Hypertension in peritoneal dialysis patients: epidemiology, pathogenesis, and treatment

Hypertension is prevalent in an estimated 29% to 80% of patients treated with peritoneal dialysis (PD). Cardiovascular disease represents the most common cause of mortality in this population, and hypertension (HTN) plays an important role. Volume overload is prevalent in PD patients because of liberal intake of fluids and loss of residual renal function (RRF). Noncompliance with salt restriction causes weight gain and makes HTN more difficult to manage. Physiology of the peritoneal membrane and its transport characteristics governs the ultrafiltration rate and consequently both volume and HTN. Therapeutic options for blood pressure control are ultrafiltration through the osmotic or colloid osmotic effects of dialysis solutions, salt restriction, and the use of antihypertensive medications such as diuretics, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Loop diuretics are used to maintain urine output in nonoliguric patients. Doses may exceed 250 mg of furosemide; ototoxicity is not problematic if blood levels are monitored carefully. Preservation of RRF is important for maintaining volume control and, thereby, control of HTN.