Residual Renal Function and Effect of Low-Sodium Solution on Blood Pressure in Peritoneal Dialysis Patients

Author:

Rutkowski Bolesław1,Tam Paul2,van der Sande Frank M.3,Vychytil Andreas4,Schwenger Vedat5,Klein Gudrun6,Himmele Rainer7,Gauly Adelheid6

Affiliation:

1. Department of Nephrology Medical University of Gdansk, Gdaśsk, Poland

2. Scarborough General Hospital, Toronto, ON, Canada

3. Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands

4. Division of Nephrology and Dialysis, Medical University of Vienna, Austria

5. Clinic for Kidney, Hypertension and Autoimmune Diseases, Transplant Center Stuttgart, Klinikum Stuttgart, Germany

6. Clinical and Epidemiological Research, Fresenius Medical Care, Bad Homburg, Germany

7. Medical Information and Education, Fresenius Medical Care North America, Waltham, MA, USA

Abstract

BackgroundResidual 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).MethodsThis 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 m2) were analyzed for BP and antihypertensive medication.ResultsIn 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.ConclusionsThe 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.

Publisher

SAGE Publications

Subject

Nephrology,General Medicine

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1. Why should we use a low sodium dialysis solution for peritoneal dialysis?;Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis;2024-01-24

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3. Electrolyte Management in Peritoneal Dialysis;Nolph and Gokal's Textbook of Peritoneal Dialysis;2023

4. New Peritoneal Dialysis Solutions and Solutions on the Horizon;Nolph and Gokal's Textbook of Peritoneal Dialysis;2023

5. Volumenmanagement bei Peritonealdialyse;Der Nephrologe;2022-01-04

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