Comparison of Overhydration with Ambulatory Hypertension in Pediatric Chronic Peritoneal Dialysis: A Prospective Observational Study

Background Overhydration (OH) and hypertension are frequently encountered in children on chronic peritoneal dialysis and contribute to cardiovascular morbidity and mortality. The assessment of OH by bedside tools and its association with blood pressure needs to be addressed in children on continuous ambulatory peritoneal dialysis (CAPD). This prospective study was undertaken in children on CAPD to detect OH by lung ultrasound (OH-LU) and bioimpedance vector analysis (OH-BIVA) and to assess the association of OH with ambulatory blood pressure (ABPM). Materials and Methods Clinically stable children aged 5–18 years on CAPD were subjected to OH-LU, OH-BIVA, and ABPM at enrollment and short-term follow-up (<12 weeks). Children were categorized as OH-BIVA based on the position of the vector on a reference graph derived from 50 healthy children. Presence of >5 B-lines was defined as OH-LU. Uncontrolled ambulatory hypertension (UH) included systolic, diastolic, or mean arterial pressures ≥95th percentile. Results Fifteen children (aged 10.3 ± 2.1 years, eight girls) on CAPD for 40.3 ± 29.1 months were studied. The burden of OH-LU and OH-BIVA at enrollment was 33% and 20%, respectively, while 73% had UH. At the end of the study (median 8 (6,12) weeks), a reduction in OH-BIVA was observed in 33.3%, 40% by OH-LU with an 18% reduction in UH. There was no significant association between OH-BIVA or OH-LU and UH at enrollment or follow-up. Conclusion In clinically stable children on CAPD, the commonly observed UH was not associated with OH measured by BIVA or LU at baseline and during short-term follow-up.