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Blood pressure, volume, and sodium control in an automated peritoneal dialysis population
Neil C Boudville1, Peter Cordy, Kristie Millman
1University of Western Australia, Perth, WA, Australia. nboudvil@cyllene.uwa.edu.au
Insights
Automated peritoneal dialysis (APD) patients using icodextrin achieved good blood pressure and volume control. Sodium removal levels did not correlate with hypertension or fluid overload in this study population.
Area of Science:
- Nephrology
- Dialysis Technology
Background:
- Automated peritoneal dialysis (APD) is a key treatment for end-stage renal disease.
- Optimizing fluid and blood pressure control in APD patients is crucial.
- Icodextrin use is increasing, but its impact on volume and sodium balance needs further study, especially when avoiding long glucose dwells.
Purpose of the Study:
- To evaluate blood pressure and volume control in APD patients utilizing icodextrin liberally.
- To assess the role of sodium removal in this APD population.
- To investigate the outcomes when avoiding long daytime glucose-based dwells.
Main Methods:
- Observational cross-sectional study at a university hospital.
- Included 56 APD patients (mean dialysis duration 1.9 years), with 50% prescribed icodextrin.
- Measured blood pressure, extracellular water (ECW) to intracellular water (ICW) ratio, and total sodium removal.
Main Results:
- Mean total sodium removal was 102.9 mmol/day, with significant variability.
- Ultrafiltration and urine volume were key predictors of sodium removal.
- Patients exhibited favorable extracellular water to intracellular water ratios and well-controlled blood pressure, irrespective of sodium removal levels.
Conclusions:
- Good blood pressure and volume control are achievable in APD patients with liberal icodextrin use and modified dwell strategies.
- Neither low nor high sodium removal was linked to increased hypertension or fluid overload in this cohort.
- This study supports the efficacy of current APD management strategies with icodextrin.
Objectives:
To examine the control of blood pressure and volume, and the role of sodium removal in a single, large, contemporary, automated peritoneal dialysis (APD) population where icodextrin is used liberally and there is a policy to avoid long duration glucose-based daytime dwells.
Design:
Observational cross-sectional study.
Setting:
A university hospital.
Patients:
56 APD patients, with a mean duration on peritoneal dialysis of 1.9 years; 50% were prescribed icodextrin.
Main Outcome Measures:
Blood pressure, extracellular water volume (ECW)-to-intracellular water volume (ICW) ratio, and total (peritoneal and urinary) sodium removal.
Results:
Sodium Removal: Mean total sodium removal, while low at 102.9 +/- 64.6 mmol/day, showed a wide range, with 41% having a sodium removal of >120 mmol/day. Total sodium removal correlated with total body water, ECW, and ICW (p < 0.001, p < 0.001, p < 0.025, respectively), as well as with height and weight (p < 0.06, p < 0.01 respectively). On multivariate analysis, only ultrafiltration volume and urine volume were significantly associated with total sodium removal (r(2) = 0.67, p < 0.0001 for both). There was also a correlation between sodium removal and urea nitrogen appearance (r(2) = 0.31, p < 0.001), with urea nitrogen appearance in turn being closely correlated with ICW (p < 0.001). Volume Status: The ECW/ICW ratio was 0.88 +/- 0.17, which was not significantly different to that found in hemodialysis patients without clinical evidence of fluid overload, either predialysis (0.96 +/- 0.16) or postdialysis (0.92 +/- 0.16); p = 0.07 and 0.36 respectively. Blood Pressure: Mean +/- standard deviation systolic blood pressure (BP) was 111.9 +/- 18.2 mmHg and diastolic BP was 63.3 +/- 11.9 mmHg, with only 4 (7%) patients having a systolic BP > 140 mmHg and 1 (2%) having a diastolic BP > 80 mmHg. Median number of antihypertensives was 1 per day. Blood pressure control and ECW/ICW ratio were similar in those with sodium removal >120 mmol/day compared to those with sodium removal < or =120 mmol/day (p = 0.39 for SBP, p = 0.70 for diastolic BP, p = 0.24 for ECW/ICW).
Conclusions:
We have shown that good blood pressure and volume control is achievable in a large contemporary APD population with liberal use of icodextrin and avoidance of long daytime glucose-based dwells. Neither low nor high sodium removal was associated with more frequent hypertension or volume expansion.
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