Better control of hypervolemia and hypertension is emphasized as necessary to reduce the high cardiovascular mortality observed in peritoneal dialysis patients.
Emphasizes hypervolemia control in PD hypertension; leaves open prospective trials for CV outcomes.
OBJECTIVES: To review the factors that impact control of blood pressure and euvolemia in peritoneal dialysis patients. DESIGN: Review of the most recent publications on this subject; inclusion of some personal data on the relation between plasma volume and evolution of blood pressure in short-term and long-term peritoneal dialysis patients. SETTING: Peritoneal dialysis program in a university hospital. RESULTS: The literature on circadian blood pressure and the role of the decreased compliance of the great vessels in uremia is reviewed. Analysis of the long-term evolution of plasma volume in peritoneal dialysis patients in correlation with the evolution of blood pressure indicates a positive correlation in 36 of 46 simultaneous determinations. The treatment of volume overload and hypertension in peritoneal dialysis includes the prescription of loop diuretics, preservation of residual renal function, reduction of dietary salt intake, and prevention and treatment of peritoneal ultrafiltration failure. CONCLUSIONS: A reduction in the great cardiovascular mortality in peritoneal dialysis patients as nowadays observed can only be expected when more attention is paid to better control of hypervolemia and hypertension in these patients.
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Lameire et al. (2001) studied this question.
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