Relación entre la presión intrabdominal en diálisis peritoneal con las hernias y fugas

Abstract

Normal intra-abdominal pressure is equal to atmospheric pressure (zero). In peritoneal dialysis the introduction of intra-peritoneal liquid increases intra-abdominal pressure. In various studies it is recommended that this does not exceed 16-20cm H2O.
In addition to possible abdominal discomfort, high intra-abdominal pressure can be linked to problems with the abdominal wall, such as hernias and fugues, and have implications for peritoneal transport and ultrafiltration deficit.
The aims of this study were the following: to find out the intra-abdominal pressure levels in the prevalent type of patients in peritoneal dialysis, to assess the factors influencing the values for this pressure and to study the relationship between intra-abdominal pressure and the development of hernias and fugues, retrospectively.
A transversal, observational and retrospective study was conducted to measure intra-abdominal pressure in the prevalent, stable patients who had been on peritoneal dialysis for more than three months.
Intra-abdominal pressure was measured using the method described by Durand: patient in a supine position, with diurnal peritoneal volume. The final intra-abdominal pressure is the average of the measurements taken during inspiration and expiration, is expressed in cm H2O and the volume drained is specified. Measurements were also taken in sitting and standing positions.
34 patients were studied, 66% of them male, with an average age of 61.2±14 years, 3 with polycystic kidney disease, an average Charlson comorbidity index of 7.9, an average body mass index of 27.4±4.2 and an average of 21±12 months on PD. Average diurnal volume was 1796±385 mL and nocturnal 2100±254 mL. 32% of the patients had a history of abdominal surgery and 5% of hernias, remedied before the start of peritoneal dialysis.
The average intra-abdominal pressure lying down was 17.5±4.1cm H2O, with an average volume by body surface of 1141±253ml/m2. 23.5 % had an intra-abdominal pressure of over 20cm H2O. In a sitting position the average was 28±5.5cm H2O and standing up it was 43.7±5.3cm H2O. Patients with an intra-abdominal pressure of > 20cm H2O had a higher percentage of hernias (50% vs 12%) and pericatheter fugues (37% vs. 12%).
As the principal conclusions, we would stress that the intra-abdominal pressure levels in our patients were rather higher than in other series. The greater the age, comorbidity and major body mass index, the higher the intra-abdominal pressure. Patients with high intra-abdominal pressure have more episodes of hernias and fugues.