title: Hypertension, cardiac state, and the role of volume overload during peritoneal dialysis.
abstract: The cardiac state and the prevalence of high blood pressure (BP) were analyzed in 21 pediatric patients (mean age 5.3 +/- 5.3 years) on chronic peritoneal dialysis (CPD), the aim being to specify the impact of hypervolemia in the etiology of hypertension. C- and N-terminal atrial natriuretic peptide (ANP-C, ANP-N) were measured as possible additional markers of hypervolemia. Baseline investigations were carried out 0.2 years after initiation of PD, and repeated after 0.9 +/- 0.2 years. Fifty-two percent of the patients had high BP, and in 40% the nocturnal BP decline was decreased. Left ventricular hypertrophy was present in 45%, but the systolic and diastolic functions of the heart were not impaired. Left ventricular mass correlated significantly with the severity of hypertension and with ANP-N (r = 0.79, P < 0.01 and r = 0.66, P < 0.01, Spearman rank correlation). Significant correlations were also found between the severity of hypertension and ANP-N and ANP-C (r = 0.82, P < 0.01 and r = 0.66, P < 0.01, Spearman rank correlation). High BP and cardiac impairment were more frequent in the younger and nephrectomized patients in whom volume overload seemed to be the most-important etiological factor. Our results suggest further that an ANP-N over 3.0 nmol/l combined with hypertension is strongly indicative of volume overload in patients on PD.
authors.affiliation: Hospital for Children and Adolescents, University of Helsinki, Pediatric Nephrology and Transplantation, Stenbäckinkatu 11, PO Box 281, 00290 Helsinki, Finland. Tuula.Holtta@hus.fi
authors.forename: T
authors.initials: T
authors.lastname: Hölttä
authors.forename: J M
authors.initials: JM
authors.lastname: Happonen
authors.forename: K
authors.initials: K
authors.lastname: Rönnholm
authors.forename: F
authors.initials: F
authors.lastname: Fyhrquist
authors.forename: C
authors.initials: C
authors.lastname: Holmberg
mesh_terms: D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D006940:Hyperemia / Q000150:complications*; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D009392:Nephrectomy; D010530:Peritoneal Dialysis; D015995:Prevalence
chemical_list: D015415:Biomarkers; D009320:Atrial Natriuretic Factor