Comparison of Extracellular Volume and Blood Pressure in Hemodialysis and Peritoneal Dialysis Patients

Abstract

Background: Extracellular volume (ECV) assessment by bioimpedance analysis is a reliable technique for determining post dialysis target weight. Overhydration and dehydration are two points of dialysis patients’ fluid status and both affect blood pressure. We compared ECV and blood pressure between hemodialysis and peritoneal dialysis patients. Methods: We studied ECV of 74 (38 females and 36 males) normal subjects, 121 (63 females and 58 males) stable chronic hemodialysis and 84 (57 females and 27 males) stable chronic peritoneal dialysis patients. ECV as a percentage of body weight was designated ECV%. An ECV% over 28% in male patients and over 25% in females was defined as overhydration according to the 100th percentile of normal subjects. An ECV% below 21% in male patients and below 18% in females was defined as dehydration. Hypertension was defined as systolic blood pressure >140 mm Hg or diastolic blood pressure >90 mm Hg. Results: In male and female hypertension and normotension, the ECV% of peritoneal dialysis patients was significantly higher than that of hemodialysis patients (all p < 0.0001). The overhydration frequency of peritoneal dialysis patients was significantly higher than that of hemodialysis patients (p < 0.0001). The dehydration frequency of peritoneal dialysis patients was significantly less than that of hemodialysis patients (p < 0.01). The proportion of hypertension in peritoneal dialysis patients was higher than that in hemodialysis patients, but with no significant difference (p = 0.085). All male and female patients with overhydration had hypertension in either the hemodialysis or peritoneal dialysis group. Patients with dehydration usually had normotension, but some of them had hypertension. Conclusions: (1) Overhydration and hypertension are more common in peritoneal dialysis patients than in hemodialysis patients. (2) Dehydration is noticed in hemodialysis patients, but not in peritoneal dialysis patients.

An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry)

“…Although none of these studies used PD as a comparison group, it is plausible that some of the known benefits of HHD over facility HD also apply when comparing HHD with PD. Indeed, although PD allows constant ultrafiltration, total fluid removal can sometimes be limited and possibly, lead to hypervolemia and hypertension (44)(45)(46)(47). Comparison of clearance quality between PD and HD is limited, although it seems reasonable to postulate that patients treated with long or long/frequent HHD receive a higher dialysis dose than most patients on PD.…”

The relation between apelin levels, echocardiographic findings and carotid intima media thickness in peritoneal dialysis patients

“…They reported that overhydration and hypertension are more common in PD patients than in HD patients. 25 Thus, in PD patients, serum apelin level can be higher than HD patients because they are more often hypervolemic than HD patients. In a different study performed by Koç et al, they found that LVMI was significantly higher in CAPD patients with uncontrolled hypertension.…”

Total Body Water and Failure to Control Blood Pressure by Medication in Hemodialysis Patients

“…Bioelectrical impedance (BIA) is a simple and low-cost method that can be useful in clinical practice to estimate the volume overload in HD patients [7,8,9]. However, until the present time, few studies showed parameters for the interpretation of the data provided by BIA associating them with total body water (TBW) or BP control.…”