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Effect of continuous ambulatory peritoneal dialysis on blood pressure control
L F Saldanha1, E W Weiler, H C Gonick
1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) demonstrates superior blood pressure control compared to hemodialysis (HD). Early improvements suggest volume-related effects, with sustained benefits over time.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Dialysis Therapy
Background:
- Hypertension is a common complication in patients with end-stage renal disease.
- Effective blood pressure management is crucial for reducing cardiovascular risk in dialysis patients.
Purpose of the Study:
- To evaluate the efficacy of continuous ambulatory peritoneal dialysis (CAPD) in controlling blood pressure.
- To compare blood pressure control in CAPD patients transitioned from hemodialysis (HD) versus those new to CAPD.
Main Methods:
- Sequential blood pressure monitoring in 63 patients transferred from HD to CAPD and 97 new CAPD patients.
- Analysis of blood pressure changes in relation to body weight, hematocrit, recombinant human erythropoietin (rHu-EPO) treatment, and antihypertensive drug use.
Main Results:
- Both groups showed immediate blood pressure improvement at 1 month, likely volume-related.
- Further blood pressure reduction observed around 6 months in both HD and NEW CAPD groups.
- Recombinant human erythropoietin treatment for anemia did not significantly impact blood pressure.
Conclusions:
- Continuous ambulatory peritoneal dialysis (CAPD) appears more effective than hemodialysis (HD) for blood pressure control.
- CAPD offers significant benefits in managing hypertension among dialysis patients.
Abstract:
To assess the efficacy of blood pressure control in continuous ambulatory peritoneal dialysis (CAPD), blood pressure was examined sequentially in 63 CAPD patients transferred from hemodialysis (HD), and in 97 patients started de novo on CAPD (NEW), over periods ranging from 3 to 63 months. Blood pressure changes were related to changes in body weight, hematocrit, and treatment with recombinant human erythropoietin (rHu-EPO), as well as to changes in antihypertensive drug requirements. Both groups of patients showed an immediate improvement in blood pressure control at 1 month, as manifested by an absolute decrease in blood pressure in HD patients (-4.3% +/- 2.1% [SEM], P < 0.05) and by a decrease in antihypertensive drug requirements in NEW patients (from 78% to 43.3%). This early improvement in blood pressure appeared to be volume-related, as reflected by changes in body weight. Both groups showed an additional decrement in blood pressure at approximately 6 months (-7.8% +/- 2.6% [SEM], P < 0.05, HD group; -3.4% +/- 2.4% [SEM], P < 0.05, NEW group). Treatment of anemia with rHu-EPO in 22 of the CAPD patients had no effect on blood pressure. CAPD thus appears to be more effective than HD in controlling blood pressure.