In peritoneal dialysis, the volume overload can lead to high blood pressure,
can cause or aggravate peritoneal dialysis patients with left ventricular
hypertrophy, congestive heart failure and other cardiovascular complications.
Since peritoneal dialysis is performed at home, need to rely on the judgment of
the water balance to achieve the patient's own, the early symptoms of water
retention is more subtle, can have no symptoms of limb edema, or just manifested
as elevated blood pressure, easily overlooked.
A common cause of edema caused by
(1) Excessive intake of salt: sodium peritoneal dialysis itself scavenging
low, especially in patients with fluid retention occurred when the more obvious.
Many patients often because of thirst, or difficult to change the habits of the
past, or understand the importance of controlling liquids and other reasons,
unable to control salt intake, leading to edema. Once edema, are often more
difficult to correct.
(2) Salt clear reduction: With prolonged peritoneal dialysis, residual renal
function in patients with decreased or loss of the patient's peritoneal membrane
function even if there is no change, the total water clear also due to the
decrease of residual renal function decline. On the other hand, since the change
in peritoneal transport, will lead to reduced clearance of the water. Coupled
with increased lymphatic drainage, lymphatic reabsorption increased, resulting
in patient volume overload, edema.
(3) the emergence of new complications: such as cardiac dysfunction or
aggravate existing heart disease, hypoalbuminemia, mechanical or anatomical
complications, so that peritoneal ultrafiltration volume reduction.
(4) Age: Compared to normal adult weight accounted for the proportion of body
fluids (male 60%, female 55%), the elderly fluid volume accounted for only 45%
of body weight, elderly fluid volume decrease was mainly cellular dehydration
retreat , reduce the intracellular fluid, extracellular fluid relative increase
in non-dominant edema easy to state. Therefore, elderly dialysis patients are
more likely in non-dominant edema state, and sometimes rely solely on clinical
symptoms and signs to determine its capacity state are inaccurate and need to
rely on physical examination.
2 How to assess edema
(1) Clinical Assessment: Review history, to understand whether chest
tightness, suffocation, whether new or existing cardiovascular disease
aggravated, if not tolerate dialysis prescription now, with or without salt
intake increases, with or without decreased urine output and so on. Blood
pressure is a reflection of the importance of the body volume load status
symbol, especially when limiting water and salt intake and increased peritoneal
ultrafiltration, the blood pressure failed to return to normal, then better able
to explain the existence of the load capacity.
(2) laboratory tests: the conduct of clinical assessment can also carry out
some laboratory tests to help determine the cause edema, such as B-type
natriuretic peptide (BNP), echocardiography, bioelectrical impedance analysis
(BIA) and so on. But these are not the assessment of the state of the gold
standard in vivo capacity, so they need doctors combine comprehensive assessment
of the patient's condition.
3 peritoneal dialysis patients how to avoid edema
(A) record daily volume of urine and ultrafiltration, periodically check the
load capacity of relevant indicators, based on urine output restrictions on
drinking water.
(2) periodic assessment of peritoneal function (PET), according to the type
of peritoneal transport, timely adjustment of dialysis prescriptions, maintain
the appropriate amount of peritoneal ultrafiltration.
(3) have occurred in patients with edema, should actively look for reasons to
strengthen restrictions salt intake. For patients with residual renal function
may be used under the guidance of doctors diuretics, as appropriate, the use of
high concentrations of glucose dialysis solution, if necessary, diverted
automated peritoneal dialysis. Diabetic patients should strictly control blood
sugar.
(4) attention to the protection of residual renal function, avoiding the use
of nephrotoxic drugs, to avoid dehydration.
(5) prevention of peritonitis occurred in strict accordance with the
operating rules for fluid.
4 limiting salt intake method
(A) control salt intake: Excessive salt should lead to water retention. Daily
salt intake should be <3 g, avoid foods high in salt, such as pickles, soy
sauce, avoid the use of chicken, MSG and other spices with high salt, low sodium
can be used when cooking can add more flavoring agents, such as green pepper,
chili, pepper, pepper, lemon, onion, ginger, garlic, onions, etc., to increase
the taste of food.
(2) control of water intake: try to eat with high moisture, low nutritional
value foods such as soup, porridge, etc., preferably in milk, soup and other
nutritious foods instead of water, tea, although may be liquid meals to
medication; may be allowed to drink water every day with a fixed glass bloom and
fractionated drinking, and small mouth slowly swallow, do not gulp, both for the
control of water can accurately Record the total daily water intake. In
addition, the water temperature to cool side appropriate to avoid overheating,
in order to achieve the purpose of thirst, we recommend gargling with cold water
containing ice (especially lemonade made of ice), but do not swallow. Regular
brushing, toothpaste, toothbrushes in the refrigerator, with sour foods, chewing
gum can keep your mouth moist.
(3) do intake and output records, especially snacks, soup, fruit, infusion
volume and water intake, etc., including the amount of dialysis ultrafiltration
volume, urine, vomit and a daily volume of about 500 ~ 700mL not dominant
negative water (change with the seasons), keeping the total daily intake and the
amount roughly equal.
