The haemodynamic and metabolic effects of hypertonic-glucose and amino-acid-based peritoneal dialysis fluids

Nephrol Dial Transplant. 2007 Mar;22(3):870-9. doi: 10.1093/ndt/gfl654. Epub 2006 Nov 22.


Background: Continuous ambulatory peritoneal dialysis (CAPD) may exert significant effects on systemic haemodynamics. We have previously demonstrated that hypertonic glucose solutions are associated with higher blood pressure (BP) due to a rise in stroke volume (SV) and cardiac output (CO). However, the mechanisms underlying these changes have not been established.

Methods: Ten non-diabetic CAPD patients entered a randomized crossover study (eight completed) to compare conventional glucose-based fluid, biocompatible pH-neutral glucose-based fluid and 1.1% amino acid solution (lactate-buffered but completely free of glucose degradation products). BP and haemodynamic variables were measured using continuous arterial pulse wave analysis, and serial plasma glucose and insulin concentrations were collected. Left ventricular (LV) diameters were measured at the start and end of each dwell period using M-mode echocardiography.

Results: BP was similar during 1.36% glucose and 1.1% amino acid dwells, but was significantly higher during 3.86% glucose dwells with both conventional and biocompatible fluids (P < 0.001). This was associated with a significantly higher SV and CO (P < 0.001), although the haemodynamic response differed between conventional and biocompatible 3.86% solutions. Plasma glucose and insulin levels did not differ from baseline during 1.36% and amino acid dwells, but increased significantly during 3.86% glucose dwells. Despite a significantly higher ultrafiltration volume with 3.86% glucose, LV diameters were similar throughout.

Conclusions: In conclusion, we have confirmed our previous findings demonstrating higher BP and adverse haemodynamics during 3.86% glucose dwells. These changes are associated with hyperglycaemia and hyperinsulinaemia, but are not related to differences in cardiac filling.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Amino Acids / analysis*
  • Amino Acids / therapeutic use
  • Blood Glucose / metabolism
  • Blood Pressure / drug effects
  • Cross-Over Studies
  • Dialysis Solutions / chemistry*
  • Dialysis Solutions / therapeutic use*
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Glucose Solution, Hypertonic / analysis*
  • Glucose Solution, Hypertonic / therapeutic use
  • Heart Rate / drug effects
  • Heart Rate / physiology
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / drug effects
  • Heart Ventricles / physiopathology
  • Humans
  • Insulin / blood
  • Ion Transport / drug effects
  • Kidney Failure, Chronic / metabolism
  • Kidney Failure, Chronic / physiopathology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Peritoneal Dialysis, Continuous Ambulatory*
  • Peritoneum / drug effects
  • Peritoneum / metabolism
  • Prognosis
  • Prospective Studies
  • Stroke Volume / drug effects
  • Stroke Volume / physiology
  • Vascular Resistance / drug effects


  • Amino Acids
  • Blood Glucose
  • Dialysis Solutions
  • Glucose Solution, Hypertonic
  • Insulin