Équilibre de la balance hydrosodée et contrôle de la pression artérielle en DPA/DPCA

Abstract

Cardiovascular disease remains the leading cause of death in ESRD patients undergoing Hemodialysis or Peritoneal Dialysis and a significant proportion of this is likely related to long-standing hypertension. Early studies had recognized the favourable effect of PD in controlling hypertension but it was soon realized that such benefit was not sustained. A U shaped trend of hypertension in patients on PD has been recently demonstrated as a result of a steadily increased blood pressure partly attributed to fluid retention resulting from lower sodium removal with time. Effort in selecting the best strategy of ultrafiltration for a single patient along with a carefull and frequent monitoring of combined 24 hours sodium elimination coupled with dietetician concelling can improve significantly fluid an sodium balance which in turn will result in much better blood pressure control. The contribution of progress in biocompatibility of PD fluid that better preserve renal function and the implementation of the first glucose polymer Icodextrin were key interventions in that aim. Further studies should be conducted to assess the power of innovative PD solutions — Low Sodium PDF and/or Bimodal Ultrafiltration — in enhancing fluid and sodium removal during CAPD/APD programmes.