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Clinical Sciences |
University of Western Australia,1 Perth, WA, Australia; University of Western Ontario,2 London, Ontario, Canada
Correspondence to: N. Boudville, Sir Charles Gairdner Hospital, School of Medicine and Pharmacology, 4th Floor G Block, Verdun Street, Nedlands, WA, 6009 Australia. nboudvil{at}cyllene.uwa.edu.au
Objectives: To examine the control of blood pressure
and volume, and the role of sodium removal in a single, large, contemporary,
automated peritoneal dialysis (APD) population where icodextrin is used
liberally and there is a policy to avoid long duration glucose-based daytime
dwells. Design: Observational cross-sectional study. Setting: A university hospital. Patients: 56 APD patients, with a mean duration on
peritoneal dialysis of 1.9 years; 50% were prescribed icodextrin. Main Outcome Measures: Blood pressure, extracellular
water volume (ECW)-to-intracellular water volume (ICW) ratio, and total
(peritoneal and urinary) sodium removal. Results: Sodium Removal: Mean total sodium removal,
while low at 102.9 ± 64.6 mmol/day, showed a wide range, with 41%
having a sodium removal of >120 mmol/day. Total sodium removal correlated
with total body water, ECW, and ICW (p < 0.001, p <
0.001, p < 0.025, respectively), as well as with height and weight
(p < 0.06, p < 0.01 respectively). On multivariate
analysis, only ultrafiltration volume and urine volume were significantly
associated with total sodium removal (r2 = 0.67,
p < 0.0001 for both). There was also a correlation between sodium
removal and urea nitrogen appearance (r2 = 0.31,
p < 0.001), with urea nitrogen appearance in turn being closely
correlated with ICW (p < 0.001). Volume Status: The ECW/ICW ratio
was 0.88 ± 0.17, which was not significantly different to that found in
hemodialysis patients without clinical evidence of fluid overload, either
predialysis (0.96 ± 0.16) or postdialysis (0.92 ± 0.16);
p = 0.07 and 0.36 respectively. Blood Pressure: Mean ±
standard deviation systolic blood pressure (BP) was 111.9 ± 18.2 mmHg
and diastolic BP was 63.3 ± 11.9 mmHg, with only 4 (7%) patients having
a systolic BP > 140 mmHg and 1 (2%) having a diastolic BP > 80 mmHg.
Median number of antihypertensives was 1 per day. Blood pressure control and
ECW/ICW ratio were similar in those with sodium removal >120 mmol/day
compared to those with sodium removal 
120 mmol/day (p = 0.39 for
SBP, p = 0.70 for diastolic BP, p = 0.24 for
ECW/ICW). Conclusions: We have shown that good blood pressure and
volume control is achievable in a large contemporary APD population with
liberal use of icodextrin and avoidance of long daytime glucose-based dwells.
Neither low nor high sodium removal was associated with more frequent
hypertension or volume expansion.
KEY WORDS: Bioimpedance; blood pressure; blood volume; hypertension; sodium.
Received 14 September 2006; accepted 4 March 2007.
This article has been cited by other articles:
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  T. T. Cnossen, C. J. Konings, F. M. van der Sande, K. M. Leunissen, and J. P. Kooman Clinical effects of icodextrin in peritoneal dialysis NDT Plus, October 1, 2008; 1(suppl_4): iv18 - iv22. [Abstract] [Full Text] [PDF]
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