Automated Blood Pressure Monitoring Patterns in Peritoneal Dialysis Modalities: Report from a Nephrology Reference Center in Mexico

Background: Arterial hypertension is a condition that affects most patients with chronic kidney disease and is a modifiable parameter to improve cardiovascular outcomes. Automated Blood Pressure Monitoring is considered the gold standard for surveillance. Various methods of BP measurement have been compared, including office-based measurements and self-monitoring. An analysis by Vaios demonstrated correlation between those compared to ABPM. ABPM classifies BP patterns over 24 hours, specifically during the night when it physiologically decreases, termed as Dipper. If this does not occur, it is considered non-dipper, a condition where BP figures increase, classified as Reverse Dipper, which increases CV risk. There are few studies that relates BP patterns to Renal Replacement Therapy. In a study of 38 patients, failed to demonstrate that the modality of Peritoneal Dialysis modifies BP patterns. Methods: This is a retrospective, single-center study from 2014 to 2019, involving 150 patients who underwent ABPM for the first time. 64% were male, with a mean age of 49 years. 66% were on APD and 34% on CAPD. 42% were using diuretics, 73% iRAS, 41% calcium channel blockers, 28% a-blockers, and 21% b-blockers. Results: The study found mean BP of 104 +/- 16 mmHg, daytime mean 105 +/- 16 mmHg, and nighttime mean 102 +/- 19 mmHg. In CAPD, 14% showed Dipper pattern, 36% reverse Dipper; in APD, 21% Dipper, 19% reverse Dipper. Non-parametric distribution confirmed via KS test (p<0.001). Significant difference in Dipper distributions by dialysis therapy (Mann-Whitney U test: U=2061.000, Z=-2.005, p=0.045). Significant relationship shown via Pearson's χ2 (χ2=5.023, df=3, p=0.170) and linear-by-linear association (χ2=4.260, df=1, p=0.039). Negative correlation observed through Kendall's Tau-b (τ=-0.155, p=0.045) and Spearman's Rho (ρ=-0.164, p=0.045). CAPD had more reverse Dipper compared to APD. Conclusion: Patients managed with CAPD had a statistically significant higher incidence of reverse Dipper pattern compared to those managed with APD.