Low-Sodium Versus Standard-Sodium Peritoneal Dialysis Solution in Hypertensive Patients: A Randomized Controlled Trial

• DOI: 10.1053/j.ajkd.2015.07.031
• Publication Date: 2015-09-24T15:53:03Z
• Authors: Bolesław Rutkowski; Paul Tam; Frank M. van der ...; Andreas Vychytil; Vedat Schwenger; Rainer Himmele; Adelheid Gauly; V. Schwenger; A. Vychytil; G. Kopriva; F.M. van der Sande; C.J.A.M. Konings; P.L. Rensma; M. van Buren; L.J. Vleming; A. Książek; M. Klinger; B. Rutkowski; M. Myśliwiec; M. Nowicki; W. Sułowicz; W. Grzeszczak; P. Tam; D. Ouimet
• Keywords: Adult; Male; CAPD PATIENTS; BLOOD-PRESSURE; hypertension control; Peritoneal dialysis (PD); 03 medical and health sciences; REMOVAL; 0302 clinical medicine; randomized controlled trial (RCT); Double-Blind Method; Peritoneal Dialysis, Continuous Ambulatory; PD solution; Humans; KINETICS; Antihypertensive Agents; Aged; dialysis adequacy; MORTALITY; Osmolar Concentration; Sodium; SALT; blood pressure; sodium balance; dialysis dose; Middle Aged; Kt/V; FLUID; TRANSPORT; Hemodialysis Solutions; 3. Good health; renal replacement therapy (RRT); Nephrology; Hypertension; low-sodium dialysis solution; Kidney Failure, Chronic; NA; Female; double-blind; sodium elimination

Peritoneal dialysis (PD) solutions with reduced sodium content may have advantages for hypertensive patients; however, they lower osmolarity and solvent drag, so the achieved Kt/Vurea be lower. Furthermore, increased transperitoneal membrane gradient can influence balance consequences blood pressure (BP) control.Prospective, randomized, double-blind clinical trial to prove noninferiority of total weekly low-sodium versus standard-sodium PD solution, confidence limit above clinically accepted difference -0.5.Hypertensive patients (≥ 1 antihypertensive drug, including diuretics, or office systolic BP ≥ 130 mmHg) on continuous ambulatory therapy from 17 sites.108 were randomly assigned (1:1) 6-month treatments either (125 mmol/L sodium; 1.5%, 2.3%, 4.25% glucose; osmolarity, 338-491 mOsm/L) (134 356-509 solution.Primary end point: Kt/Vurea; secondary outcomes: control, safety, tolerability.Total was determined 24-hour dialysate urine collection; BP, by measurement.Total after 12 weeks 2.53 ± 0.89 in group (n = 40) 2.97 1.58 control 42). The could not confirmed. There no peritoneal (1.70 0.38 low sodium, 1.77 0.44 standard sodium), but there a renal (0.83 0.80 1.20 1.54 sodium). Mean daily removal at week 1.188 g higher (P < 0.001). changed marginally decreased resulting less medication.Broader variability study population than anticipated, particularly regarding residual kidney function.The solution proved; it showed beneficial effects BP.