Hypotension in CAPD: role of volume and sodium depletion.
The prevalence of hypotension in continuous ambulatory peritoneal dialysis (CAPD) patients varies between 10% and 16%. The main causes of hypotension in these patients include hypovolemia, antihypertensive medications, myocardial failure, and a variety of poorly understood causes, viz, severe autonomic neuropathy, amyloidosis, malignancies, adrenal insufficiency, removal of vasopressor substances by dialysis and steroid withdrawal. In addition, there are a large number of patients with hypotension due to unknown causes. Between 1989 and 1994 we had 65 of 525 CAPD patients suffering from persistent hypotension. Sixteen (25%) patients were hypovolemic, 14 improved after increasing the target weight, but 2 did not because of concurrent administration of coronary vasodilators. The various steps in the treatment of this group include fluid repletion after discontinuing anti-hypertensive medications and excluding myocardial failure, oral sodium supplementation and possibly increasing the dialysate sodium. Preventive measures include frequent assessment of the hydration status. Judicious use of diuretics is also important. Bioelectrical impedance and inferior vena caval ultrasound are two promising tools to assess the fluid status and supplement careful clinical examination.
Afthentopoulos
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IE
Division of Nephrology, Toronto Hospital, Ontario, Canada.
Shetty
A
A
Oreopoulos
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DG
D001810:Blood Volume; D001834:Body Water / Q000378:metabolism; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D009994:Osmolar Concentration; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D012964:Sodium / Q000378:metabolism*; D014883:Water-Electrolyte Imbalance / Q000150:complications
D012964:Sodium