Prevalence And Influencing Factors Of Apparent Treatment-Resistant Hypertension In Patient With Peritoneal Dialysis

Background and Objective:Apparent treatment-resistant hypertension(aTRH)is the most commonly used term to report resistant hypertension(RH).Patients with aTRH are more likely to suffer from cardiovascular disease,death,end-stage renal disease(ESRD)and other adverse events.With the progression of renal failure,the prevalence of aTRH has increased in chronic kidney disease(CKD)patients.There are studies on aTRH from HD patients.However,the prevalence of aTRH in peritoneal dialysis(PD)patients with higher burden of hypertension is not clear.We conducted a multi-center cross-sectional study to evaluate the prevalence of aTRH in PD patients and analyze relevant influencing factors.Meanwhile,based on the Chinese Kidney Disease Data platform,we further evaluated the prevalence of aTRH in PD inpatients and discussed the related risk factors.Methods:1.We conducted a multi-center cross-sectional study involving 1789 PD patients from 9 centers in Guangdong Province,China,from December 2019 to March 2021.General information,medication status,laboratory data and medical history of patients were obtained through outpatient questionnaires and medical records.The prevalence of aTRH was estimated by three consecutive days home blood pressure monitoring.Evaluating drug adherence through Eight-item Morisky Medication Adherence Scale(MMAS-8)and pill counting were performed to assess RH in one PD center.Related factors of aTRH were analyzed using logistic regression analysis.2.The last electronic medical record information of PD hospitalized patients was extracted from the Chinese Kidney Disease Data platform before September 2021.The prevalence characteristics of aTRH in PD inpatients were analyzed by R Programming Language software.Significant univariate variables were included in multivariate logistic regression analysis to further explore the related factors of aTRH.Results:1.The prevalence of aTRH in PD patients was estimated at 42.2%based on home blood pressure.Of those,91.4%patients were classified as uncontrolled RH,2.0%as controlled RH,and 6.6%as refractory hypertension.2.The prevalence of RH was 40.6%and 41.9%among those with medium/high adherence based on the MMAS-8 scores and the pill counting rate,respectively.3.After adjusting for age,sex,body mass index(BMI),dialysis duration,diabetes,smoking,drinking,serum creatinine,serum albumin,hemoglobin,PD ultra-filtration,urine volume,Kt/V,PD patients who were younger,with higher BMI,with lower serum albumin and poorer dialysis adequacy were significantly associated with higher aTRH incident(P<0.05).4.A total of 5094 hospitalized PD patients with hypertension were included from the Chinese Kidney Disease Data platform,and the prevalence of aTRH was 29.3%.Age,gender,BMI,diabetes,smoking,cardio-cerebrovascular history,serum creatinine,serum albumin,hemoglobin,serum phosphorus,serum sodium,blood urea nitrogen and use of erythropoiesis-stimulating agents were covariates.After adjustment,logistic regression analysis showed that younger men,high BMI,smoking,cardio-cerebrovascular history,high levels of serum creatinine,serum sodium and low levels of albumin and use of erythropoiesis-stimulating agents were associated with aTRH.Conclusions:In conclusion,the present study demonstrates a high prevalence of aTRH in PD population,which occurs in about two in five PD hypertensive patients and about one in three of PD inpatients.Nutritional status and dialysis adequacy might tightly associate with aTRH PD patients.Age,BMI,smoking,cardio-cerebrovascular history,and the level of serum creatinine,serum sodium,serum albumin and use of erythropoiesis-stimulating agents relate to aTRH in PD hospitalized patients.In the future,we should pay more attention to blood pressure management in PD patients.