Low-Sodium Versus Standard-Sodium Peritoneal Dialysis Solution in Hypertensive Patients: A Randomized Controlled Trial

Himmele, Rainer; Gauly, Adelheid; Schwenger, Vedat; Vychytil, Andreas; Kopriva, G.; Sande, Frank M. van der; Konings, Constantijn; Rensma, Pieter L.; Buren, Marjolijn van; Vleming, Louis‐Jean; Książek, Andrzej; Klinger, Milton E.; Rutkowski, Bolesław; Mysliwiec, M.; Nowicki, Michał; Sułowicz, W; Grzeszczak, W; Tam, Paul; Ouimet, Denis

doi:10.1053/j.ajkd.2015.07.031

Cited by 45 publications

(35 citation statements)

References 25 publications

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“…These outcomes were attributed to a reduction in thirst and fluid intake in the treatment group, potentially reducing fluid overload and urine excretion (similar to salt-restricted diet intervention), which led to a significant reduction in renal Kt/V in the treatment group. There was a trend towards improved blood pressure control in the low-sodium group although more patients developed hyponatraemia than the control group [81]. In light of the paucity of evidence to date and the presence of some safety signals, low-sodium PD solutions cannot be routinely recommended for clinical practice at this stage.…”

Section: Pd Solutions: Futurementioning

confidence: 95%

Peritoneal Dialysis Solutions

Mahmood¹,

Cho²,

Johnson³

2016

Some Special Problems in Peritoneal Dialysis

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Conventional peritoneal dialysis PD solutions are characterized by several undesirable characteristics, including acidic pH . . , high glucose concentrations . . g/L , hyperosmolarity mOsm/kg and relatively high concentrations of glucose degradation products GDPs . These characteristics have been shown to result in adverse clinical outcomes, including acute peritoneal membrane toxicity manifested as inflow pain , chronic peritoneal toxicity including membrane failure, ultrafiltration failure, peritonitis and encapsulating peritoneal sclerosis and adverse systemic sequelae including hyperglycaemia, dyslipidaemia, metabolic syndrome, cardiovascular disease and residual renal function decline . Consequently, there has been a great interest in manufacturing newer solutions with more biocompatible features to mitigate these adverse effects. This has led to the development of neutral-pH, low or ultralow GDP solutions, glucose-sparing PD solutions icodextrin and amino acid solutions , solutions using alternative osmotic agents such as hyperbranched polyglycerol and low-sodium PD solutions. The aim of this chapter is to provide an up-to-date comprehensive review of all types of PD solutions that are currently available, including their impact on patient-level outcomes.

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Section: Pd Solutions: Futurementioning

confidence: 95%

Peritoneal Dialysis Solutions

Mahmood¹,

Cho²,

Johnson³

2016

Some Special Problems in Peritoneal Dialysis

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“…For haemodialysis patients, restricting sodium intake and increasing sodium removal by the use of lower dialysate sodium concentrations leads to an improvement in blood pressure control [19][20][21]. Similarly, both dietary sodium restriction and lower sodium dialysates been reported to lower blood pressure in peritoneal dialysis patients in the short term [13,22].…”

Section: Discussionmentioning

confidence: 99%

Estimated dietary sodium intake in peritoneal dialysis patients using food frequency questionnaires and total urinary and peritoneal sodium losses and assessment of extracellular volumes

Amalia

Davenport

2018

Eur J Clin Nutr

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“…The glucose concentration can be increased in these solutions to maintain osmotic pressure and prevent decline in ultrafiltration (i.e., compensated low-sodium PD solutions). In a randomized controlled trial on 108 patients treated with CAPD, use of a modestly low-sodium solution (i.e., 125 mmol/L) in all dwells resulted in a marked increase in SR by 50 mmol/day [27]. The authors observed a trend towards decreased thirst in the low-sodium group.…”

Section: Potential Future Approachesmentioning

confidence: 99%

Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

2019

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Background: Peritoneal dialysis (PD) has emerged as a mechanistically relevant therapeutic option for patients with heart failure (HF), volume overload, and varying degrees of renal dysfunction (i.e., chronic cardiorenal syndrome). Congestion has been identified as a potent ominous prognostic factor in this patient population, outperforming a number of established risk factors. As such, excess fluid removal is recognized as a relevant therapeutic target in this setting. Methods: Accumulating evidence points to the importance of sodium removal as part of any decongestive strategy because extraction of sodium-free water has little or no impact on the outcomes of these patients. Hence, optimization of sodium removal by PD should be the primary focus in the setting of HF and cardiorenal syndrome, especially if PD is started when the patient still has adequate residual renal function for clearance of waste products. Results: Herein, we provide an overview of approaches that can tailor PD treatment to the patients’ characteristics and clinical needs (e.g., choice of PD modality) to fully exploit its decongestive properties. Other methods that could prove helpful in the future will also be briefly discussed. Conclusion: While these strategies could help with efficient sodium extraction and volume optimization, future studies are needed to evaluate their impact on the outcomes of this specific patient population.

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Low-Sodium Versus Standard-Sodium Peritoneal Dialysis Solution in Hypertensive Patients: A Randomized Controlled Trial

Abstract: The noninferiority of the low-sodium PD solution for total Kt/Vurea could not be proved; however, it showed beneficial clinical effects on sodium removal and BP.

Cited by 45 publications

References 25 publications

Peritoneal Dialysis Solutions

Peritoneal Dialysis Solutions

Estimated dietary sodium intake in peritoneal dialysis patients using food frequency questionnaires and total urinary and peritoneal sodium losses and assessment of extracellular volumes

Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

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