Acute central haemodynamic effects induced by intraperitoneal glucose instillation.

BACKGROUND The supposed lack of a haemodynamic impact of peritoneal dialysis (PD) has been challenged recently by the finding of a mild increase of peripheral blood pressure (BP) during an acute dwell. It is not clear whether, besides the effect of changes in intraperitoneal (IP) volume and/or pressure, IP glucose instillation and absorption plays a role in this. Therefore, we tested the impact of IP instillation of glucose on the evolution of central haemodynamic parameters, using SphygmoCor, during an acute dwell with two different glucose concentrations. METHODS Stable, non-diabetic PD patients (N = 22) were treated consecutively in a randomized, cross-over design (A then B or B then A) with one 1.36% (A) and one 3.86% (B) physioneal dwell of 100 min. Central BP was measured with SphygmoCor and blood was sampled for serum glucose and insulin levels every 20 min. Insulin resistance was defined as a Homeostatic Model Assessment Index (HOMA-index) >1.4. RESULTS Serum glucose levels rose during both the 1.36% and the 3.86% dwell, whereas insulin levels rose only during the 3.86% dwell. The increase of both glucose and insulin levels was more pronounced in patients with insulin resistance (11/22 patients). There was, however, no accompanying change versus baseline in haemodynamic parameters (carotid systolic blood pressure, diastolic BP, heart rate or augmentation index). CONCLUSION Despite substantial increases in blood glucose and insulin levels, there was no accompanying change in central haemodynamic parameters during an acute PD dwell with low or high glucose concentrations.

[1]  N. Selby,et al.  Effects of peritoneal dialysis fluid biocompatibility on baroreflex sensitivity. , 2008, Kidney international. Supplement.

[2]  W. van Biesen,et al.  Acute Central Hemodynamic Effects of a Volume Exchange in Peritoneal Dialysis , 2008, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[3]  P. Ivarsen,et al.  Increasing fill volume reduces cardiac performance in peritoneal dialysis. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[4]  N. Selby,et al.  The haemodynamic and metabolic effects of hypertonic-glucose and amino-acid-based peritoneal dialysis fluids. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[5]  L. F. Gonçalves,et al.  Insulin resistance is associated with circulating fibrinogen levels in nondiabetic patients receiving peritoneal dialysis. , 2007, Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation.

[6]  W. van Biesen,et al.  The glomerular filtration rate in an apparently healthy population and its relation with cardiovascular mortality during 10 years. , 2007, European heart journal.

[7]  M. Canbakan,et al.  The effect of icodextrin and glucose-containing solutions on insulin resistance in CAPD patients. , 2006, Clinical nephrology.

[8]  R. Fluck,et al.  Automated Peritoneal Dialysis Has Significant Effects on Systemic Hemodynamics , 2006, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[9]  R. Townsend,et al.  Prolonged (48-hour) modest hyperinsulinemia decreases nocturnal heart rate variability and attenuates the nocturnal decrease in blood pressure in lean, normotensive humans. , 2006, The Journal of clinical endocrinology and metabolism.

[10]  R. Fluck,et al.  Hypertonic glucose-based peritoneal dialysate is associated with higher blood pressure and adverse haemodynamics as compared with icodextrin. , 2005, Nephrology, Dialysis and Transplantation.

[11]  P. Verdonck,et al.  Noninvasive Assessment of Local Pulse Pressure: Importance of Brachial-to-Radial Pressure Amplification , 2005, Hypertension.

[12]  Z. Massy,et al.  Chronic kidney disease as cause of cardiovascular morbidity and mortality. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[13]  D. Goldsmith,et al.  The Influence of Dialytic Modality on Arterial Stiffness, Pulse Wave Reflections, and Vasomotor Function , 2004, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[14]  W. van Biesen,et al.  A Randomized Clinical Trial with a 0.6% Amino Acid/1.4% Glycerol Peritoneal Dialysis Solution , 2004, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[15]  Trefor Owen Morgan,et al.  Effect of different antihypertensive drug classes on central aortic pressure. , 2004, American journal of hypertension.

[16]  N. Lameire.  Volume Control in Peritoneal Dialysis Patients: Role of New Dialysis Solutions , 2004, Blood Purification.

[17]  Bertram L Kasiske,et al.  Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. , 2003, Hypertension.

[18]  R. N. Garrison,et al.  Sepsis alters vessel contraction by adrenoceptor-induced nitric oxide and prostanoid. , 2003, The Journal of surgical research.

[19]  K. Leunissen,et al.  Fluid status in CAPD patients is related to peritoneal transport and residual renal function: evidence from a longitudinal study. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[20]  R. Foley.  THE CLINICAL EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES IN CHRONIC KIDNEY DISEASE: Clinical Epidemiology of Cardiac Disease in Dialysis Patients: Left Ventricular Hypertrophy, Ischemic Heart Disease, and Cardiac Failure , 2003, Seminars in dialysis.

[21]  H. Koyama,et al.  Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. , 2002, Journal of the American Society of Nephrology : JASN.

[22]  M E Safar,et al.  Arterial Wave Reflections and Survival in End-Stage Renal Failure , 2001, Hypertension.

[23]  K. Ateş,et al.  Effect of fluid and sodium removal on mortality in peritoneal dialysis patients. , 2001, Kidney international.

[24]  J. Staessen,et al.  Non-invasive assessment of local arterial pulse pressure: comparison of applanation tonometry and echo-tracking , 2001, Journal of hypertension.

[25]  R. Krediet,et al.  Acute Effects of Peritoneal Dialysis on Hemodynamics , 2001, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.