Respiratory Complications

Print PDF

Compromised respiratory function has been reported in acutely ill patients undergoing PD.  In stable patients the infusion of two liters of PDF into the abdominal cavity results in some reduction of lung volume and functional residual capacity (FRC).  After two weeks lung volumes and FRC return to normal in most patients.  Obstructive airway disease is not a contraindication for PD.  Severe pulmonary disease requires evaluation of pulmonary function with simultaneous installation of PDF using the normally prescribed exchange volumes.  Restrictive lung disease, reflux and chronic aspiration may occur due to increased IAP.  Diffusion factor for carbon monoxide may be low in patients with sub-clinical pulmonary edema and extremely low serum albumin concentrations. 

In addition to respiratory complications related to the physical presence of PDF in the peritoneal cavity, other problems have been reported due to carbohydrate loading and their effect on intermediary metabolism¹.  Carbohydrate and lactate loads lead to increased ventilation, minute volume, oxygen consumption and CO₂ excretion^2,3.  Glucose and lactate are absorbed through the peritoneal membrane and incorporated into the Krebs cycle.  Part of the glucose is metabolized without oxygen producing CO₂.  The increased CO₂ is eliminated by hyperventilation.  If the patient is unable to hyperventilate, respiratory acidosis ensues.

Back to Non-Infectious Complications of PD

References:

1. Eiser A. Pulmonary gas exchange during hemodialysis and peritoneal dialysis: Interaction between respiration and metabolism.  Am J Kidney Dis 6:131, 1985
2. Fabris A, Biasioli S, Chiaramonte C, Feriani M, Pisani E, Ronco C, Cantarella G, La Greca G. Buffer metabolism in continuous ambulatory peritoneal dialysis (CAPD): relationship with respiratory dynamics. Trans Am Soc Artif Intern Organs 28:270-275, 1985
3. Cohn J, Balk RA, Bone RC. Dialysis-induced respiratory acidosis. Chest 98:1285, 1990