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Peritoneal dialysis not better than haemodialysis for BP control in ESRD

18 Sep 2020
Long waiting times, cost and inconvenience of haemodialysis are off-putting to many patients.
Peritoneal dialysis (PD) poses no clear advantage over haemodialysis (HD) for overall blood pressure (BP) control in end-stage renal disease (ESRD), a recent study has found.

Researchers enrolled 38 PD patients, who were matched for age, sex, and dialysis vintage with 76 HD patients. Participants underwent 48 hours of ambulatory BP monitoring, during which BP and BP variability (BPV) were compared between groups. Researchers also included age- and sex-matched patients with stage 2–4 chronic kidney disease (CKD) whose BP were monitored for 24 hours.

Significant between-group differences were observed in systolic BP (SBP) across all monitoring periods: 48 hours (p=0.003), first 24 hours (p=0.006), and second 24 hours (p=0.001). Pairwise comparisons showed that SBP was significantly higher in both PD (p=0.003) and HD (p=0.041) patients than in the CKD controls, but no statistical difference was detected between the two dialysis groups.

Two-way mixed analysis of variance further showed that dialysis modality had no significant effect on both SBP and diastolic BP (DBP) at different time points or time intervals over a 40-hour monitoring period.

A similar pattern of interaction was found with BPV. SBP and DBP indices were statistically different when either dialysis arm was compared with CKD controls, but not when compared with each other.

“These results clearly suggest that PD is no better than HD with regard to overall BP control or short-term BP fluctuations,” researchers said. “Longitudinal studies evaluating the associations of ambulatory BP and BPV with future cardiovascular events in PD patients are needed to shed more light on the complex BP-related effects in this heavily diseased population.”

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