Hypertension in peritoneal dialysis patients

Abstract

INTRODUCTION: Continuous ambulatory peritoneal dialysis (CAPD) is effective in reducing blood pressure. Mean arterial pressure falls within 6 months of starting CAPD in the majority of patients. This improved blood pressure control reflects removal of excess fluid volume and body sodium. However, after several years, there is a decline in the efficacy of CAPD in controlling blood pressure. High incidence of hypertension in long-term CAPD patients may be related to hypervolemia as a consequence of loss of residual renal function (RRF), loss of ultrafiltration (UF) due to functional or structural changes in the peritoneal membrane, to a more liberated intake of sodium and fluid, or to administration of erythropoietin. The aim of the present study was to compare the efficacy in blood pressure contol in peritoneal dialysis patients depending on the dialysis modality and duration, RRF and dialysis adequacy. MATERIAL AND METHODS: This study was a retrospective analysis of 67 patients who attended our Clinic monthly in 2003. All patients received antihypertensive therapy (monotherapy - 16 pts, two drugs - 27 pts, three drugs - 22 pts and four - 2 pts.). RESULTS: The prevalence of hypertension (TA > 140/90 mmHg) was 73.13%. Most of them (50.75%) had mild hypertension (mean value TA <160/100 mmHg). There was no statistically significant difference in hypertension prevalence between diabetic (78.27%) and non-diabetic patients (75%). The prevalence of hypertension in patients with residual diuresis of more than 1000 ml was 36.6%, but there were 80.64% patients with residual diuresis less than 500 ml. A statistically significant negative correlation was found between D/D0, UF volume and systolic blood pressure and RRF, D/D0 and Ccr and diastolic blood pressure. A statistically significant positive correlation was found between age, body weight, duration of dialysis and systolic blood pressure and age and diastolic blood pressure. CONCLUSION: We can conclude that duration of PD treatment has a negative effect on blood pressure control. Residual renal function plays an important role in volume and blood pressure control. High and high average transporters are the two groups of patients at increased risk of developing hypertension, especially if they are anuric.