Recurrent Accelerated Hypertension Better Managed by Continuous Ambulatory Peritoneal Dialysis: A Case Series of Three Patients

Aims and Objectives: To highlight the role of continuous ambulatory peritoneal dialysis (CAPD) in controlling recurrent accelerated hypertension in end-stage renal disease (ESRD) patients who remain hypertensive despite optimal medical management and adequate volume control on maintenance haemodialysis (MHD). Materials and Methods: A retrospective analysis of three ESRD patients with recurrent accelerated hypertension on MHD at our center was conducted. Clinical profiles, comorbidities, antihypertensive regimens, dialysis details, and outcomes following transition to CAPD were reviewed. Patients were followed up for a minimum period of six months post-CAPD initiation. Results: Case 1: A 48-year-old male with type 2 diabetes mellitus, hypertension, and ESRD on twice-weekly MHD since April 2023 developed multiple episodes of accelerated hypertension with left ventricular failure (LVF) requiring ICU admissions despite intensified dialysis and maximal antihypertensive therapy. Following CAPD initiation in September 2023, hypertensive crises reduced to two in the first month and were absent thereafter. Pill burden decreased from five to two agents. Case 2: A 32-year-old female with long-standing hypertension and ESRD, initiated on MHD in January 2024, experienced recurrent accelerated hypertension and LVF despite thrice-weekly HD and maximal antihypertensive therapy. After CAPD initiation in April 2024, no further episodes occurred and pill burden decreased from four to one. Case 3: An 18-year-old female with focal segmental glomerulosclerosis (FSGS) on twice-weekly MHD for two years was switched to CAPD due to vascular access failure. Hypertension, previously sub-optimally controlled, improved significantly without escalation of antihypertensive therapy. Conclusion: CAPD provided rapid and sustained blood pressure control in ESRD patients with refractory hypertension on MHD, including those with recurrent LVF and those with vascular access issues. CAPD should be considered as a viable alternative modality in similar challenging cases. Further studies with larger cohorts are needed to establish its efficacy.