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Zhu Q, Huo Z, Zeng F, Gong N, Ye P, Pan J, Kong Y, Dou X, Wang D, Huang S, Yang C, Liu D, Zhang G, Ai J. Apparent Treatment-Resistant Hypertension in the First Year Associated With Cardiovascular Mortality in Peritoneal Dialysis Patients. Am J Hypertens 2024; 37:514-522. [PMID: 38252960 PMCID: PMC11176273 DOI: 10.1093/ajh/hpae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/19/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Few reports have focused on the association between apparent treatment-resistant hypertension (aTRH) and cardiovascular (CV) mortality in peritoneal dialysis (PD) population, thus we conducted this retrospective cohort to explore it. METHODS This was a retrospective cohort study conducted from January 2011 to January 2020 with PD patients in 4 Chinese dialysis centers. aTRH was defined according to the American College of Cardiology and American Heart Association guidelines. aTRH duration was calculated as the total number of months when patients met the diagnostic criteria in the first PD year. The primary outcome was CV mortality, and the secondary outcomes were CV events, all-cause mortality, combined endpoint (all-cause mortality and transferred to hemodialysis [HD]), and PD withdrawal (all-cause mortality, transferred to HD, and kidney transplantation). Cox proportional hazards models were used to assess the association. RESULTS A total of 1,422 patients were finally included in the analysis. During a median follow-up period of 26 months, 83 (5.8%) PD patients incurred CV mortality. The prevalence of aTRH was 24.1%, 19.9%, and 24.6% at 0, 3, and 12 months after PD initiation, respectively. Overall, aTRH duration in the first PD year positively associated with CV mortality (per 3 months increment, adjusted hazards ratio [HR], 1.29; 95% confidence interval 1.10, 1.53; P = 0.002). After categorized, those with aTRH duration more than 6 months presented the highest adjusted HR of 2.92. Similar results were found for secondary outcomes, except for the CV event. CONCLUSIONS Longer aTRH duration in the first PD year is associated with higher CV mortality and worse long-term clinical outcomes. Larger studies are warranted to confirm these findings. CLINICAL TRIALS REGISTRATION There is no clinical trial registration for this retrospective study.
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Affiliation(s)
- Qingyao Zhu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Zhihao Huo
- Department of Nephrology, Guangdong Clinical Research Academy of Chinese Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang Zeng
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People’s Hospital), Ganzhou, China
| | - Nirong Gong
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Peiyi Ye
- Nephrology Department, The First People’s Hospital of Foshan, Foshan, China
| | - Jianyi Pan
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yaozhong Kong
- Nephrology Department, The First People’s Hospital of Foshan, Foshan, China
| | - Xianrui Dou
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Di Wang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Shuting Huang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Cong Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Dehui Liu
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People’s Hospital), Ganzhou, China
| | - Guangqing Zhang
- Administrative Office, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Ai
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
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Ma L, Zhang C, Gao J, Jiao X, Yu Z, Zhu Y, Wang T, Ma X, Wang Y, Tang W, Zhao X, Ruan W, Wang T. Mortality prediction with adaptive feature importance recalibration for peritoneal dialysis patients. PATTERNS (NEW YORK, N.Y.) 2023; 4:100892. [PMID: 38106617 PMCID: PMC10724364 DOI: 10.1016/j.patter.2023.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/18/2023] [Accepted: 11/10/2023] [Indexed: 12/19/2023]
Abstract
The study aims to develop AICare, an interpretable mortality prediction model, using electronic medical records (EMR) from follow-up visits for end-stage renal disease (ESRD) patients. AICare includes a multichannel feature extraction module and an adaptive feature importance recalibration module. It integrates dynamic records and static features to perform personalized health context representation learning. The dataset encompasses 13,091 visits and demographic data of 656 peritoneal dialysis (PD) patients spanning 12 years. An additional public dataset of 4,789 visits from 1,363 hemodialysis (HD) patients is also considered. AICare outperforms traditional deep learning models in mortality prediction while retaining interpretability. It uncovers mortality-feature relationships and variations in feature importance and provides reference values. An AI-doctor interaction system is developed for visualizing patients' health trajectories and risk indicators.
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Affiliation(s)
| | | | - Junyi Gao
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Health Data Research UK, London, UK
| | | | | | | | | | - Xinyu Ma
- Peking University, Beijing, China
| | | | - Wen Tang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Xinju Zhao
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Wenjie Ruan
- Department of Computer Science, University of Exeter, Exeter, UK
| | - Tao Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
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Panuccio V, Provenzano PF, Tripepi R, Versace MC, Parlongo G, Politi E, Vilasi A, Mezzatesta S, Abelardo D, Tripepi GL, Torino C. Home Pulse Pressure Predicts Death and Cardiovascular Events in Peritoneal Dialysis Patients. J Clin Med 2023; 12:3904. [PMID: 37373599 DOI: 10.3390/jcm12123904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Increased arterial hypertension represents a prevalent condition in peritoneal dialysis patients that is often related to volume expansion. Pulse pressure is a robust predictor of mortality in dialysis patients, but its association with mortality is unknown in peritoneal patients. We investigated the relationship between home pulse pressure and survival in 140 PD patients. During a mean follow-up of 35 months, 62 patients died, and 66 experienced the combined event death/CV events. In a crude COX regression analysis, a five-unit increase in HPP was associated with a 17% increase in the hazard ratio of mortality (HR: 1.17, 95% CI 1.08-1.26 p < 0.001). This result was confirmed in a multiple Cox model adjusted for age, gender, diabetes, systolic arterial pressure, and dialysis adequacy (HR: 1.31, 95% CI 1.12-1.52, p = 0.001). Similar results were obtained considering the combined event death-CV events as an outcome. Home pulse pressure represents, in part, arterial stiffness, and it is strongly related to all-cause mortality in peritoneal patients. In these high cardiovascular risk populations, it is important to maintain optimal blood pressure control, but it is fundamental to consider all the other cardiovascular risk indicators, such as pulse pressure. Home pulse pressure measurement is easy and feasible and can add important information for the identification and management of high-risk patients.
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Affiliation(s)
- Vincenzo Panuccio
- Nephology, Dialysis and Transplantation Unit-GOM "Bianchi-Melacrino-Morelli", Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Pasquale Fabio Provenzano
- National Research Council-Institute of Clinical Physiology, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Rocco Tripepi
- National Research Council-Institute of Clinical Physiology, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Maria Carmela Versace
- National Research Council-Institute of Clinical Physiology, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Giovanna Parlongo
- Nephology, Dialysis and Transplantation Unit-GOM "Bianchi-Melacrino-Morelli", Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Emma Politi
- Nephology, Dialysis and Transplantation Unit-GOM "Bianchi-Melacrino-Morelli", Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Antonio Vilasi
- National Research Council-Institute of Clinical Physiology, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Sabrina Mezzatesta
- National Research Council-Institute of Clinical Physiology, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Domenico Abelardo
- National Research Council-Institute of Clinical Physiology, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Giovanni Luigi Tripepi
- National Research Council-Institute of Clinical Physiology, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
| | - Claudia Torino
- National Research Council-Institute of Clinical Physiology, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
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Zhan X, Zeng C, He J, Wang M, Xiao J. Non-specific electrocardiographic ST-T abnormalities predict mortality in patients on peritoneal dialysis. Front Cardiovasc Med 2022; 9:930517. [PMID: 36588547 PMCID: PMC9798218 DOI: 10.3389/fcvm.2022.930517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to evaluate the predictive value of non-specific ST-segment and/or T-wave abnormalities in electrocardiography (ECG) for all-cause and cardiovascular mortality (CVM) in peritoneal dialysis (PD) patients. Methods All patients who started PD between November 1, 2005, and February 28, 2017, at the First Affiliated Hospital of Nanchang University were enrolled. The primary outcomes were all-cause mortality and CVM. The Kaplan-Meier method and a log-rank test were used for the survival analysis. Multivariate Cox proportional hazards models were used to investigate the risk factors for all-cause mortality and CVM. Results A total of 724 eligible PD patients were enrolled, including 401 (55.4%) men. In total, 153 (21.1%) patients died during a mean follow-up period of 27 (interquartile range, 13-41) months, and cardiovascular death was responsible for 84 of these deaths. The patients with non-specific ST-T abnormalities (NSSTTAs) had lower overall and cardiovascular survival rates compared to those free from any ECG abnormalities. According to the multivariate Cox proportional hazards models, (NSSTTAs) are independent risk factors for all-cause mortality and CVM, the hazard ratios are 1.81 (95% confidence interval, 1.11-2.95; p = 0.017) and 2.86 (95% confidence interval, 1.52-5.37; p = 0.001), respectively. Conclusion Non-specific ST-T abnormalities can serve as risk markers of all-cause and CVM in PD patients.
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Affiliation(s)
- Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chuanfei Zeng
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jiajing He
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Menghui Wang
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jun Xiao
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China,*Correspondence: Jun Xiao,
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Duan Y, Peng Z, Zhong S, Huang H, He Z. Association between subclinical left ventricular ejection fraction and platelet-to-lymphocyte ratio in patients with peritoneal dialysis. Front Med (Lausanne) 2022; 9:961453. [DOI: 10.3389/fmed.2022.961453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
BackgroundReduced left ventricular ejection function (LVEF) was associated with increased mortality in patients with peritoneal dialysis (PD) in Asia and the United States of America. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were correlated with LVEF in PD. However, little information is available regarding the relationship between monocyte-to-lymphocyte ratio (MLR), left ventricular ejection fraction (LVEF), and the use of NLR, PLR, and MLR in predicting left ventricular systolic dysfunction (LVSD) in patients with PD.MethodsAll 181 patients with PD were enrolled between 2014 and 2021 from the Nephrology Department of the First Affiliated Hospital of the University of South China. Demographic features, clinical characteristics, laboratory values, and echocardiographic parameters were collected.ResultsThe mean age of patients with PD was 47.4 ± 12.6, and 90 (49.7%) of the patients were men. LVEF showed a negative correlation with PLR (r = −0.200, p = 0.007) and MLR (r = −0.146, p = 0.049). The levels of NLR, PLR, and MLR were elevated in patients with PD with LVSD compared with those without (all p < 0.05). PLR (OR 4.331, 95% CI: 1.223, 15.342) and albumin (OR 13.346, 95% CI: 3.928, 45.346) were significantly associated with LVSD patients with PD in the multivariate logistic analysis. For differentiating patients with PD with LVSD, optimal cutoffs of NLR, PLR, MLR, and albumin were 4.5 (sensitivity: 76.7%, specificity: 55.0%, and overall accuracy: 58%), 202.6 (sensitivity: 66.7%, specificity: 69.5%, and overall accuracy: 69%), 0.483 (sensitivity: 53.3%, specificity: 72.8%, and overall accuracy: 30%), and 34.6 (sensitivity: 72.2%), respectively.ConclusionsOur results revealed that PLR was better than NLR, MLR, and albumin in predicting LVSD in PD.
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Georgianos PI, Vaios V, Zebekakis PE, Liakopoulos V. The Relation of Clinic and Ambulatory BP with the Risk of Cardiovascular Events and All-Cause Mortality among Patients on Peritoneal Dialysis. J Clin Med 2021; 10:jcm10112232. [PMID: 34063995 PMCID: PMC8196741 DOI: 10.3390/jcm10112232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
Large observational studies showed a U-shaped association of clinic blood pressure (BP) with mortality among patients undergoing peritoneal dialysis (PD). Whether ambulatory BP provides a more direct risk signal in this population remains unknown. In a prospective cohort of 108 PD patients, standardized clinic BP was recorded at baseline with the validated device HEM-705 (Omron, Healthcare, Bannockburn, IL, USA) and 24-h ambulatory BP monitoring was performed using the Mobil-O-Graph monitor (IEM, Stolberg, Germany). Over a median follow-up of 16 months (interquartile range: 19 months), 47.2% of the overall population reached the composite outcome of non-fatal myocardial infarction, non-fatal stroke, or all-cause death. In Cox-regression analysis, systolic but not diastolic BP was prognostically informative. Compared with the reference quartile 1 of 24-h systolic BP (SBP), the multivariate-adjusted hazard ratio for the composite outcome was 1.098 (95% confidence interval (CI): 0.434–2.777) in quartile 2, 1.004 (95% CI: 0.382–2.235) in quartile 3 and 2.449 (95% CI: 1.156–5.190) in quartile 4. In contrast, no such association was observed between increasing quartiles of clinic SBP and composite outcome. The present study shows that among PD patients, increasing ambulatory SBP is independently associated with higher risk of adverse cardiovascular events and mortality, providing superior prognostic information than standardized clinic SBP.
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Guo P, He Z, Jalaludin B, Knibbs LD, Leskinen A, Roponen M, Komppula M, Jalava P, Hu L, Chen G, Zeng X, Yang B, Dong G. Short-Term Effects of Particle Size and Constituents on Blood Pressure in Healthy Young Adults in Guangzhou, China. J Am Heart Assoc 2021; 10:e019063. [PMID: 33942624 PMCID: PMC8200702 DOI: 10.1161/jaha.120.019063] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/04/2021] [Indexed: 12/21/2022]
Abstract
Background Although several studies have focused on the associations between particle size and constituents and blood pressure, results have been inconsistent. Methods and Results We conducted a panel study, between December 2017 and January 2018, in 88 healthy university students in Guangzhou, China. Weekly systolic blood pressure and diastolic blood pressure were measured for each participant for 5 consecutive weeks, resulting in a total of 440 visits. Mass concentrations of particles with an aerodynamic diameter of ≤2.5 µm (PM2.5), ≤1.0 µm (PM1.0), ≤0.5 µm (PM0.5), ≤0.2 µm (PM0.2), and number concentrations of airborne particulates of diameter ≤0.1 μm were measured. Linear mixed-effect models were used to estimate the associations between blood pressure and particles and PM2.5 constituents 0 to 48 hours before blood pressure measurement. PM of all the fractions in the 0.2- to 2.5-μm range were positively associated with systolic blood pressure in the first 24 hours, with the percent changes of effect estimates ranging from 3.5% to 8.8% for an interquartile range increment of PM. PM0.2 was also positively associated with diastolic blood pressure, with an increase of 5.9% (95% CI, 1.0%-11.0%) for an interquartile range increment (5.8 μg/m3) at lag 0 to 24 hours. For PM2.5 constituents, we found positive associations between chloride and diastolic blood pressure (1.7% [95% CI, 0.1%-3.3%]), and negative associations between vanadium and diastolic blood pressure (-1.6% [95% CI, -3.0% to -0.1%]). Conclusions Both particle size and constituent exposure are significantly associated with blood pressure in the first 24 hours following exposure in healthy Chinese adults.
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Affiliation(s)
- Peng‐Yue Guo
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk AssessmentDepartment of Occupational and Environmental HealthSchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Zhi‐Zhou He
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk AssessmentDepartment of Occupational and Environmental HealthSchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Bin Jalaludin
- Centre for Air Quality and Health Research and EvaluationGlebeAustralia
- Ingham Institute for Applied Medial ResearchUniversity of New South WalesSydneyAustralia
| | - Luke D. Knibbs
- School of Public HealthThe University of QueenslandHerstonQueenslandAustralia
| | - Ari Leskinen
- Finnish Meteorological InstituteKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Marjut Roponen
- Department of Environmental and Biological SciencesUniversity of Eastern FinlandKuopioFinland
| | | | - Pasi Jalava
- Department of Environmental and Biological SciencesUniversity of Eastern FinlandKuopioFinland
| | - Li‐Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk AssessmentDepartment of Occupational and Environmental HealthSchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Gongbo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk AssessmentDepartment of Occupational and Environmental HealthSchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Xiao‐Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk AssessmentDepartment of Occupational and Environmental HealthSchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Bo‐Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk AssessmentDepartment of Occupational and Environmental HealthSchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Guang‐Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk AssessmentDepartment of Occupational and Environmental HealthSchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
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Vecchi L, Bonomini M, Palumbo R, Arduini A, Borrelli S. Mild sodium reduction in peritoneal dialysis solution improves hypertension in end stage kidney disease: a case-report study. BMC Nephrol 2021; 22:170. [PMID: 33964894 PMCID: PMC8105985 DOI: 10.1186/s12882-021-02380-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/29/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction Blood Pressure (BP) control is largely unsatisfied in End Stage Kidney Disease (ESKD) principally due to sodium retention. Peritoneal Dialysis (PD) is the most common type of home dialysis, using a peritoneal membrane to remove sodium, though sodium removal remains challenging. Methods This is a case-study reporting two consecutive ESKD patients treated by a novel peritoneal PD solution with a mildly reduced sodium content (130 mmol/L) to treat hypertension. Results In the first case, a 78-year-old woman treated by Continuous Ambulatory PD (CAPD) with standard solution (three 4 h-dwells per day 1.36% glucose 132 mmol/L) showed resistant hypertension confirmed by ambulatory blood pressure monitoring (ABPM), reporting 24 h-BP: 152/81 mmHg, day-BP:151/83 mmHg and night-ABP: 153/75 mmHg, with inversion of the circadian systolic BP rhythm (1.01), despite use of three anti-hypertensives and a diuretic at adequate doses. No sign of hypervolemia was evident. We then switched from standard PD to low-sodium solution in all daily dwells. A six-months low-sodium CAPD enabled us to reduce diurnal (134/75 mmHg) and nocturnal BP (122/67 mmHg), restoring the circadian BP rhythm, with no change in ultrafiltration or residual diuresis. Diet and drug prescription were unmodified too. The second case was a 61-year-old woman in standard CAPD (three 5 h-dwells per day) suffering from hypertension confirmed by ABPM (mean 24 h-ABP: 139/84 mmHg; mean day-ABP:144/88 mmHg and mean night-ABP:124/70 mmHg). She was switched from 132-Na CAPD to 130-Na CAPD, not changing dialysis schedule. No fluid expansion was evident. During low-sodium CAPD, antihypertensive therapy (amlodipine 10 mg and Olmesartan 20 mg) has been reduced until complete suspension. After 6 months, we repeated ABPM showing a substantial reduction in mean 24 h-ABP (117/69 mmHg), mean diurnal ABP (119/75 mmHg) and mean nocturnal ABP (111/70 mmHg). Ultrafiltration and residual diuresis remained unmodified. No side effects were reported in either cases. Conclusions This case-report study suggests that mild low-sodium CAPD might reduce BP in hypertensive ESKD patients.
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Affiliation(s)
- Luigi Vecchi
- Unit of Nephrology, Santa Maria Hospital, Terni, Italy
| | - Mario Bonomini
- Department of Medicine, Section of Nephrology and Dialysis, G. d'Annunzio University, Chieti-Pescara, Chieti, Italy
| | | | | | - Silvio Borrelli
- Department of Advanced Medical and Surgical Sciences, Nephrology Unit of University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy.
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