Sarkar S, Bernardini J, Johnston J, Piraino B
Patient tolerance of 2, 2.5, and 3 L PD exchange volumes
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S22 1997
In this study from the Pittsburgh group, patient recognition and
tolerance of different exchange volumes is examined. Nine patients
were studied on 60 separate occasions, with 2L, 2.5L and 3L bags being
used approximately 20 times each. In each case the tonicity used was
2.5% dextrose, and patients were blinded to the infusion volume, which
was left in place for 4 hours. A meal was eaten during the dwell. A
discomfort score ranging from 0 to 8 was used, and patients were also
asked to identify their bag volumes. Ability to eat a "normal meal"
was also assessed.
The authors find that patients were unable to distinguish between the
different dwell volumes and discomfort scores were not different
either. It was noted, however, that 40% of patients with a 3L dwell
reported some discomfort as compared to 14% and 16% with 2L and 2.5L
dwells. The authors conclude that patients are unable to distinguish
exchange volumes and tolerate large volumes with little discomfort.
Comment: The study is very interesting and confirms previous
impressions that physicians and nurses may be more concerned about
larger dwell volumes than patients are. One weakness of the study is
that patients are only exposed to the different volumes for a 4-hour
period. Chronic use of higher dwell volumes may be associated with
less tolerance and more symptoms, but this is not clear. It must also
be noted that the patients studied had a median body surface area of
1.83 m2. This raises the question of whether findings would be
similar in a group of patients with smaller body surface area. This
subject merits further investigation. It does give encouragement,
however, to strategies to improve clearances based on increasing dwell
volumes rather than exchange frequency.
(Peter G. Blake, M.D., Victoria Hospital, London, Ontario)
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17th Annual CAPD Conference
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Chronic PD regimens, adequacy, modeling
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Complications of PD