De volta ao básico : edema periférico como um sinal clínico útil na orientação da otimização do tratamento da hipertensão arterial sistêmica em pacientes incidentes em diálise peritoneal

Abstract

Introduction: Systemic arterial hypertension (SAH) is an important risk factor for cardiovascular disease, the main cause of death in CKD patients. Fluid overload is an important component of hypertension in these patients and peripheral edema is one of its clinical manifestations. The aim of this study was to evaluate the association of edema with blood pressure behavior in incident PD dialysis patients. Methods: We analyzed 1089 incident PD patients from December 2004 to October 2007 of a large Brazilian cohort. Patients were followed for 12 months with a monthly evaluation of blood pressure and were subdivided into 2 groups according to a clinically detectible edema status: presence (E+) or absence (E-). The behavior of systemic blood pressure during the whole study period was compared between groups using analyzes of variance for repeat measures. Results: Mean age was 58.2 ± 15.3 years with a female predominance (56.9%). Mean systolic (SAP) and diastolic blood pressure (DAP) were 156.7 ± 18.7 and 90.0 ± 12.7 respectively. There was a reduction of SAP from 156.7 ± 18.7 at 1st month to 144.5 ± 24.7 mmHg at the 5th month (p < 0.05) but not of DAP (90.0 ± 12.7 to 85.6 ± 16.3 mmHg, p = ns). Both SAP and DAP levels remained constant until the end of follow up. At baseline the group E+ presented higher SAP, mean arterial pressure (MAP), body mass index (BMI), prevalence of erythropoietin use and older age. The differences in SAP and MAP remained constant between groups until the end of follow up. Conclusion: Initiation of PD partially corrects the increased arterial blood pressure of incident PD patients. Such incomplete response is associated with the presence of edema pointing to a pivotal role of fluid overload. The presence of clinically detectible edema can be a simple and important tool to guide the optimization of systemic arterial hypertension.