Abstract
BackgroundHypertension is common in peritoneal dialysis (PD) patients and associated with adverse outcomes. Besides solute clearance, PD convective clearance is used to control extracellular water (ECW) volume and sodium balance. Previous studies have reported on hypertension in PD patients treated with continuous ambulatory peritoneal dialysis (CAPD) using hypertonic glucose dialysates. However, increasing numbers of PD patients are now treated with automated peritoneal dialysis (APD) and icodextrin dialysates. As such, we wished to explore factors associated with systolic blood pressure (SBP) in a modern cohort to identify targets to improve blood pressure control in PD patients.MethodsWe retrospectively reviewed the results from PD patients attending for peritoneal membrane assessment who had corresponding bioimpedance ECW and brain natriuretic peptide (NT-proBNP) measurements.ResultsWe studied 510 PD patients: 317 (72.2%) male, 216 (42.4%) diabetics, median age 59 (47–72) years, and 51% treated by APD with a day-time icodextrin exchange. Mean systolic blood pressure (SBP) was 140 ± 24.8 mmHg. SBP was independently associated with 4-hour dialysate to plasma creatinine ratio (β = 29.5 (95% confidence limits 11.4–47.5, p = 0.001), N-terminal brain natriuretic peptide [β = 11.9 (7.2–16.7), p < 0.001], and daily urine sodium excretion [β = 1.7 (1.0–2.3), p < 0.001].ConclusionIn the era of APD cyclers and icodextrin, SBP is associated with increased NT-proBNP, a marker of ECW expansion, and faster peritoneal transport, a risk factor for a positive sodium balance, and increased urinary sodium suggestive of higher dietary sodium intake. Patients should be encouraged to restrict sodium intake and PD prescriptions targeted to control ECW to improve SBP control.
Highlights
Hypertension is one of the major determinants contributing to the increased cardiovascular morbidity and mortality in dialysis patients [1]
Five hundred and forty-nine patients started peritoneal dialysis (PD), 31 patients were unable to have bioimpedance measurements and 8 patients developed PD peritonitis shortly after starting PD or had an acute illness, and so we studied five hundred and ten adult PD patients attending the clinic for their first assessment of peritoneal membrane function 2 (2–3) months after starting PD, who had Multifrequency bioelectrical impedance assessments (MFBIA) recorded on the same day; (Table 1)
We divided patients according to peritoneal transport status [13], patients who were faster transporters had higher systolic blood pressure (SBP), NTproBNP, and bothe EC and extracellular water (ECW) adjusted for height compared to slower transporters (Table 2)
Summary
Hypertension is one of the major determinants contributing to the increased cardiovascular morbidity and mortality in dialysis patients [1]. The introduction of bioimpedance devices into clinical practice to measure ECW expansion and body composition [10], has led to the realization that ECW expansion can occur in patients with malnutrition and inflammation [11], and this may aid explaining the discordant results of previous studies investigating the association between volume status and hypertension. Many of these previous studies investigated patients treated by continuous ambulatory peritoneal dialysis (CAPD) prescribed hypertonic glucose peritoneal dialysates.
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