Abstract
BackgroundIntradialytic hypotension is a common complication of hemodialysis. The Hemocontrol biofeedback system, improving intradialytic hemodynamic stability, is associated with an initial transient increase in plasma sodium levels. Increases in sodium could affect blood pressure regulators.MethodsWe investigated whether Hemocontrol dialysis affects vasopressin and copeptin levels, endothelial function, and sympathetic activity in twenty-nine chronic hemodialysis patients. Each patient underwent one standard hemodialysis and one Hemocontrol hemodialysis. Plasma sodium, osmolality, nitrite and nitrate (NOx), endothelin-1, angiopoietins-1 and 2, and methemoglobin as measures of endothelial function, plasma catecholamines as indices of sympathetic activity and plasma vasopressin and copeptin levels were measured six times during each modality. Blood pressure, heart rate, blood volume, and heart rate variability were repeatedly monitored. Generalized Estimating Equations was used to compare the course of the parameters during the two treatment modalities.ResultsPlasma sodium and osmolality were significantly higher during the first two hours of Hemocontrol hemodialysis. Overall, mean arterial pressure (MAP) was higher during Hemocontrol dialysis. Neither the measures of endothelial function and sympathetic activity nor copeptin levels differed between the two dialysis modalities. In contrast, plasma vasopressin levels were significantly higher during the first half of Hemocontrol dialysis. The intradialytic course of vasopressin was associated with the course of MAP.ConclusionsA transient intradialytic increase in plasma sodium did not affect indices of endothelial function or sympathetic activity compared with standard hemodialysis, but coincided with higher plasma vasopressin levels. The beneficial effect of higher intradialytic sodium levels on hemodynamic stability might be mediated by vasopressin.Trial registrationClinicalTrials.gov. Identifier: NCT03578510. Date of registration: July 5th, 2018. Retrospectively registered.
Highlights
IntroductionThe Hemocontrol biofeedback system, improving intradialytic hemodynamic stability, is associated with an initial transient increase in plasma sodium levels
Intradialytic hypotension is a common complication of hemodialysis
This study investigated whether the biofeedback system Hemocontrol, characterized by initially higher dialysate and plasma sodium levels as a model for an acute and transient increase of plasma sodium levels, is associated with a different intradialytic course of vasopressin and its surrogate marker copeptin and various markers of endothelial function and sympathetic activity compared with standard hemodialysis
Summary
The Hemocontrol biofeedback system, improving intradialytic hemodynamic stability, is associated with an initial transient increase in plasma sodium levels. The dialysate sodium concentration is one of the determinants of hemodynamic stability during hemodialysis, with higher dialysate sodium concentrations resulting in higher intradialytic blood pressures and less dialysis hypotension [4,5,6,7,8]. A common assumption is that the improved hemodynamic stability during dialysis with higher dialysate sodium concentration is based on a higher plasma refill rate as a result of an increase in plasma sodium and osmolality [2, 4, 7, 9]. A rise in plasma sodium concentration during hemodialysis could affect various other blood pressure regulating systems. An increase in plasma sodium concentration may have a direct stimulating effect on the sympathetic nervous system [18,19,20,21,22]
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