Key result
Low-sodium peritoneal dialysis fluid reduced systolic blood pressure compared to standard fluid in patients with low residual renal function (mean difference -16.9 mmHg; 95% CI -27.2 to -6.6).
Why the study?
Residual renal function affects sodium and fluid balance, but its impact on the blood pressure effects of sodium-reduced peritoneal dialysis fluid was unclear.
Does low-sodium peritoneal dialysis fluid reduce blood pressure in patients on continuous ambulatory peritoneal dialysis compared to standard-sodium fluid?
RCT (n=82)
Double-blind
randomized
Does low-sodium peritoneal dialysis fluid reduce blood pressure in patients on continuous ambulatory peritoneal dialysis compared to standard-sodium fluid?
A sodium-reduced peritoneal dialysis fluid effectively lowers blood pressure in CAPD patients with low residual renal function, but has minimal effect in those with higher residual function.
Supports low-sodium PD fluid to lower BP in low-RRF CAPD patients; confirms RCT efficacy in this subgroup.
Background Residual renal function (RRF) affects sodium and fluid balance. The aim of this analysis was to examine the impact of RRF on the effect of a sodium-reduced peritoneal dialysis fluid (PDF) on blood pressure (BP). Methods This is a post-hoc analysis of a prospective, randomized, controlled double-blind clinical trial with 82 patients on continuous ambulatory PD (CAPD) treated with a low-sodium (125 mmol/L Na) or a standard-sodium (134 mmol/L Na) PDF. Subgroups according to glomerular filtration rate (GFR) at baseline (≤ / > 6 mL/min/1.73 m 2 ) were analyzed for BP and antihypertensive medication. Results In the low-GFR group on low-sodium PDF ( N = 26), systolic BP was reduced from 152 ± 24 mmHg at baseline to 137 ± 21 mmHg at week 12, diastolic BP from 90 ± 16 mmHg to 83 ± 11 mmHg. In the low-GFR group on standard-sodium PDF and in the high-GFR group on both PDF types, only minor changes were observed. For the low-GFR subgroup, the confounder-adjusted mean study group difference in systolic BP at week 12 between low-sodium and standard-sodium PDF was -16.9 (95% confidence interval [CI] -27.2 to -6.6) mmHg, for diastolic BP, it was -7.0 (95% CI -12.6 to -1.4) mmHg. In both GFR subgroups, more patients had a reduced daily dose of antihypertensive medication and fewer patients an increased daily dose in the low-sodium compared with the standard-sodium group at week 12. Conclusions The reduction of BP with a sodium-reduced PDF seems to be more effective in patients with no or low RRF than in patients with residual capacity of renal sodium and fluid control.
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Tam et al. (2019) conducted an RCT in peritoneal dialysis (n=82). low-sodium peritoneal dialysis fluid vs. standard-sodium (134 mmol/L Na) peritoneal dialysis fluid was evaluated on systolic blood pressure at week 12 in the low-GFR subgroup (MD -16.9 mmHg, 95% CI -27.2 to -6.6). Low-sodium peritoneal dialysis fluid reduced systolic blood pressure compared to standard fluid in patients with low residual renal function (mean difference -16.9 mmHg; 95% CI -27.2 to -6.6).
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