AMBULATORY BLOOD PRESSURE PROFILE AND BLOOD PRESSURE VARIABILITY IN PERITONEAL DIALYSIS COMPARED TO HEMODIALYSIS AND CHRONIC KIDNEY DISEASE PATIENTS

Objective: Hypertension in ESRD patients is highly prevalent and poorly controlled. Data on ambulatory blood pressure (BP) profile and BP variability (BPV) in peritoneal dialysis (PD) patients are absent. This study examined the BP profile and BPV of patients undergoing PD in comparison to hemodialysis (HD) and pre-dialysis CKD patients. Design and method: Thirty-eight PD patients were matched for age, gender and dialysis vintage with 76 HD patients and for age and gender with 38 patients with CKD stage 2–4. Patients under PD and HD underwent 48-hour and CKD patients 24-hour ambulatory BP monitoring. BP levels and BPV indexes were compared for the 48hour, 1st and 2nd 24hour, daytime and nighttime periods. Two-way mixed ANOVA analysis for repeated measurements was used to evaluate the effect of dialysis modality and time on ambulatory BP in PD and HD. Results: During all periods studied, SBP and DBP were numerically higher but not statistically different in PD than in HD patients. Systolic BP was significantly higher in PD or HD compared with predialysis CKD (PD:138.38 ± 20.97; HD:133.75 ± 15.5; CKD:125.52 ± 13.4, p = 0.003), a difference evident also during daytime and night-time periods. Repeated-measurements analysis showed no effect of dialysis modality on ambulatory BP during all periods studied. All BPV indexes studied were similar between PD and HD patients and higher than CKD individuals (1st-24hour systolic-ARV: PD: 11.86 ± 3.19; HD:11.23 ± 3.45; CKD:9.81 ± 2.49, p = 0.016). Conclusions: Average BP levels and BPV indices are similar between PD and HD patients and higher compared to CKD counterparts. The dialysis modality has no effect on ambulatory BP profile. These results suggest that PD is no better than HD with regards to overall BP control or BP fluctuations over time.