Transition between peritoneal dialysis modalities: Impact on blood pressure levels and drug prescription in a national multicentric cohort.

Autor:	Dariva M; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil., Guedes M; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil., Rigodon V; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.; Global Medical Office, Fresenius Medical Care, Waltham, MA, USA., Kotanko P; Renal Research Institute, New York, NY, USA.; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Larkin JW; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.; Global Medical Office, Fresenius Medical Care, Waltham, MA, USA., Ferlin B; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil., Pecoits-Filho R; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.; Arbor Research Collaborative for Health, Ann Arbor, MI, USA., Barretti P; Universidade Estadual Paulista (UNESP), Botucatu, Brazil., de Moraes TP; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
Jazyk:	angličtina
Zdroj:	Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis [Perit Dial Int] 2024 Apr 10, pp. 8968608241240566. Date of Electronic Publication: 2024 Apr 10.
DOI:	10.1177/08968608241240566
Abstrakt:	Background: Hypertension is a leading cause of kidney failure, affects most dialysis patients and associates with adverse outcomes. Hypertension can be difficult to control with dialysis modalities having differential effects on sodium and water removal. There are two main types of peritoneal dialysis (PD), automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). It is unknown whether one is superior to the other in controlling blood pressure (BP). Therefore, the aim of our study was to analyse the impact of switching between these two PD modalities on BP levels in a nationally representative cohort. Methods: This was a cohort study of patients on PD from 122 dialysis centres in Brazil (BRAZPD II study). Clinical and laboratory data were collected monthly throughout the study duration. We selected all patients who remained on PD at least 6 months and 3 months on each modality at minimum. We compared the changes in mean systolic/diastolic blood pressures (SBP/DBP) before and after modality transition using a multilevel mixed-model where patients were at first level and their clinics at the second level. Results: We analysed data of 848 patients (814 starting on CAPD and 34 starting on APD). The SBP decreased by 4 (SD 22) mmHg when transitioning from CAPD to APD ( p < 0.001) and increased by 4 (SD 21) mmHg when transitioning from APD to CAPD ( p = 0.38); consistent findings were seen for DBP. There was no significant change in the number of antihypertensive drugs prescribed before and after transition. Conclusions: Transition between PD modalities seems to directly impact on BP levels. Further studies are needed to confirm if switching to APD could be an effective treatment for uncontrolled hypertension among CAPD patients. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MD, PB and MG have no conflict to declare. BF is a student at Pontifícia Universidade Católica do Paraná. JWL and VR are employed by Fresenius Medical Care. TPM and RPF are employed by Pontifícia Universidade Católica do Paraná and are recipients of scholarships from the Brazilian Council for Research (CNPq), received consulting fees from Astra Zeneca and Baxter Healthcare and speaker honoraria from Astra Zeneca, Lilly-Boehringer, Baxter and Takeda. RPF is employed by Arbor Research Collaborative for Health and received research grants, consulting fees and honoraria from Astra Zeneca, Novo Nordisc, Akebia and Fresenius Medical Care.
Databáze:	MEDLINE
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