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Blood pressure profile in continuous ambulatory peritoneal dialysis patients
Rizna Abdul Cader1, Halim Abdul Gafor1, Rozita Mohd1
1Nephrology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia.
Insights
Blood pressure control is poor in patients on continuous ambulatory peritoneal dialysis (CAPD). Diabetic patients on CAPD exhibit higher pulse pressure and a lack of nocturnal blood pressure dip, increasing cardiovascular risk.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Cardiovascular mortality is the leading cause of death in end-stage renal disease (ESRD) patients.
- Blood pressure (BP) control remains a significant challenge for patients on continuous ambulatory peritoneal dialysis (CAPD).
- Elevated pulse pressure and non-dipping BP patterns are linked to increased cardiovascular mortality in ESRD.
Purpose of the Study:
- To assess BP control and the prevalence of non-dipping in CAPD patients.
- To compare BP control and dipping status between diabetic and non-diabetic CAPD patients.
- To investigate the association between BP, peritoneal membrane permeability, and cardiovascular risk factors in CAPD.
Main Methods:
- Retrospective analysis of CAPD patients meeting inclusion criteria.
- Comparison of BP parameters (systolic, diastolic, pulse pressure) and dipping status between diabetic and non-diabetic groups.
- Assessment of peritoneal membrane transport characteristics and their correlation with BP.
Main Results:
- Diabetic CAPD patients were older, with lower diastolic BP and higher pulse pressure compared to non-diabetics.
- A significantly higher proportion of diabetic patients were non-dippers (15 vs. 1).
- Age was identified as the primary predictor of pulse pressure on multivariate analysis.
Conclusions:
- BP remains inadequately controlled in patients undergoing chronic maintenance PD.
- Diabetic CAPD patients face elevated cardiovascular risk due to higher pulse pressure and non-dipping patterns.
- Optimizing BP management and restoring nocturnal dipping are crucial for reducing cardiovascular risk in this population.
Background:
Cardiovascular mortality is the leading cause of death in end stage renal disease. Despite being on continuous ambulatory peritoneal dialysis (CAPD), blood pressure (BP) remains poorly controlled. A higher pulse pressure and non dipping are associated with increased cardiovascular mortality. We studied BP control and the prevalence of non dipping in CAPD patients.
Methods:
All patients undergoing CAPD at our institution who met the inclusion criteria were recruited. We compared BP control and dipping status in diabetic and non diabetic patients on CAPD. We also determined whether BP and peritoneal membrane permeability were associated.
Results:
Forty six patients with a mean age 45 ± 13 years were enrolled. Diabetic patients were older (mean age 54 ± 13 vs. 40 ± 11 yrs, p <0.001), had a lower mean diastolic BP (80 ± 14 vs. 90 ± 14 mmHg, p = 0.025) and a higher mean pulse pressure (59 ± 17 vs. 49 ± 14 mmHg, p = 0.035). They were also non dippers (n = 15 vs. n = 1, p = 0.007). The low and low average transporters tended to have a higher systolic BP (p = 0.054) and a higher pulse pressure (p = 0.058). On multivariate analysis, age was the main predictor of pulse pressure.
Conclusion:
Despite being on chronic maintenance PD, BP was not well controlled. Diabetic patients had a higher pulse pressure and were non dippers thereby increasing their cardiovascular risk. We should therefore optimize BP control and aim to restore the nocturnal dip in these patients.
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