Sodium and volume overload in peritoneal dialysis: limitations of current treatment and possible solutions

Cardiovascular disease is a leading cause of death in patients with chronic kidney disease. Recent evidence suggests that hypertension and subclinical volume expansion is common in patients on peritoneal dialysis. Moreover, recent studies pointed out that sodium removal is limited in patients on peritoneal dialysis and mortality has been shown to co-relate with fluid and sodium removal. Treatment of sodium and fluid removal includes dietary salt and fluid restriction, use of diuretics, icodextrin, strategies also considered helpful to control hypertension. Despite availability of these measures, prevalence of hypertension remains high in PD patients. Hence, innovative strategies are urgently required to address this common and difficult clinical problem. This article reviews limitations of available measures to manage sodium and fluid overload and hypertension and suggests possible role and place of low sodium dialysis solutions in PD patients.