Assessment and management of hypertension among patients on peritoneal dialysis

Vasilios Vaios, Panagiotis I. Georgianos, Vassilios Liakopoulos, Rajiv Agarwal

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Approximately 7%-10% of patients with ESKD worldwide undergo peritoneal dialysis (PD) as kidney replacement therapy. The continuous nature of this dialytic modality and the absence of acute shifts in pressure and volume parameters is an important differentiation between PD and in-center hemodialysis. However, the burden of hypertension and prognostic association of BP with mortality follow comparable patterns in both modalities. Although management of hypertension uses similar therapeutic principles, long-term preservation of residual diuresis and longevity of peritoneal membrane function require particular attention in the prescription of the appropriate dialysis regimen among those on PD. Dietary sodium restriction, appropriate use of icodextrin, and limited exposure of peritonealmembrane to bioincompatible solutions, as well as adaptation of the PDregimen to the peritoneal transport characteristics, are first-line therapeutic strategies to achieve adequate volume control withapotential long-termbenefitontechnique survival.A ntihypertensive drug therapy is a second-line therapeutic approach, used when BP remains unresponsive to the above volume management strategies. In this article, we reviewthe available evidence on epidemiology, diagnosis, andtreatment of hypertension among patientson PD and discuss similarities and differences between PD and in-center hemodialysis. We conclude with a call for randomized trials aiming to elucidate several areas of uncertainty in management of hypertension in the PD population.

Original languageEnglish (US)
Pages (from-to)297-305
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume14
Issue number2
DOIs
StatePublished - Feb 7 2019

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ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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