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Assessment and Management of Hypertension among Patients on Peritoneal Dialysis.

TitleAssessment and Management of Hypertension among Patients on Peritoneal Dialysis.
Publication TypeJournal Article
Year of Publication2019
AuthorsVaios, V., Georgianos P. I., Liakopoulos V., & Agarwal, iv R.
JournalClin J Am Soc Nephrol
Volume14
Issue2
Pagination297-305
Date Published2019 02 07
ISSN1555-905X
KeywordsAngiotensin-Converting Enzyme Inhibitors, Blood Pressure, Body Water, Dialysis Solutions, Diet, Sodium-Restricted, Diuretics, Humans, Hypertension, Icodextrin, Kidney Failure, Chronic, Mortality, Peritoneal Dialysis, Continuous Ambulatory, Prevalence, Renal Dialysis
Abstract

Approximately 7%-10% of patients with ESKD worldwide undergo peritoneal dialysis (PD) as kidney replacement therapy. The continuous nature of this dialytic modality and the absence of acute shifts in pressure and volume parameters is an important differentiation between PD and in-center hemodialysis. However, the burden of hypertension and prognostic association of BP with mortality follow comparable patterns in both modalities. Although management of hypertension uses similar therapeutic principles, long-term preservation of residual diuresis and longevity of peritoneal membrane function require particular attention in the prescription of the appropriate dialysis regimen among those on PD. Dietary sodium restriction, appropriate use of icodextrin, and limited exposure of peritoneal membrane to bioincompatible solutions, as well as adaptation of the PD regimen to the peritoneal transport characteristics, are first-line therapeutic strategies to achieve adequate volume control with a potential long-term benefit on technique survival. Antihypertensive drug therapy is a second-line therapeutic approach, used when BP remains unresponsive to the above volume management strategies. In this article, we review the available evidence on epidemiology, diagnosis, and treatment of hypertension among patients on PD and discuss similarities and differences between PD and in-center hemodialysis. We conclude with a call for randomized trials aiming to elucidate several areas of uncertainty in management of hypertension in the PD population.

DOI10.2215/CJN.07480618
Alternate JournalClin J Am Soc Nephrol
PubMed ID30341090
PubMed Central IDPMC6390915
Grant ListR01 HL126903 / HL / NHLBI NIH HHS / United States

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