Division of Physiology, Otto Loewi Research Center, 31475Medical University of Graz, Graz, Austria.
Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria.
Perit Dial Int. 2020 Sep;40(5):477-486. doi: 10.1177/0896860819895176. Epub 2020 Jan 13.
Increased intra-abdominal pressure (PIA) leads to venous congestion in splanchnic and adjoining circulations. The aim is to examine whether PIA in peritoneal dialysis (PD) affects the mobilization of extracellular fluid from the lower body in supine body position.
Patients were studied during a regular peritoneal equilibration test (PET) in supine body position using multifrequency bioimpedance analysis to determine extracellular resistance and absolute volume overload (AVO) in wrist-to-ankle (W2A) as well as in ankle-to-ankle (A2A) configurations. Measurements were taken at baseline (T0) after draining the peritoneal cavity, at T1 shortly after filling with 2 L of standard dialysate, and at T2 before taking the 2 h PET samples. PIA was measured from the column height in the PD catheter. Extracellular resistance in the lower extremities (RL) was taken as half of the A2A resistance.
Eighteen patients (56 ± 15 years, 76 ± 21 kg, body mass index (BMI) 26.4 ± 7 kg/m, 13 men) were studied. After having assumed a supine body position for the duration of 17, 77, and 155 min, AVO continuously decreased from 1.6 ± 1.3 (T0) to 1.2 ± 1.5 (T1) and 1.0 ± 1.4 L (T2). RL significantly increased from 238 ± 57 (T0) to 254 ± 62 (T1) and 264 ± 67 Ohm (T2). This increase was negatively correlated to BMI and PIA measured at any time point, but not to net ultrafiltration volume.
Orthostatic fluid shifts from the lower limbs may take up to 2 h in supine PD patients, especially with high BMI and PIA because of venous congestion in splanchnic and adjoining circulations.
腹腔内压（PIA）升高会导致内脏和毗邻循环的静脉充血。目的是研究腹膜透析（PD）中的 PIA 是否会影响仰卧位时从下肢动员细胞外液。
患者在仰卧位常规腹膜平衡试验（PET）期间接受多频生物阻抗分析研究，以确定腕踝（W2A）和踝踝（A2A）配置中外周电阻和绝对体积超负荷（AVO）。在排空腹腔后（T0）、用 2 L 标准透析液填充后不久（T1）以及在进行 2 h PET 样本之前（T2）进行测量。PIA 从 PD 导管的柱高测量。下肢外周电阻（RL）取 A2A 电阻的一半。
研究了 18 名患者（56 ± 15 岁，76 ± 21 kg，体重指数（BMI）26.4 ± 7 kg/m，13 名男性）。在仰卧位持续 17、77 和 155 分钟后，AVO 连续从 1.6 ± 1.3（T0）降至 1.2 ± 1.5（T1）和 1.0 ± 1.4 L（T2）。RL 从 238 ± 57（T0）显著增加至 254 ± 62（T1）和 264 ± 67 Ohm（T2）。这种增加与任何时间点的 BMI 和 PIA 呈负相关，但与净超滤量无关。
仰卧 PD 患者的体位性液体从下肢转移可能需要长达 2 小时，尤其是 BMI 和 PIA 较高的患者，因为内脏和毗邻循环的静脉充血。
