Chen Wei, Cheng Li-Tao, Wang Tao
Institute of Nephrology, Third Hospital, Peking University, Beijing, China.
Ren Fail. 2007;29(4):427-32. doi: 10.1080/08860220701260461.
Although fluid overload contributes to hypertension in CAPD patients, less attention has been paid to the role of excess salt and fluid intake. Therefore, we investigated the role of salt and fluid intake in the development of hypertension in CAPD patients.
A total of 165 stable CAPD patients were included into this study. Based on the blood pressure in three consecutive months, they were divided into three groups: persistent hypertensive (PH; n = 33), intercurrent hypertensive (IH; n = 58) and persistent normotensive (PN; n = 74). The IH group was further divided into two phases: normotensive and hypertensive. Fluid status was evaluated by clinical assessment and bioimpedance analysis (BIA).
There were no differences in age, gender, and duration of dialysis among groups. Patients were more fluid overloaded in the PH group. Extracellular water (ECW), total body water (TBW), and normalized extracellular water by height (NECW) were higher in the PH group than the PN group (16.77 +/- 3.62 L vs. 14.61 +/- 2.92 L for ECW, p < 0.01; 32.22 +/- 8.23 L vs. 28.98 +/- 6.00 L for TBW, p < 0.05; and 10.28 +/- 1.86 L/m vs. 9.08 +/- 1.63 L/m for NECW, p < 0.01). However, patients in the PH group also had more total fluid removal (TFR) and total sodium removal (TSR) compared with the PN group (1346.82 +/- 431.27 mL/d vs. 1139.28 +/- 412.65 mL/d for TFR, p < 0.05; and 141.52 +/- 61.57 mmol/d vs. 102.42 +/- 62.51 mmol/d for TSR, p < 0.01). The same trend was demonstrated when compared values of hypertensive and normotensive phase in IH group; patients had higher ECW, TBW, NECW, TSR, and PNa when they were in hypertensive phase than in the normotensive phase.
This study confirmed that fluid overload was closely associated with the development of hypertension in CAPD patients. It also showed that hypertensive patients were in general more fluid overloaded despite a higher fluid and sodium removal as compared with normotensive patients.
尽管液体超负荷会导致持续性非卧床腹膜透析（CAPD）患者发生高血压，但人们对过量盐和液体摄入的作用关注较少。因此，我们研究了盐和液体摄入在CAPD患者高血压发生中的作用。
本研究共纳入165例稳定的CAPD患者。根据连续三个月的血压情况，将他们分为三组：持续性高血压组（PH；n = 33）、间歇性高血压组（IH；n = 58）和持续性血压正常组（PN；n = 74）。IH组进一步分为两个阶段：血压正常阶段和高血压阶段。通过临床评估和生物电阻抗分析（BIA）评估液体状态。
各组患者在年龄、性别和透析时间方面无差异。PH组患者的液体超负荷情况更严重。PH组的细胞外液（ECW）、总体液（TBW）和按身高标准化的细胞外液（NECW）均高于PN组（ECW：16.77±3.62 L对14.61±2.92 L，p < 0.01；TBW：32.22±8.23 L对28.98±6.00 L，p < 0.05；NECW：10.28±1.86 L/m对9.08±1.63 L/m，p < 0.01）。然而，与PN组相比，PH组患者的总液体清除量（TFR）和总钠清除量（TSR）也更高（TFR：1346.82±431.27 mL/d对1139.28±412.65 mL/d，p < 0.05；TSR：141.52±61.57 mmol/d对102.42±62.51 mmol/d，p < 0.01）。比较IH组高血压阶段和血压正常阶段的值时也显示出相同趋势；患者在高血压阶段的ECW、TBW、NECW、TSR和血钠水平高于血压正常阶段。
本研究证实液体超负荷与CAPD患者高血压的发生密切相关。研究还表明，与血压正常的患者相比，高血压患者尽管液体和钠清除量较高，但总体液体超负荷情况更严重。
