Volume expansion and sodium balance in peritoneal dialysis patients. Part II: Newer insights in management.

As noted in part I of this article, emerging evidence indicates that overt and (more commonly) subclinical volume expansion is frequent in patients on peritoneal dialysis (PD). That expansion in turn leads to hypertension. With loss of residual renal function, the hypertension becomes difficult to control even with increasing doses and varieties of antihypertensive drugs. Poor volume and blood pressure control aggravates already existing left ventricular hypertrophy and leads to increased cardiovascular morbidity and mortality. Indeed, cardiovascular events are the leading cause of death in PD patients. Part II of this article reviews various strategies available to manage fluid overload and hypertension. Also, we discuss sodium removal with various PD modalities and clinical studies related to use of low-sodium dialysis solutions.