Other Complications Associated with Increased Intra-abdominal Pressure

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Hemorrhoids and uterine prolapse can present de novo or become aggravated by markedly increased IAP.  Vaginal leaks without evidence of pelvic wall perforation have been attributed to increased IAP and leakage of dialysate through the fallopian tubes¹.  Significant decreases in cardiac output and stroke volume, regardless of a higher heart rate, have been described following intraperitoneal (IP) infusion of dialysate^2-4.  These changes have occurred even with small exchange volumes ranging between 15 to 26 mL/kg of body weight. These hemodynamic changes are probably the result of preload reduction from increased IAP and compression of the inferior vena cava. Although the effects of IAP on hemodynamics have been well documented, the presence of up to 2 L of IP dialysate in the normal adult does not seem to adversely affect the hemodynamics of most patients on PD or their ability to cope with postural changes^5,6.  In patients with pre-existing cardiac compromise such as those with left ventricular hypertrophy, cardiomyopathy, or valvular disease, cautious monitoring of cardiac hemodynamics are recommended following initiation of PD.

Vasovagal syncope related to PD infusion has been observed by several investigators^7,8.  The precise pathophysiologic mechanism for this complication is uncertain and includes peritoneal irritation from unphysiologic solutions, hyperosmolality, and acute abdominal distention. The use of atropine and scopolamine has been advocated to minimize vasovagal reflex during the implantation of a peritoneal catheter⁷. 

Wadhwa et al. have studied the subjective and objective effects of PD on sleep parameters in a prospective randomized study⁹. A significant relationship between PD patients with chronic sleep disturbance and sleep apnea syndrome was reported. The data suggested that apneic patients may be susceptible to oxygen desaturation due to the increased IAP caused by the presence of dialysate in the peritoneal cavity.

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References:

1. Caporale N, Perez D, Alegre S. Vaginal leak of peritoneal dialysis liquid. Perit Dial Int 11:284, 1991
2. Gotloib LA, Mines M, Garmizo L, et al. Hemodynamic effects of increasing intra-abdominal pressure in peritoneal dialysis. Perit Dial Bull 1:41, 1981
3. Swartz C, Onesti G, Mailloux L. The acute hemodynamic and pulmonary perfusion effects of peritoneal dialysis. Trans Am Soc Artif Intern Organs 15:367, 1969
4. Acquatella H, Perez-Rojas M, Burger B, Guinand-Baldo A. Left ventricular function in terminal uremia: A hemodynamic and echocardiographic study. Nephron 22:160, 1978
5. Kong CH, Raval U, Thompson FD. Effect of 2 liters of intraperitoneal dialysate on the cardiovascular system. Clin Nephrol 26:134, 1986
6. Franklin JO, Alpert MA, Twardowski ZJ. Effect of increasing intraabdominal pressure and volume on left ventricular function in continuous ambulatory peritoneal dialysis (CAPD). Am J Kidney Dis 12:291, 1988
7. Caravaca F, Dominguez C, Machado V, et al. Vasovagal syncope related to peritoneal dialysate infusion. Perit Dial Int 13:63, 1993
8. Handa SP. Vasovagal syncopy related to peritoneal dialysate infusion. Perit Dial Int 13:240, 1993
9. Wadhwa NK, Seliger M, Greenberg HE, et al. Sleep related respiratory disorders in end-stage renal disease patients on peritoneal dialysis. Perit Dial Int 12:51, 1992