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Sep 1, 2010Keywords:
CAPD diabetes mellitus fluid overload residual renal Function
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Copyright belongs to The Arab Society of Nephrology and Renal Transplantation (ASNRT)
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Tackling Fluid Overload in a High-transporter Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis
Abstract
Introduction: Diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) are more prone to fluid overload than non-diabetic patients, but the use of hypertonic glucose solutions to improve their ultrafiltration (UF) may hamper their glycemic control. Maintaining euvolemia in such patients may be tricky and needs special care.
Case report: A 72 year old diabetic and hypertensive patient presented with severe fluid overload shortly after initiation of CAPD despite producing more than one liter of urine per day. He only achieved modest ultrafiltration (UF) during the day, and had a negative UF during the long hypertonic night dwell. Peritoneal equilibration tests (PET) confirmed that he was a high transporter, and his weekly Kt/V was found to be 1.36. Since automated peritoneal dialysis (APD) is not yet available in Sudan, the PD prescription was modified to comprise five short cycles during the day, including two short hypertonic daytime dwells, and a dry abdomen at night. This approach succeeded in improving his fluid status, but required the addition of intra-peritoneal soluble insulin to his regular subcutaneous insulin in order to achieve acceptable blood sugar control. After 8 months his residual renal function (RRF) had declined remarkably and he began to suffer from intermittent fluid overload of variable degrees. Nevertheless, we managed to maintain him satisfactorily on CAPD for 14 months.
Conclusion: Simple measures such as omitting the night dwell and using five short cycles during the day, including two short hypertonic dwells, can be effective in controlling fluid overload in diabetic patients who have a high transporter status.
Key words: CAPD, diabetes mellitus, fluid overload, residual renal Function
Case report: A 72 year old diabetic and hypertensive patient presented with severe fluid overload shortly after initiation of CAPD despite producing more than one liter of urine per day. He only achieved modest ultrafiltration (UF) during the day, and had a negative UF during the long hypertonic night dwell. Peritoneal equilibration tests (PET) confirmed that he was a high transporter, and his weekly Kt/V was found to be 1.36. Since automated peritoneal dialysis (APD) is not yet available in Sudan, the PD prescription was modified to comprise five short cycles during the day, including two short hypertonic daytime dwells, and a dry abdomen at night. This approach succeeded in improving his fluid status, but required the addition of intra-peritoneal soluble insulin to his regular subcutaneous insulin in order to achieve acceptable blood sugar control. After 8 months his residual renal function (RRF) had declined remarkably and he began to suffer from intermittent fluid overload of variable degrees. Nevertheless, we managed to maintain him satisfactorily on CAPD for 14 months.
Conclusion: Simple measures such as omitting the night dwell and using five short cycles during the day, including two short hypertonic dwells, can be effective in controlling fluid overload in diabetic patients who have a high transporter status.
Key words: CAPD, diabetes mellitus, fluid overload, residual renal Function
