Unit of Nephrology, Santa Maria Hospital, Terni, Italy.
Department of Medicine, Section of Nephrology and Dialysis, G. d'Annunzio University, Chieti-Pescara, Chieti, Italy.
BMC Nephrol. 2021 May 8;22(1):170. doi: 10.1186/s12882-021-02380-4.
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.
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.
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.
This case-report study suggests that mild low-sodium CAPD might reduce BP in hypertensive ESKD patients.
在终末期肾病（ESKD）患者中，血压（BP）控制主要不满意，主要是由于钠潴留。腹膜透析（PD）是最常见的家庭透析类型，使用腹膜膜来去除钠，尽管去除钠仍然具有挑战性。
这是一项病例研究，报告了两名连续的 ESKD 患者，他们使用一种新型的腹膜 PD 溶液进行治疗，该溶液的钠含量略低（130mmol/L），以治疗高血压。
在第一个病例中，一名 78 岁的女性接受持续流动 PD（CAPD）治疗，使用标准溶液（每天 3 次 4 小时卧床，1.36%葡萄糖 132mmol/L），通过动态血压监测（ABPM）证实患有难治性高血压，报告 24 小时 BP：152/81mmHg，白天 BP：151/83mmHg，夜间 ABPM：153/75mmHg，且白天收缩压节律发生反转（1.01），尽管使用了三种降压药和一种利尿剂，但剂量足够。没有明显的血容量过多迹象。然后，我们将所有日常卧床的标准 PD 切换为低钠溶液。六个月的低钠 CAPD 使我们能够降低白天（134/75mmHg）和夜间血压（122/67mmHg），恢复昼夜血压节律，超滤和残余尿量无变化。饮食和药物处方也没有改变。第二个病例是一名 61 岁的女性，在标准 CAPD（每天 3 次 5 小时卧床）中患有高血压，通过 ABPM 证实（平均 24 小时 ABPM：139/84mmHg；平均日间 ABPM：144/88mmHg 和平均夜间 ABPM：124/70mmHg）。她从 132-Na CAPD 转换为 130-Na CAPD，未改变透析时间表。没有明显的液体扩张。在低钠 CAPD 期间，抗高血压治疗（氨氯地平 10mg 和奥美沙坦 20mg）已减少到完全停药。6 个月后，我们重复 ABPM 显示平均 24 小时 ABPM（117/69mmHg）、平均日间 ABPM（119/75mmHg）和平均夜间 ABPM（111/70mmHg）有显著降低。超滤和残余尿量无变化。在这两种情况下均未报告任何副作用。
本病例报告研究表明，轻度低钠 CAPD 可能会降低高血压 ESKD 患者的血压。
