In addition to the previously discussed complications associated with increased intra-abdominal pressure, patients can also present with complication such as vaginal leaks, hemodynamic effects, vasovagal syncope, and sleep issues.

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 tubes(1).

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 catheter(7).

Wadhwa et al. have studied the subjective and objective effects of PD on sleep parameters in a prospective randomized study(9). 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.

References

1. Caporale N, Perez D, Alegre S. Vaginal leak of peritoneal dialysis liquid. Perit Dial Int. 1991;11(3):284-285. Available from: https://www.ncbi.nlm.nih.gov/pubmed/1912027.
2. Gotloib L, Mines M, Garmizo L, Varka I. Hemodynamic effects of increasing intra-abdominal pressure in peritoneal dialysis. Perit Dial Int. 1981;1(4):41-43. Available from: http://www.pdiconnect.com/content/1/4/41.abstract.
3. Swartz C, Onesti G, Mailloux L, Neff M, Ramirez O, Germon P, Kazem I, Brady LW. The acute hemodynamic and pulmonary perfusion effects of peritoneal dialysis. Trans Am Soc Artif Intern Organs. 1969;15:367-372. Available from: https://www.ncbi.nlm.nih.gov/pubmed/5791411.
4. Acquatella H, Pérez-Rojas M, Burger B, Guinand-Baldó A. Left ventricular function in terminal uremia. A hemodynamic and echocardiographic study. Nephron. 1978;22(1-3):160-174. Available from: https://www.ncbi.nlm.nih.gov/pubmed/154616.
5. Kong CH, Raval U, Thompson FD. Effect of 2 liters of intraperitoneal dialysate on the cardiovascular system. Clin Nephrol. 1986;26(3):134-139. Available from: https://www.ncbi.nlm.nih.gov/pubmed/3769229.
6. Franklin JO, Alpert MA, Twardowski ZJ, Khanna R, Nolph KD, Morgan RJ, Kelly DL. Effect of increasing intraabdominal pressure and volume on left ventricular function in continuous ambulatory peritoneal dialysis (CAPD). Am J Kidney Dis. 1988;12(4):291-298. Available from: https://www.ncbi.nlm.nih.gov/pubmed/2972199.
7. Caravaca F, Dominguez C, Machado V, Arrobas M. Vasovagal syncope related to peritoneal dialysate infusion. Perit Dial Int. 1993;13(1):63-64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8443282.
8. Handa SP. Vasovagal syncopy related to peritoneal dialysate infusion. Perit Dial Int. 1993;13(3):240. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8240539.
9. Wadhwa NK, Seliger M, Greenberg HE, Bergofsky E, Mendelson WB. Sleep related respiratory disorders in end-stage renal disease patients on peritoneal dialysis. Perit Dial Int. 1992;12(1):51-56. Available from: https://www.ncbi.nlm.nih.gov/pubmed/1543782.

P/N 102508-01 Rev. A 06/2016