Vongsanim, S;
Davenport, A;
(2020)
Factors associated with systolic hypertension in peritoneal dialysis patients.
Journal of Nephrology
, 33
pp. 365-370.
10.1007/s40620-019-00633-y.
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Abstract
BACKGROUND: Hypertension is common in peritoneal dialysis (PD) patients and associated with adverse outcomes. Besides solute clearance, PD convective clearance is used to control extracellular water (ECW) volume and sodium balance. Previous studies have reported on hypertension in PD patients treated with continuous ambulatory peritoneal dialysis (CAPD) using hypertonic glucose dialysates. However, increasing numbers of PD patients are now treated with automated peritoneal dialysis (APD) and icodextrin dialysates. As such, we wished to explore factors associated with systolic blood pressure (SBP) in a modern cohort to identify targets to improve blood pressure control in PD patients. METHODS: We retrospectively reviewed the results from PD patients attending for peritoneal membrane assessment who had corresponding bioimpedance ECW and brain natriuretic peptide (NT-proBNP) measurements. RESULTS: We studied 510 PD patients: 317 (72.2%) male, 216 (42.4%) diabetics, median age 59 (47–72) years, and 51% treated by APD with a day-time icodextrin exchange. Mean systolic blood pressure (SBP) was 140 ± 24.8 mmHg. SBP was independently associated with 4-hour dialysate to plasma creatinine ratio (β = 29.5 (95% confidence limits 11.4–47.5, p = 0.001), N-terminal brain natriuretic peptide [β = 11.9 (7.2–16.7), p < 0.001], and daily urine sodium excretion [β = 1.7 (1.0–2.3), p < 0.001]. CONCLUSION: In the era of APD cyclers and icodextrin, SBP is associated with increased NT-proBNP, a marker of ECW expansion, and faster peritoneal transport, a risk factor for a positive sodium balance, and increased urinary sodium suggestive of higher dietary sodium intake. Patients should be encouraged to restrict sodium intake and PD prescriptions targeted to control ECW to improve SBP control.
| Type: | Article |
|---|---|
| Title: | Factors associated with systolic hypertension in peritoneal dialysis patients |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1007/s40620-019-00633-y |
| Publisher version: | https://doi.org/10.1007/s40620-019-00633-y |
| Language: | English |
| Additional information: | © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/). |
| Keywords: | Systolic blood pressure, Extracellular water, Sodium, Peritoneal transport, Brain natriuretic peptide |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10079338 |
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