Hypotension on continuous ambulatory peritoneal dialysis

Hypotension in patients on CAPD is almost an unexplored area in the literature. This retrospective analysis of 525 patients treated at the Toronto Hospital. Toronto over the last five years, of whom 65 were hypotensive, describes the possible causes of hypotension, the response to treatment, morbidity and mortality rates. The incidence of hypotension was 12% in our CAPD population. The mean age of these patients was 58 +/- 17 years with a male to female ratio of 1.25:1. The distribution of various comorbid conditions such as, insulin-dependent diabetes mellitus, neoplasia coronary/cerebro/peripheral vascular diseases was similar to nonhypotensive patients. There was a higher proportion of malignancies, noninsulin-dependent diabetes mellitus and chronic obstructive pulmonary disease (CAPD) in hypotensive group. Hypotension was attributed to hypovolemia in 16 (25%), heart failure in 15 (23%) and antihypertensive medications in 12 (18%) patients. In 26 (34%) patients the exact cause of hypotension was unclear. Five patients had malignancies and 4 had severe autonomic neuropathy. Among 16 hypovolemic patients, 14 responded to volume expansion and 2 did not because of concurrent administration of coronary vasodilators. Seven out of 12 patients with hypotension due to antihypertensive medications improved. In 3 patients, blood pressure increased marginally after stopping the drugs and 2 remained hypotensive because of continuation of the drugs. Of the patients with heart failure, 40% (6/15) responded to a decrease to the target weight. Two patients treated with captopril did not respond. Of the patients from the unknown category, 50% (13/26) improved. One out of 4 patients treated with midodrine responded. The mortality rate was higher among hypotensive patients than among the nonhypotensives on CAPD.