SYMPTOMATIC FLUID RETENTION IN PATIENTS ON CONTINUOUS PERITONEAL-DIALYSIS

The clinical features, pathogenesis, management, prognosis, and predic tors of symptomatic fluid gain (SFR) were analyzed for 71 episodes occ urring in 66 patients on continuous peritoneal dialysis, 94.4% on cont inuous ambulatory peritoneal dialysis (CAPD) and 5.6% on continuous cy cling peritoneal dialysis. Compared with a control group of 149 CAPD p atients, the SFR group had a higher percentage of diabetics (64 versus 46%) and a higher frequency of noncompliance with fluid restriction ( 76 versus 22%), salt restriction (74 versus 23%), and performance of d ialysis (30 versus 7%) (all at P less than or equal to 0.015). Periphe ral edema (100%), pulmonary congestion (80%), pleural effusions (76%), and systolic (83%) and diastolic (66%) hypertension were the most com mon manifestations of SFR. The annual hospitalization rate for SFR was 4.1 +/- 5.8 days per patient. SFR resulted in the discontinuation of CAPD in 10 patients and death in 1 patient. Serum sodium concentration was not different between dry and maximal weight in the SFR group. Th irty-eight (58%) of SFR and 61 (41%) of control patients were evaluate d by peritoneal equilibration tests (PET), SFR patients had lower PET drain volume (2.08 +/- 0.47 versus 2.54 +/- 0.23 L) and a higher frequ ency of high peritoneal solute transport (32.2 versus 2.4%), In this g roup, logistic regression identified dietary noncompliance, low PET dr ain volume, and young age as independent predictors of SFR. Response t o management and preventive measures was inconsistent, The best result s were obtained by the use of short dwell exchanges with hypertonic di alysate in compliant patients with high peritoneal solute transport. S FR has serious consequences in CAPD. Its primary causes are noncomplia nce to salt restriction and inadequate peritoneal ultrafiltration. Die tary counseling and shortening of the dwell time guided by standardize d evaluation of peritoneal ultrafiltration may be useful in SFR manage ment and prevention.