Hypertension in peritoneal dialysis patients: epidemiology, pathogenesis, and treatment.

J Am Soc Hypertens 2011 May-Jun;5(3):128-36. Epub 2011 Apr 1.

Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.

Hypertension is prevalent in an estimated 29% to 80% of patients treated with peritoneal dialysis (PD). Cardiovascular disease represents the most common cause of mortality in this population, and hypertension (HTN) plays an important role. Volume overload is prevalent in PD patients because of liberal intake of fluids and loss of residual renal function (RRF). Noncompliance with salt restriction causes weight gain and makes HTN more difficult to manage. Physiology of the peritoneal membrane and its transport characteristics governs the ultrafiltration rate and consequently both volume and HTN. Therapeutic options for blood pressure control are ultrafiltration through the osmotic or colloid osmotic effects of dialysis solutions, salt restriction, and the use of antihypertensive medications such as diuretics, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Loop diuretics are used to maintain urine output in nonoliguric patients. Doses may exceed 250 mg of furosemide; ototoxicity is not problematic if blood levels are monitored carefully. Preservation of RRF is important for maintaining volume control and, thereby, control of HTN.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jash.2011.02.004DOI Listing
July 2011
4 Reads

Publication Analysis

Top Keywords

peritoneal dialysis
8
salt restriction
8
blood pressure
4
pressure control
4
options blood
4
therapeutic options
4
volume htn
4
control ultrafiltration
4
htn therapeutic
4
osmotic colloid
4
dialysis solutions
4
solutions salt
4
effects dialysis
4
osmotic effects
4
consequently volume
4
colloid osmotic
4
ultrafiltration osmotic
4
ultrafiltration rate
4
gain htn
4
htn difficult
4

Similar Publications