any other usual parameter of PD. In hours, 7% of IPP differences were >3 cmH2O, 22% in 1 week, and 50% in 2 years. In conclusion, Durand's method is precise enough to measure IPP in peritoneal dialysis. This parameter is not stable over long timescales, so it is necessary to use recent measurements.
Assuntos
Diálise Peritoneal , Adulto , Índice de Massa Corporal , Humanos , Cavidade Peritoneal , Peritônio , PressãoRESUMO
En condiciones fisiológicas el abdomen actúa como una cavidad cerrada cuya presión aumenta de forma proporcional al volumen que contiene. El valor normal de la presión hidrostática intraperitoneal está alrededor de 0 y en pacientes en diálisis peritoneal con volúmenes intraperitoneales de 2 litros puede estar en torno a 12±2 cmH2O. Realizamos un estudio multicéntrico cuantitativo, descriptivo, longitudinal y prospectivo, que incluía a 42 pacientes en programa de diálisis peritoneal con el fin de examinar la presión intraperitoneal y la ultrafiltración conseguida al infundir diferentes volúmenes de líquido de diálisis. Se hicieron dos intercambios consecutivos el primero con 2500 ml y el segundo con 1500 ml con líquido de diálisis con glucosa 2,3% y permanencia de 120 minutos en cada intercambio. De los 42 pacientes el 71,5% eran hombres, con una edad de 59.31±12.23 años y con un índice de masa corporal de 27.01±4.46. La presión intraperitoneal con volumen intraperitoneal 0 fue de 8.2±4.1; con volumen intraperitoneal 2500 ml la presión fue de 13.8±4.4 y la ultrafiltración de 131±206; con volumen intraperitoneal de 1500 ml la presión fue de 11.2±4.2 y la ultrafiltración de 192±145. La ultrafiltración con respecto a la infusión fue del 5,2%±8,2% con volumen de 2500 ml y del 12,8%±9,6% con volumen de 1500 ml. Podemos describir un aumento de la presión intraperitoneal al aumentar el volumen intraperitoneal, al mismo tiempo hemos observado una mayor ultrafiltración con volúmenes más bajos que implicaban a su vez cifras menores de presión (AU)
Under physiological conditions the abdomen acts as a closed cavity whose pressure increases proportionally to the volume contained. The normal value of intraperitoneal hydrostatic pressure is around 0 and in peritoneal dialysis patients with intraperitoneal volumes of 2 liters can be around 12 ± 2 cmH2O. A quantitative, descriptive, longitudinal, and prospective multicentric study was conducted with 42 patients on a peritoneal dialysis program to examine intraperitoneal pressure and ultrafiltration achieved by infusing different volumes of dialysis fluid. Two consecutive exchanges were made: the first with 2500 ml and the second with 1500 ml; both with dialysis fluid with glucose 2.3% and permanence of 120 minutes in each exchange. Of the 42 patients, 71.5% were men, with a mean age of 59.31 ± 12.23 years and a body mass index of 27.01 ± 4.46. The intraperitoneal pressure with intraperitoneal volume 0 was 8.2 ± 4.1; with the intraperitoneal volume of 2500 ml the pressure was 13.8 ± 4.4 and the ultrafiltration of 131 ± 206; with the intraperitoneal volume of 1500 ml the pressure was 11.2 ± 4.2 and the ultrafiltration of 192 ± 145. Ultrafiltration with respect to infusion was 5.2% ±8.2% with a volume of 2500 ml and of 12.8% ±9.6% with a volume of 1500 ml. We can describe an increase in intraperitoneal pressure by increasing the intraperitoneal volume; at the same time we have observed a higher ultrafiltration with lower volumes which, in turn, implied lower values of pressure (AU)
