The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status

Davies, Simon; Carlsson, Ola; Simonsen, Ole; Johansson, Alf; Venturoli, Daniele; Ledebo, Ingrid; Wieslander, Anders; Chan, Cian; Rippe, Bengt

doi:10.1093/ndt/gfn668

Cited by 76 publications

(56 citation statements)

References 20 publications

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“…96 However, if the low dialysate sodium was not accompanied by a reduction in dry weight, BP did not change. Prescribing both low dialysate sodium and challenging dry weight may improve BP control over and above one strategy alone.…”

Section: Dietary Sodium Restrictionmentioning

confidence: 97%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

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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Section: Dietary Sodium Restrictionmentioning

confidence: 97%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

156

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“…Individualisation of the dialysate sodium prescription was shown to reduce intra-dialytic weight gain, thirst and episodes of intra-dialytic hypotension in a randomised, cross-over study [44]. Use of a low sodium PD solution has also shown promise, with increased diffusive sodium removal, reduced thirst, improved ultrafiltration and reduction in BP [45].…”

Section: Hypertensionmentioning

confidence: 99%

Cardiovascular Disease in Dialysis Patients

Jegatheesan¹,

Yang²,

Krishnasamy³

et al. 2018

Aspects in Dialysis

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Cardiovascular disease (CVD) is highly prevalent in the dialysis population, affecting up to 60% of cohorts. Cardiovascular mortality rates are reported to be ~14 per 100 patient-years, which are 10-to 20-fold greater than those of age-and gender-matched controls. CVD is the primary cause of death in up to 40% of dialysis patients in Australia, New Zealand and the United States. Dialysis patients endure a greater burden of both traditional risk factors for CVD and risk factors related to loss of kidney function that may account for the higher CVD morbidity and mortality. Many cardiology guidelines include chronic kidney disease (CKD) and end-stage kidney disease (ESKD) as coronary heart disease (CHD) risk equivalents. It is therefore important for clinicians to both recognise and optimise the cardiovascular health of patients receiving maintenance dialysis. This chapter will focus on risk factor modification, screening and prevention of CVD in dialysis patients.

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“…Longer dwell time, an additional daytime dwell, and icodextrin may be considered. PD solutions with lower sodium concentration (116-125 mmol/L) have been shown to remove more salt and thus to improve hydration status and blood pressure in adults but not yet in children [71]. Likewise, combining short small dwells with long and large dwells may remove more sodium [96]; also see "Adapted APD.…”

Section: Sodiummentioning

confidence: 99%

Peritoneal Dialysis in Children

Patel

Kv³

et al. 2015

Pediatric Nephrology

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In children with chronic kidney disease stage 5D peritoneal dialysis (PD) remains the dialysis modality most commonly prescribed, especially as automated PD. Nowadays it can be started from the first days of life on, and applied even to some preterm babies. This chapter gives an overview on PD membrane ultrastructure and function, on technical prerequistes of PD, on optimal PD prescription and on specific treatment targets and tools to monitor efficacy. It describes PD related infectious and noninfectious complications, long term peritoneal and systemic sequelae and current state of the art of how these can be mitigated or even be prevented.

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The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status

Cited by 76 publications

References 20 publications

Assessment and Management of Hypertension in Patients on Dialysis

Assessment and Management of Hypertension in Patients on Dialysis

Cardiovascular Disease in Dialysis Patients

Peritoneal Dialysis in Children

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