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Hypertension, cardiac state, and the role of volume overload during peritoneal dialysis

T Hölttä1, J M Happonen, K Rönnholm

  • 1Hospital for Children and Adolescents, University of Helsinki, Pediatric Nephrology and Transplantation, Stenbäckinkatu 11, PO Box 281, 00290 Helsinki, Finland. Tuula.Holtta@hus.fi

Pediatric Nephrology (Berlin, Germany)
|May 17, 2001
PubMed

Insights

In pediatric patients on chronic peritoneal dialysis (CPD), high blood pressure (BP) and cardiac issues were common, often linked to hypervolemia. Elevated N-terminal atrial natriuretic peptide (ANP-N) levels indicate volume overload in hypertensive patients on PD.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Physiology
  • Hypertension Research

Background:

  • Pediatric patients on chronic peritoneal dialysis (CPD) face risks of hypertension and cardiac complications.
  • Hypervolemia is a suspected contributor to hypertension in this population.
  • Biomarkers for hypervolemia require further investigation in pediatric CPD patients.

Purpose of the Study:

  • To analyze the cardiac state and high blood pressure (BP) prevalence in pediatric patients undergoing CPD.
  • To determine the impact of hypervolemia on hypertension etiology in this cohort.
  • To evaluate C- and N-terminal atrial natriuretic peptide (ANP-C, ANP-N) as potential hypervolemia markers.

Main Methods:

  • Cross-sectional and longitudinal analysis of 21 pediatric patients on CPD.
  • Measurement of blood pressure (BP), including nocturnal BP decline.
  • Assessment of cardiac structure (left ventricular hypertrophy) and function.
  • Quantification of serum ANP-C and ANP-N levels.

Main Results:

  • Fifty-two percent of patients exhibited high BP; 40% had reduced nocturnal BP decline.
  • Left ventricular hypertrophy was observed in 45% of patients, without impaired systolic/diastolic function.
  • Left ventricular mass correlated significantly with hypertension severity and ANP-N levels.
  • Hypertension severity correlated strongly with both ANP-N and ANP-C levels.
  • High BP and cardiac impairment were more prevalent in younger, nephrectomized patients, suggesting volume overload as a key factor.

Conclusions:

  • Hypervolemia appears to be a significant etiological factor for hypertension and cardiac impairment in pediatric CPD patients.
  • Elevated ANP-N levels (> 3.0 nmol/l) alongside hypertension strongly suggest volume overload in patients on PD.
  • ANP-C and ANP-N show promise as additional markers for assessing hypervolemia in this clinical context.

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