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Blood Pressure Control in Peritoneal Dialysis

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Nolph and Gokal's Textbook of Peritoneal Dialysis

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Abstract

Hypertension among patients on peritoneal dialysis (PD) is highly prevalent and remains often inadequately controlled. The burden and epidemiology of hypertension in this dialytic modality appear to follow similar patterns akin to in-center hemodialysis. Once an accurate diagnosis is made with the use of home or ambulatory blood pressure (BP) monitoring, management of hypertension relies firstly on non-pharmacological strategies aiming to control sodium and volume overload. Dietary sodium restriction, individualized prescription of the PD regimen according to the peritoneal transport characteristics, and appropriate use of icodextrin solutions during the long dwells are effective therapeutic approaches that facilitate the achievement of dry-weight. When BP is not adequately controlled with non-pharmacological management, antihypertensive drug therapy then becomes necessary. Choice of the appropriate antihypertensive agent should be individualized and should take into consideration the presence of comorbidities and other clinical characteristics of each patient. β-Blockers are our preferred antihypertensive drug class in pharmacotherapy of hypertension in patients on dialysis. Long-acting dihydropyridine calcium-channel-blockers and agents blocking the renin-angiotensin-system are our second- and third-line choices. In this chapter, we discuss the epidemiology, diagnosis, and management of hypertension among patients on PD. We provide a comparative evaluation between PD and in-center hemodialysis and conclude with clinical practice recommendations and a call for randomized trials to elucidate several areas of uncertainty in the management of hypertension in this high-risk population.

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Acknowledgments

Financial support: R.A. is supported by NIH 5 R01 HL126903 and a grant from VA Merit Review 1-I01CX001753.

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Authors and Affiliations

  1. Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panagiotis I. Georgianos

  2. Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Rajiv Agarwal

  3. Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA

    Rajiv Agarwal

Authors
  1. Panagiotis I. Georgianos
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  2. Rajiv Agarwal
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Correspondence to Rajiv Agarwal .

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Editors and Affiliations

  1. Nephrology, School of Medicine Department of Medicine Division of, Columbia, MO, USA

    Ramesh Khanna

  2. Dept. Medicine Div. Nephrology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands

    Raymond T. Krediet

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Georgianos, P.I., Agarwal, R. (2021). Blood Pressure Control in Peritoneal Dialysis. In: Khanna, R., Krediet, R.T. (eds) Nolph and Gokal's Textbook of Peritoneal Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-319-90760-4_34-1

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  • DOI: https://doi.org/10.1007/978-3-319-90760-4_34-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90760-4

  • Online ISBN: 978-3-319-90760-4

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