Improvement in uremic symptoms after increasing daily dialysatte volume in anuric peritoneal dialysis patients

Hippokratia 2004, 8(4):182-187

V Liakopoulos, M Krishnam, I Stefanidis, DG Oreopoulos


Background. Patients on peritoneal dialysis (PD) can develop uremic symptoms as their residual renal function declines and they finally become anuric. In this retrospective study, we assessed the effect of increasing the dose of dialysis in anuric patients who developed uremic symptoms.
Materials and Methods. We evaluated retrospectively the effect of increasing the dose of dialysis on the prevalence of uremic symptoms in 44 anuric PD patients in whom the dose of dialysis was increased during the last five years. We also reviewed the charts of 12 patients with no increase in their dialysis dose, despite the onset of anuria. We recorded data for fatigue, anorexia, insomnia, pruritus and nausea, urine and peritoneal clearances, serum creatinine, BUN, PO4, Hb, EPO dose, blood pressure and weight for a period of 6 months before and 6 months after the change in the PD prescription.
Results. Of the 44 patients (mean age 52±16, with 43 %males), 37 were on continuous ambulatory peritoneal dialysis (CAPD) and 7 on continuous cycler peritoneal dialysis (CCPD). Twenty three percent were diabetics; mean duration of PD before the change in dialysis dose was 27.8±18 months. Daily dialysate volume was increased an average of 2.2 L in CAPD and 4.3 L in APD patients. Peritoneal Kt / V and weekly creatinine clearance increased from 1.91±0.04 to 2.44 ±0.08 and from 49.8±1.2 to 61.5±2.1 L/week respectively. The prevalence of fatigue decreased from 80 % to 38 %, anorexia from 50 % to 20 %, insomnia from 45 % to 11 %, pruritus from 34 % to 9 % and nausea from 11 % to 4 %. All these changes were statistically significant. On the other hand, we observed a slight trend towards an increase, but certainly no decrease, in the prevalence of uremic symptoms in the 12 patients, whose dialysis dose remained unchanged. Of these patients with a mean age of 60±16 years (58 % males and 58 % diabetics) 9 were on CAPD. Their peritoneal Kt/V was 2.04±0.25 and their weekly creatinine clearance 54.7±7.8 L. Before the onset of anuria, the prevalence of fatigue was 50 %, anorexia 25 %, insomnia 33 %, pruritus 33 % and nausea 0 %. After six months of established anuria these figures became 83 %, 25 %, 25 %, 33 % and 17 % respectively.
Conclusion: After a little over two years on PD most anuric patients develop uremic symptoms. Fatigue is the most common symptom followed by anorexia. An increase in the dialysis dose leads to a decrease in the prevalence of all the symptoms. Such an increase in prescription should be considered if PD patients become symptomatic.