Clinical Benefits and Tolerability of Increased Fill Volumes in Japanese Peritoneal Dialysis Patients

Abstract

Background Increasing fill volume is an effective means of improving clearances in patients on peritoneal dialysis (PD). Since Japanese PD patients are physically smaller than their Western counterparts, there is some concern that PD patients in Japan may be unable to tolerate larger fill volumes. Objective To determine patient tolerance and changes in solute clearance and net ultrafiltration resulting from increased fill volumes in Japanese patients on PD. Design Prospective double-blind study, randomizing patients to three different fill volumes (2.5% dextrose solution: 1.5 L, 2.0 L, or 2.5 L) administered in random order on three different occasions separated by 1 week. Results Twenty-one patients with a mean age of 55.4 ± 2.1 years and a mean body surface area of 1.66 ± 0.03 m2 were studied. On a scale of 0 to 10, patients’ mean discomfort scores were 2.14 ± 0.59, 3.48 ± 0.54, and 3.81 ± 0.63 ( p = 0.047) at the end of the 1.5-L, 2.0-L, and 2.5-L dwells, respectively. There were no reports of cramps or shortness of breath with any fill volume. Patients were able to correctly guess the actual fill volume for only 34 of the 63 total exchanges (54.0%). Increasing fill volume resulted in an incremental improvement in peritoneal creatinine clearance, from 3.74 ± 0.16 to 4.49 ± 0.21 ( p < 0.001, 2.0 L vs 1.5 L) to 5.12 ± 0.20 mL/minute ( p < 0.001, 2.5 L vs 2.0 L) for 1.5-L, 2.0-L, and 2.5-L dwells, respectively. Peritoneal urea clearance also increased significantly, from 5.65 ± 0.13 to 7.04 ± 0.17 ( p < 0.001, 2.0 L vs 1.5 L) and 8.16 ± 0.29 mL/minute ( p < 0.001, 2.5 L vs 2.0 L), with incremental increases in fill volume. Similarly, net ultrafiltration in a 4-hour dwell increased significantly with fill volume, from 255.24 ± 24 mL with 1.5 L, to 356 ± 24 ( p < 0.004, 2.0 L vs 1.5 L) and 392 ± 29 mL ( p < 0.086, 2.5 L vs 2.0 L) in patients receiving 2.0 L and 2.5 L, respectively. Conclusion Increasing the fill volume results in improvement in solute clearance and net ultrafiltration in Japanese PD patients, with minimal increase in patient discomfort. A large percentage of patients were unable to identify the actual fill volume.