Volume expansion and sodium balance in peritoneal dialysis patients. Part I: Recent concepts in pathogenesis.
Cardiovascular disease is a leading cause of death in patients with end-stage renal disease. Uncontrolled hypertension and volume expansion contribute to alternations in left ventricular geometry and are independent predictors of poor survival in dialysis patients. Excessive salt intake is a major handicap with loss of residual renal function. Sodium removal becomes inadequate in the face of declining residual renal function. Continued salt intake and inadequate sodium removal lead to volume expansion, which aggravates arterial hypertension. In part I of this two-part review, we consider information on dietary salt intake and its relationship to blood pressure and volume control in peritoneal dialysis (PD) patients. In addition, we review recently published studies on the use of various PD modalities to remove sodium, emphasizing the significance of volume expansion and uncontrolled hypertension in PD patients. Part II reviews the various measures available to enhance sodium and fluid removal in PD patients.
Khandelwal
Mukesh
M
Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
Kothari
Jatin
J
Krishnan
Murali
M
Liakopoulos
Vassilis
V
Tziviskou
Efstathia
E
Sahu
Krishna
K
Chatalalsingh
Carole
C
Bargman
Joanne
J
Oreopoulos
Dimitrios
D
D001835:Body Weight; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D010530:Peritoneal Dialysis / Q000009:adverse effects; D012964:Sodium / Q000378:metabolism*; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000503:physiopathology*
D012964:Sodium