Is there a need for low sodium dialysis solution for peritoneal dialysis patients?
Cardiovascular disease is a leading cause of death in patients with end-stage renal disease (ESRD), and hypertension and volume expansion are highly prevalent in long-term peritoneal dialysis (PD) patients. The ADEMEX study made it clear that increased small-solute clearance does not lead to better outcomes. To manage the problem, current clinical practice uses strategies of dietary salt and fluid restriction, diuretics, antihypertensive drugs, icodextrin, extra day dwells, and (as a last resort) PD combined with hemodialysis (HD) or switch to HD. Nevertheless, the prevalence of hypertension remains alarmingly high. In this article, we briefly discuss the therapeutic measures currently available for treating hypertension and volume overload in PD patients, the limitations of those measures, and the possibility of increasing sodium removal by reducing the dialysate sodium level.
Khandelwal
Mukesh
M
Division of Nephrology, University of Toronto, Toronto, Ontario, Canada.
Oreopoulos
Dimitrios G
DG
D000959:Antihypertensive Agents / Q000627:therapeutic use; D004039:Diet, Sodium-Restricted; D004232:Diuretics / Q000627:therapeutic use; D005936:Glucans / Q000008:administration & dosage; D005947:Glucose / Q000008:administration & dosage; D015312:Hemodialysis Solutions / Q000737:chemistry*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000628:therapy*; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D010530:Peritoneal Dialysis; D012964:Sodium / Q000032:analysis*
D000959:Antihypertensive Agents; D004232:Diuretics; D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D012964:Sodium; D005947:Glucose