Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients

Tonbul, Zeki; Altıntepe, Lütfullah; Sözlü, Çetin; Yeksan, Mehdi; Yildiz, Alaattin; Türk, Süleyman

doi:10.1038/sj.jhh.1001449

Cited by 33 publications

(35 citation statements)

References 22 publications

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“…The BP profile of the study population displayed the com- mon characteristics of predominance of nondippers that has been described in patients with chronic kidney disease and patients who are on dialysis (27)(28)(29)(30). BP control was satisfactory at baseline, and the enhancement of UF with icodextrin did not result in any changes in BP control or in the circadian behavior of BP levels.…”

Section: Discussionmentioning

confidence: 69%

Superiority of Icodextrin Compared with 4.25% Dextrose for Peritoneal Ultrafiltration

Finkelstein¹,

Healy²,

Abu‐Alfa³

et al. 2005

Journal of the American Society of Nephrology

131

119

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Several clinical observations suggest the superiority of icodextrin compared with 4.25% dextrose in optimizing peritoneal ultrafiltration (UF), but no rigorous controlled evaluation has hitherto been performed. For comparing icodextrin and 4.25% dextrose during the long dwell of automated peritoneal dialysis, a multicenter, randomized, double-blind trial was conducted in 92 patients (control, 45; icodextrin, 47) with 4-h dialysate to plasma ratio creatinine >0.70 and D/D 0 glucose <0.34. Long-dwell net UF and the UF efficiency ratio (net UF volume per gram of dialysate carbohydrate absorbed) were determined at baseline, week 1, and week 2. The control and treatment groups were comparable at baseline (all patients using 4.25% dextrose for the long dwell) with regard to mean (؎SEM) net UF (201.7 ؎ 103.1 versus 141.6 ؎ 75.4 ml, respectively; P ‫؍‬ 0.637) and the percentage of patients with negative net UF (control, 37.8%; treatment, 42.6%; P ‫؍‬ 0.641). During the study period, net UF was unchanged from baseline in the control group but increased significantly (P < 0.001) in the icodextrin group from 141.6 ؎ 75.4 to 505.8 ؎ 46.8 ml at week 1 and 540.2 ؎ 46.8 ml at week 2. In the icodextrin group, the incidence of negative net UF was significantly lower (P < 0.0001) than in the control group. Findings were similar for UF efficiency ratio. Rash was reported significantly more often in the icodextrin group. This study showed that in high-average and high transporters, icodextrin is superior to 4.25% dextrose for long-dwell fluid and solute removal.

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Section: Discussionmentioning

confidence: 69%

Superiority of Icodextrin Compared with 4.25% Dextrose for Peritoneal Ultrafiltration

Finkelstein¹,

Healy²,

Abu‐Alfa³

et al. 2005

Journal of the American Society of Nephrology

131

119

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“…13 In another study, the comparison of 22 patients on HD with 24 patients on PD with 44-hour ambulatory BP monitoring showed no differences in daytime and nighttime BP. 14 Nonetheless, highquality head-to-head studies are sparse and the epidemiology of hypertension may be similar to that seen among HD patients. 15 Among PD patients, volume excess, as assessed by tracer dilution, was common and was related to DBP and eccentric left ventricular hypertrophy (LVH).…”

Section: Epidemiology Of Hypertension In Peritoneal Dialysismentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

157

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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“…However, in the measurement of LVH, formulas are applied that rely heavily on the cube root of end diastolic diameter [43], so that small differences in hydration status have substantial impacts on the obtained values. With regard to blood pressure control, 44 h blood pressure monitoring has shown that hypertension is less prevalent in HD than in PD patients on the day of dialysis but on the second day, is more prevalent and more expressed [44].…”

Section: Dialysis Modality and De Novo Cardiac Diseasementioning

confidence: 99%

Cardiovascular disease in haemodialysis and peritoneal dialysis: arguments pro peritoneal dialysis

Biesen

Verbeke

Vanholder

2006

Nephrology Dialysis Transplantation

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Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients

Cited by 33 publications

References 22 publications

Superiority of Icodextrin Compared with 4.25% Dextrose for Peritoneal Ultrafiltration

Superiority of Icodextrin Compared with 4.25% Dextrose for Peritoneal Ultrafiltration

Assessment and Management of Hypertension in Patients on Dialysis

Cardiovascular disease in haemodialysis and peritoneal dialysis: arguments pro peritoneal dialysis

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