Abstract
Objective
This study aimed to investigate the relationship between fluid and sodium excretion and blood pressure, echocardiographic parameters, and arterial stiffness in peritoneal dialysis (PD) patients and to evaluate the effect of sodium excretion on patients’ survival.
Method
This study was conducted as a single-centered, prospective study in the Department of Nephrology in Erciyes University. The patients included in the study were followed up for 3 years. Seventy PD patients were included in the study. We recorded demographic characteristics, biochemical parameters, urine and peritoneal ultrafiltration volumes, peritoneal equalization tests, ambulatory blood pressure measurements, and echocardiographic measurements. We measured the amount of total sodium excretion of the patients and arterial stiffness using pulse wave velocity (PWV). Patients were divided into two groups based on the amount of total sodium excretion: low group and high group. We compared these groups in terms of cardiac and biochemical parameters.
Results
When demographic data and biochemical values were compared, there was no significant difference between the two groups. NT-proBNP level, systolic blood pressure, and mean arterial pressure were significantly higher in the low group (p: 0.02, p: 0.031, p: 0.05, respectively). Net ultrafiltration was significantly higher in the high group (p: 0.03), was also found to be high in patients with high sodium excretion (p: 0.001). Negative correlations were found between sodium excretion and net ultrafiltration, NT-Pro BNP, and PWV. At the end of the 3-year follow-up, the survival rate was shorter and the mortality rate was higher in the low group (p: 0.042).
Discussion and conclusion
Fluid status in PD patients can affect arterial stiffness both directly and through hypertension. Correction of hypervolemia has the potential to not only prevent hypertension and left ventricular hypertrophy, but also to improve arterial stiffness, a well-known cardiovascular risk factor. The mortality rate was higher in PD patients with low total sodium excretion. Therefore, these patients should be followed more closely to ensure volume control.
Similar content being viewed by others
References
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO (2012) clinical practice guideline for the evaluation and management of chronic kidneyd isease. Kidney Int Suppl 2013(3):1–150
Tokgöz B (2009) Clinical advantages of peritoneal dialysis. Perit Dial Int 29(Suppl 2):S59–61
United States Renal Data System (2016) 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda
De Jager DJ, Grootendorst DC, Jager KJ, vanDijk PC, Tomas LM, Ansell D, Collart F, Finne P, Heaf JG, De Meester J, Wetzels JF, Rosendaal FR, Dekker FW (2009) Cardiovascular and non cardiovascular mortality among patients starting dialysis. JAMA 302:1782–1789
Levey AS, Beto JA, Coronado BE et al (1998) Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? Am J Kidney Dis 32(853):906
Brunner FP, Selwood NH on be half of the EDTA Registry Committee (1992) Profile of patients on RRT in Europe and death rates due to majör causes of death groups. Kidney Int 42[Suppl 38]:S4–S15.
Zoccali C (2000) Cardiovascular risk in uraemic patients is it fully explained by classical risk factors? Nephrol Dial Transpl 15(454):7
Locatelli F, Marcelli D, Conte F et al (2000) Cardiovascular disease in chronic renal failure: the challenge continues. Nephrol Dial Transpl 15(Suppl 5):S69–S80
Arnett DK, Evans GW, Rley WA (1994) Arterial stiffness a new cardiovascular risk factor. Am J Epidemiol 40(8):669–682
Blacher J, Guerrin A, Pannier B et al (1998) Arterial remodelling anditsimpact on mortalitiy in uremic patients. Third İnternational Workshop Structure and Function of Large Arteries, Versailles
Ateş K, Nergizoğlu G, Keven K, Sen A, Kutlay S, Ertürk S, Duman N, Karatan O, Ertuğ AE (2001) Effect of fluid and sodium removal on mortality in peritoneal dialysis patients. Kidney Int 60(2):767–776
Watson PE, Watson ID, Batt RD (1980) Total body water volumes for adult males and females estimated from simple anthropometric measurements. Am J Clin Nutr 33:27–39
Yasue H, Yoshimura M, Sumida H et al (1994) Localizationand mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 90:195–203
Munagala VK, Burnett JC Jr, Redfield MM (2004) The natriuretic peptides in cardiovascular medicine. Curr Probl Cardiol 29:707–769
Lo WK, Ho YW, Li CS, Wong KS, Chan TM, Yu AW, Ng FS, Cheng IK (2003) Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study. Kidney Int 64:649–656
Wei CM, Heublein DM, Perella MA et al (1993) Natriuretic peptidesystem in heartfailure. Circulation 88:1004–1009
Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM (1999) Impact of aortic stiffnesson survival in end-stage renal disease. Circulation 99:2434–2439
Kocyigit I, Sipahioglu MH, Orscelik O, Unal A, Celik A, Abbas SR, Zhu F, Tokgoz B, Dogan A, Oymak O, Kotanko P, Levin NW (2014) The association between arterial stiffness and fluid status in peritoneal dialysis patients. Perit Dial Int 34(7):781–790
Enia G, Mallamaci F, Benedetto FA, Panuccio V, Parlongo S, Cutrupi S, Giacone G, Cottini E, Tripepi G, Malatino LS, Zoccali C (2001) Long-term CAPD patients are volüme expanded and display more severe left ventricular hypertrophy than haemodialysis patients. Nephrol Dial Transpl 16:1459–1464
Takeda K, Nakamoto M, Hirakata H, Baba M, Kubo M, Fujishima M (1998) Disadvantage of long-term CAPD for preserving cardiac performance: an echocardiographic study. Am J Kidney Dis 32:482–487
Konings CJ, Kooman JP, Schonck M, Dammers R, Cheriex E, PalmansMeulemans AP et al (2002) Fluid status, blood pressure, and cardiovascular abnormalities in patients on peritoneal dialysis. Perit Dial Int 22:477–487
Covic A, Goldsmith DJ, Panaghiu L, Covic M, Sedor J (2000) Analysis of theeffect of hemodialysis on peripheral and central arterial pressure wave forms. Kidney Int 57:2634–2643
London GM (2002) Left ventricular alterations and end-stage renal disease. Nephrol Dial Transpl 17(Suppl 1):29–36
Caliskan Y, Ozkok A, Akagun T, Alpay N, Guz G, Polat N, Tufan F, Ecder T, Bozfakioglu S (2012) Cardiac biomarkers and non invasive predictors of atherosclerosis in chronic peritoneal dialysis patients. Kidney Blood Press Res 35(5):340–348
Nakahigashi M, Tsukaguchi H, Morimoto S, Nakano C, Ueda H, Someya K, Kusabe M, Kikuchi S, Imada T, Shiojima I (2017) Determinants of the change in arterial stiffness in peritoneal dialysis patients. Int Heart J 58(6):915–925
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kocyigit, H., Koyuncu, S., Kocyigit, I. et al. The effect of sodium exchange and dialytic biochemical parameters on blood pressure, arterial stiffness, and endothelial functions in patients with peritoneal dialysis. Int Urol Nephrol 52, 2197–2203 (2020). https://doi.org/10.1007/s11255-020-02541-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-020-02541-8