Strict volume control normalizes hypertension in peritoneal dialysis patients

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Hypertension is common in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
• Achieving normal blood pressure (BP) in CAPD patients often requires antihypertensive medications.
• Volume management is crucial for BP control in CAPD patients.

Purpose of the Study:

• To determine if strict volume control, without antihypertensive drugs, can achieve normal BP in hypertensive CAPD patients.
• To assess the efficacy of dietary salt restriction and ultrafiltration (UF) in managing BP.
• To evaluate the impact of these interventions on cardiothoracic index (CTI) and residual renal function.

Main Methods:

• Discontinuation of antihypertensive drugs in hypertensive CAPD patients.
• Implementation of severe dietary salt restriction.
• Addition of ultrafiltration (UF) using hypertonic peritoneal dialysis solutions if salt restriction was insufficient.
• Monitoring of BP, body weight, and cardiothoracic index (CTI).
• Assessment of residual renal function and Kt/V urea.

Main Results:

• A significant decrease in BP was observed in 37 patients (from 158.2/95.7 to 119.7/77.9 mm Hg) with a mean weight loss of 2.8 kg and reduced CTI.
• Residual renal function and Kt/V urea decreased in patients with preserved renal function.
• In 7 non-responsive patients, BP normalized after adding an angiotensin-converting enzyme (ACE) inhibitor, with normal CTI indicating no hypervolemia.
• Three patients did not achieve target BP due to noncompliance.

Conclusions:

• Severe salt restriction combined with increased UF effectively normalizes BP in the majority of CAPD patients.
• This approach reduces CTI to normal ranges but may decrease residual renal function.
• ACE inhibitors are effective for BP control in CAPD patients who do not respond to volume management alone.
• Strict adherence to treatment is essential for successful BP management in CAPD.