Effect of remote patient management in peritoneal dialysis on hemodynamic and volume control.

Yeter, Hasan Haci; Karacalik, Ceren; Eraslan, Esra; Akcay, Omer Faruk; Derici, Ulver; Ronco, Claudio

AIM Reduced treatment compliance in patients with peritoneal dialysis facilitates the development of fluid overload and as a result increased blood pressure and vascular stiffness in the long term. We aimed to evaluate blood pressure change and antihypertensive needs of patients within one year after changeover to remote monitoring automated peritoneal dialysis (RM-APD) and compare the effect of RM-APD and continuous ambulatory peritoneal dialysis (CAPD) on peripheral and central hemodynamic parameters, volume status of patients and antihypertensive drug needs. METHODS This was an observational and cross-sectional study. We enrolled 15 patients performing CAPD, 20 patients performing RM-APD, and 38 age, and gender-matched healthy control. We measured pulse wave velocity to assess arterial stiffness, peripheral and central hemodynamic parameters. We measured volume status of participants via bioimpedance spectroscopy. RESULTS The mean excess hydration of patients who underwent CAPD were higher than those who performed RM-APD and healthy control (p=0.02). We found that mean diastolic blood pressure, heart rate, central systolic and diastolic blood pressure, and central pulse pressure were significantly different between the RM-APD, CAPD and healthy control (p=0.02, p=0.05, p=0.007, p=0.05 and p=0.005, respectively). Post-hoc analysis of these results showed that the differences between the groups were caused by the healthy control group and the patients with underwent CAPD. Daily anti-hypertensive drug count in patients with performing RM-APD was reduced over time (p<0.001). CONCLUSION RM-APD provides better control of peripheral blood pressure and decrease of central hemodynamic parameters via controlling the excess body water.