Association of plasma asymmetric dimethylarginine concentration changes with intradialytic hypotension and hypertension in chronic hemodialysis patients

Abstract

Intradialytic hypertension and hypotension are both independently associated with increased morbidity and mortality among patients with chronic hemodialysis. Prior studies investigate the role of endothelial dysfunction in the mechanism of adverse intradialytic blood pressure changes. The aim of the current study was to investigate the association of plasma asymmetric dimethylarginine (ADMA), a marker for endothelial dysfunction, concentration changes pre-to-post-dialysis with both intradialytic hypertension and intradialytic hypotension. The study was a case-control study of 36 patients with chronic hemodialysis (12 patients in each group for intradialytic hypertension, intradialytic hypotension, and stable blood pressure). Intradialytic blood pressure changes were defined as increased or decreased systolic blood pressure pre-to-post-dialysis ≥10 mmHg in ≥4/6 consecutive HD sessions. Dialysis resulted in significant reduction of the plasma ADMA concentration pre-to-post dialysis in each group (0.26±0.15µmol/L, p=0.00 in patients with intradialytic hypertension; 0.18±0.15µmol/L, p=0.01 in patients with intradialytic hypotension; 0.17±0.09µmol/L, p=0.00 in patients with stable blood pressure). The reduction of plasma ADMA concentration in patients with intradialytic hypertension was significantly different compared to control group (p=0.02), albeit the insignificant difference in patients with intradialytic hypotension (p=0.78). Plasma ADMA concentration changes pre-to-post dialysis was considered as an insignificant risk factor (OR=1.96, 95%CI [0.38-9.93, p=0.41]) for intradialytic hypertension.