Title:
Hypotension in peritoneal dialysis-more than hypovolemia

Marina Avramovic¹

1. Institute of Nephrology and Hemodialysis

E-mail address corresponding author:
posta@ptt.yu

Background:
Hypotension in peritoneal dialysis is relatively rare problem. It occurs as an acute or chronic event in app. 12% patients. Hypotension has a dramatic impact on survival of dialysis patients. The main cause of hypotension in peritoneal dialysis is hypovolemia in most studies. Most of the patients do have hypotension without an obvious cause.

Methods:
We evaluated 104 patients on peritoneal dialysis in PD Department in Institute of Nephrology and Hemodialysis, Medical School of Nis. Patients were regularly followed once a month during 2004. The patient's data were recorded: 1. clinical parameters: age, gender, renal disease, dialysis vintage (prior hemodialysis and/or peritoneal dialysis), body weight, BMI, blood pressure (and duration of hypertension before hypotension), hydratation status; 2. blood biochemistry (sodium, potassium, lipid parameters, albumin, CRP, calcium, phosphorus, PTH); 3. dialysis adequacy parameters (residual renal function, Kt/V, peritoneal equilibration test (PET); 4. echocardiografic evaluation 5. Valsalva manoever. All patients were divided into 2 groups: hypotension from the start of peritoneal dialysis treatment (chronic hypotension-C)and group with acute hypotension (A). Statistical analysis is made by SPSS 10.0 for Windows. Statistical data were presented as mean + SE. Differences between groups were compared with Mann-Whitney test for nonparametric data. A P-value<0.05 was considered significant.

Results:
The total of 13 patients (12.5%)were hypotensive during the study period:2 were hypotensive from start of dialysis (C) and 11 were with acute hypotension (A). Pts. age: A:52+1; C:57.4; all:56.6 yrs. Gender: male/female=8/5. Previous HD duration: A:17+16;C:150+54;all:37+20 moth.Prevoius hypertension:11 out of 13.Renal disease: GN:2, ADPKD:2,Diabetes:2, Py chr:2, Tu:1, Calculosis:1,Ishaemic nephr:1, unknown:2. PD duration (months): A:14.3, C:21.5, all:15.1. BMI:A:>18;C:<18, PTH:A:148+53,C:172+30. RRF-A:562+160, C:0; Kt/V-A:2.08; C:1.72; PET-A:LA,HA,H, C:HA. Patients in C group were longer on HD (p<0.05),were malnourished (p<0.05) and had higher values of PTH(p<0.05).

Conclusion:
The most common cause of hypotension in our patients was cardiac failure of diastolic origin in 3 patients and systolic in 2 pts. Only in 2 pts. hypovolemia was the cause of hypotension. The other causes were:autonomic dysfunction-3, sepsis-1, pulmonary embolism-1 and pericarditis-1 pat. In every hypotensive patient on PD as a cause of hypotension cardiac failure should be suspected.

Subject:
Peritoneal Dialysis

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