Original paper
Blood pressure control according to prevalence of diabetes in peritoneal dialysis patients

Introduction : Hypertension (HTN) is a common problem in patients with both type 1 and type 2 diabetes. Among those with type 1 at 10 years hypertension is found in about 5-10%, at 20 years – in about 33% and at 40 years – in above 70% patients. Hypertension is also an ubiquitous finding in chronic kidney disease. It affects more than 60-80% of dialysis patients and the blood pressure control is often very poor in this group. Nonpharmacological antihypertensive therapy is usually insufficient and pharmacological treatment is often multidirectional and is still a challenge for nephrologists and diabetologists.

Aim : The aim of the study was to assess blood pressure control in patients with chronic kidney disease stage 5 treated with peritoneal dialysis according to the presence of diabetes.

Material and methods : The retrospective analysis of 80 patients with end-stage kidney disease (median age 57 years) treated with peritoneal dialysis patients in 2007-2011 was made, based on the medical documentation. The medical history, BP measurements – twice a visit during three visits, body mass index (BMI), residual diuresis, laboratory tests, the presence of peripheral edema and the echocardiography were taken. The study group was divided according to the presence of diabetes: group I – patients with diabetes, group II – patients without diabetes. The kind of using hypotensive drugs and the connection between the presence of diabetes and the blood pressure control, the presence of volume overload and the rate of residual diuresis was analyzed.

Results : The group I (with diabetes) contained 23 patients (28%), and group II (without diabetes) 57 persons (71%). Five patients had diabetes type 1 (21% of group I) and 18 (78%) diabetes type II. The patients from the group I was significantly older (Me = 64 years vs. Me = 53 years, p < 0.05) and they were treated with dialysis significantly longer (Me = 39 months vs. Me = 17 months, p < 0.05). There were no differences between study groups in the frequency of blood pressure rates above 140/90 mmHg and the amount of diuresis. There were higher BMI rate (Me = 30.7 vs. Me = 23.67 kg/m²) and the more often prevalence of peripheral edema (78% vs. 49%) in the group I, p < 0.05. Patients with diabetes had a higher level of phosphorus and parathormon (p < 0.05). There were no difference in the prevalence of hypotensive drugs in the study groups. Echo revealed significantly wider dimension of the ascending aorta (3.6 cm vs. 3.3 cm, p = 0.041) and interventricular septum (1.3 vs. 1.1 cm, p = 0.016) in patients with diabetes. The patients with diabetes type 1 were statistically younger, with the lower BMI, the diastolic blood pressure rate and the amount of residual diuresis comparing to the patients with diabetes type 2.

Conclusions : There were no significant influence of diabetes on the blood pressure control in peritoneal dialysis patients and we affirmed the higher risk of volume status and heart hypertrophy in the peritoneal dialysis patients with diabetes. There should be the more aggressive salt dietary restriction and the better volume control in our patients, particularly in those with diabetes. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers should be used more widely, particularly in patients with the high risk of cardiovascular disease. We also confirmed the relationship between BMI and a blood pressure control.