Khandelwal Mukesh, Kothari Jatin, Krishnan Murali, Liakopoulos Vassilis, Tziviskou Efstathia, Sahu Krishna, Chatalalsingh Carole, Bargman Joanne, Oreopoulos Dimitrios
Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
Adv Perit Dial. 2003;19:44-52.
As noted in part I of this article, emerging evidence indicates that overt and (more commonly) subclinical volume expansion is frequent in patients on peritoneal dialysis (PD). That expansion in turn leads to hypertension. With loss of residual renal function, the hypertension becomes difficult to control even with increasing doses and varieties of antihypertensive drugs. Poor volume and blood pressure control aggravates already existing left ventricular hypertrophy and leads to increased cardiovascular morbidity and mortality. Indeed, cardiovascular events are the leading cause of death in PD patients. Part II of this article reviews various strategies available to manage fluid overload and hypertension. Also, we discuss sodium removal with various PD modalities and clinical studies related to use of low-sodium dialysis solutions.
如本文第一部分所述，新出现的证据表明，腹膜透析（PD）患者中明显的（更常见的是）亚临床容量扩张很常见。这种扩张继而导致高血压。随着残余肾功能的丧失，即使增加降压药物的剂量和种类，高血压也难以控制。容量和血压控制不佳会加重已有的左心室肥厚，并导致心血管发病率和死亡率增加。事实上，心血管事件是PD患者死亡的主要原因。本文第二部分综述了管理液体超负荷和高血压的各种可用策略。此外，我们还讨论了不同腹膜透析方式的钠清除以及与使用低钠透析液相关的临床研究。
