Variações hemodinâmicas sistêmicas agudas após a infusão de solução de diálise peritoneal em pacientes diabéticos e não diabéticos

Abstract

Objective: This study sought to compare acute systemic hemodynamic changes after the infusion of peritoneal dialysis (PD) solution to diabetic and non-diabetic patients. Design: Diabetic and non-diabetic CKD patients receiving PD between July 2011 and August 2012 were selected. Patients: A total of 42 patients undergoing PD were analyzed and divided into 2 groups: diabetics (D) and non-diabetics (ND). Interventions: After echocardiography and clinical evaluation, patients were submitted to thoracic electrical bioimpedance (TEB) cardiography. Two liters of 1.5% glucose PD solution (Dianeal PD-2, Baxter®) at room temperature (25 to 28°C) was then infused into the abdominal cavity. TEB was performed 20 min before and after the initiation of infusion. Outcome measures: The following parameters were measured before and after the infusion of PD solution: systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) (mmHg); heart rate (HR) (bpm); cardiac index (CI) (L/min/m²); stroke index (SI) (mL/beat/m²); systemic vascular resistance index (SVRI) (dyne·sec·cm&#713;5/m²) and total arterial compliance index (TACI) (mL/mmHg/m²). Results: Significant increases in SAP, DAP, MAP and SVRI were found, as well as a significant decrease in the CI, after the infusion of PD solution to both groups (p < 0.05). The HR values changed from 67 ± 7 to 62 ± 9 bpm (p < 0.05) in the ND group and maintained the baseline values in the D group after the infusion of PD solution. In addition, TACI was reduced from 6.2 ± 2.5 to 5.4 ± 2.4 mL/mmHg/m² (p < 0.05) in the D group but exhibited no alterations in the ND group after the infusion of PD solution. Conclusion: The infusion of PD solution acutely alters left ventricular systolic function in diabetic and non-diabetic patients. Moreover, hemodynamic reflex adaptive processes, such as changes in HR, seem to be attenuated in diabetic patients.