Factors associated with systolic hypertension in peritoneal dialysis patients
© 2019, The Author(s). 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 hypertensio...
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th-cmuir.6653943832-667262019-09-16T12:58:07Z Factors associated with systolic hypertension in peritoneal dialysis patients Surachet Vongsanim Andrew Davenport Medicine © 2019, The Author(s). 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. 2019-09-16T12:58:07Z 2019-09-16T12:58:07Z 2019-01-01 Journal 17246059 11218428 2-s2.0-85070573935 10.1007/s40620-019-00633-y https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85070573935&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/66726 |
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Medicine Surachet Vongsanim Andrew Davenport Factors associated with systolic hypertension in peritoneal dialysis patients |
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© 2019, The Author(s). 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. |
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Journal |
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Surachet Vongsanim Andrew Davenport |
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Surachet Vongsanim Andrew Davenport |
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Surachet Vongsanim |
title |
Factors associated with systolic hypertension in peritoneal dialysis patients |
title_short |
Factors associated with systolic hypertension in peritoneal dialysis patients |
title_full |
Factors associated with systolic hypertension in peritoneal dialysis patients |
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Factors associated with systolic hypertension in peritoneal dialysis patients |
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Factors associated with systolic hypertension in peritoneal dialysis patients |
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factors associated with systolic hypertension in peritoneal dialysis patients |
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2019 |
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https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85070573935&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/66726 |
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