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Kidney Week

Abstract: SA-PO671

Impaired Sodium Dipping Is Associated with Poor Blood Pressure Control in Patients on Peritoneal Dialysis

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Freire Filho, Washington Alves, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Vieira, Ana Teresa Pereira, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • dos Santos, Edilene Maria, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Araujo, Luiza Karla, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Pereira, Benedito J., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Abensur, Hugo, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Britto, Zita Maria Leme, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Elias, Rosilene M., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
Background

Overhydration is often found in patients on peritoneal dialysis (PD). There is no clear association between fluid overload and hypertension in this population. Since short dwells are associated with decreased sodium removal because of peritoneal sodium sieving, we hypothesized that impaired sodium dipping may be associated with worse blood pressure (BP) control.

Methods

This is a cross-sectional analysis of prevalent patients on PD. We evaluated sodium dipping (dialysate sodium dipping after 1 hour with 4.5% glucose bag), fluid overload (excess extracellular volume ≥ 0.39 measured by bioimpedance spectroscopy) and BP control (high BP was defined as office-measured values > 140/90 mmHg).

Results

47 patients (age 52 ± 18 years, 53% men) were included. Overhydration was found in 62% of patients and high BP in 34% of patients; sodium dipping < 5mmol/L was found in 57% of patients. (Table 1) These patients were characterized by a higher percentage of high BP (81.3% vs 18.8%, p=0.018), despite similar use of antihypertensive drugs, and no difference in overhydration status, membrane transport profile, cycles/volume PD prescription, ultrafiltration volume, and residual renal function. Sodium dipping < 5mmol/L remained significantly associated with high BP in a fully adjusted model (HR 11.8, 95% CI 2.0-68, p=0.006).

Conclusion

The association between lower sodium dipping and poor BP control suggests that dialytic sodium removal should be included as an important parameter of PD adequacy.

Table 1
 Na dipping ≥ 5 mmol/LNa dipping < 5mmol/Lp
Extracellular water/Total body water0.38 ± 0.020.39 ± 0.010.993
Systolic BP, mmHg126 ± 23137 ± 230.067
Serum Na, mEq/L140 ± 3141 ± 30.109
Renal Kt/V1.2 ± 0.51.2 ± 0.60.890
Ultrafiltration, mL556 ± 427628 ± 4400.579
Use of antihypertensive, %43.656.40.751
Classes of antihypertensive, n (%)
0-1
2
≥ 3
.
7 (35)
10 (50)
3 (15)
.
10 (37)
9 (33.4)
8 (29.6)
0.396