MO717EFFECT ON BLOOD PRESSURE OF UNCOMPENSATED 130 MM SODIUM DIALYSATE IN CAPD PATIENT WITH RESISTANT HYPERTENSION

Background and Aims In peritoneal dialysis (PD) blood pressure (BP) control is largely unsatisfied mainly due to sodium retention. Currently, sodium removal in PD patients depends substantially on ultrafiltration. Lowering sodium in PD solution might improve sodium removal by diffusion, though the real benefit of low PD solution remains still undetermined. Method In this case report, we used a novel uncompensated glucose-based PD solution (DextroCore LS, Iperboreal Pharma, Italy) containing 130 mM sodium to treat resistant hypertension in 78-year-old female treated by CAPD (3 dwells glucose 1.5% a day, Na 132). Results At baseline, Ambulatory BP monitoring (ABPM) showed 24h-BP (152/81 mmHg), diurnal BP (151/83 mmHg) and nocturnal BP (153/75 mmHg), with inversion of circadian rhythm in systolic BP (systolic night/day ratio: 1.02), despite the use of three anti-hypertensive (doxazosin 4mg, amlodipine 10 mg, telmisartan 80 mg) and diuretic (furosemide 250 mg) at adequate doses. She had no signs of hypervolemia. We switched from standard PD (132 mM/L) to low sodium PD solution using 1.5% glucose bags with sodium concentration of 130 mM. CAPD schedule was confirmed. Second ABPM after six months reported a reduction 24h BP (131/73 mmHg), diurnal (134/75 mmHg) and nocturnal BP (122/67 mmHg), with restoring of circadian BP rhythm. No change in body weight, UF and residual diuresis was found. Diet and therapy prescriptions were unmodified. No side effects were reported. Conclusion Six-months PD treatment with uncompensated glucose-based PD solution containing 130 mM sodium in all daily dwells has allowed to reduce systolic BP (-16 mmHg) in a CAPD patient affected by resistant hypertension, with no change in ultrafiltration and residual diuresis.

Fungal Peritonitis Caused by Rhodotorula mucilaginosa in a CAPD Patient Treated with Liposomal Amphotericin B: A Case Report and Literature Review

Rhodotorula mucilaginosa is a ubiquitous yeast that may cause serious peritoneal dialysis (PD) infections. A 70-year-old man receiving continuous ambulatory peritoneal dialysis (CAPD) for 6 months presented with a PD infection caused by Rhodotorula mucilaginosa. The patient was treated with intravenous liposomal amphotericin B. His peritoneal catheter was simultaneously removed and reinserted. To date, only 10 cases of Rhodotorula CAPD infections have been reported. Catheters, corticoids, cancer, and previous antibiotic therapy were the main risk factors for these infections. For most patients, the peritoneal catheter was removed, leading to a definitive transfer to hemodialysis. Along with flucytosine, amphotericin B is the main antifungal that is used. Both have a lower minimal inhibitory concentration (MIC), whereas fluconazole and caspofungin have the highest MICs. We highlighted the efficacy of liposomal amphotericin B associated with simultaneous withdrawal and reinsertion of a peritoneal catheter in a case of Rhodotorula peritonitis in a CAPD patient. Further studies are needed to evaluate the treatment of this condition.