Assessment and Management of Hypertension among Patients on Peritoneal Dialysis.
Title | Assessment and Management of Hypertension among Patients on Peritoneal Dialysis. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Vaios, V., Georgianos P. I., Liakopoulos V., & Agarwal, iv R. |
Journal | Clin J Am Soc Nephrol |
Volume | 14 |
Issue | 2 |
Pagination | 297-305 |
Date Published | 2019 02 07 |
ISSN | 1555-905X |
Keywords | Angiotensin-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. |
DOI | 10.2215/CJN.07480618 |
Alternate Journal | Clin J Am Soc Nephrol |
PubMed ID | 30341090 |
PubMed Central ID | PMC6390915 |
Grant List | R01 HL126903 / HL / NHLBI NIH HHS / United States |