Abstract
Background: Intradialytic hypertension is one of many complications during Hemodialysis (HD). The mechanism of intradialytic hypertension is currently unclear. Objective: This research aims to understand the association between excessive Ultrafiltration (UF) and intradialytic hypertension episode and its relationship with changes in endothelin-1 level (ET-1), Asymmetric Dimethylarginine (ADMA) level and Nitric Oxide (NO) level during HD. Methods: This study utilized a case-control design. A sample of one hundred and eleven patients who were already undergoing maintenance HD for more than three months was included. Serum levels of NO, ET-1, and ADMA were examined before and after HD; samples were followed by as much as six times consecutive HD session, in which ultrafiltration and blood pressure during HD were noted. Results: From 112 samples obtained, 32.1% (36/112) had intradialytic hypertension. Using regression analysis, we found a significant association between changes in NO levels and intradialytic hypertension. We found a significant association between excessive UF and intradialytic hypertension (p=0.001), adjusted OR=5.17. Path analysis showed the existence of a significant relationship between UF volume during HD and intradialytic hypertension (CR 5.74; p<0.01), as well as a significant relationship between UF volume during HD and NO levels (CR -3.70: p<0.01). There was a direct relationship between NO serum levels with intradialytic hypertension (CR -7.08: p<0.01). Conclusion: Excessive UF during HD plays a role in intradialytic hypertension episode through decreased NO serum levels. There was no clear role of ADMA and ET-1 serum levels on intradialytic hypertension episode.
Highlights
Hemodialysis (HD) remains as one of the management procedures in order to substitute a part of the renal function.1874-303X/18 2018 Bentham OpenUltrafiltration during Hemodialysis Plays Nitric Oxide (NO)The Open Urology & Nephrology Journal, 2018, Volume 11 61This action is routinely performed in patients with stage V Chronic Kidney Disease (CKD) or Chronic Renal Failure (CRF) [1]
Excessive UF during HD plays a role in intradialytic hypertension episode through decreased NO serum levels
There was no clear role of Asymmetric Dimethylarginine (ADMA) and ET-1 serum levels on intradialytic hypertension episode
Summary
Hemodialysis (HD) remains as one of the management procedures in order to substitute a part of the renal function.1874-303X/18 2018 Bentham OpenUltrafiltration during Hemodialysis Plays Nitric Oxide (NO)The Open Urology & Nephrology Journal, 2018, Volume 11 61This action is routinely performed in patients with stage V Chronic Kidney Disease (CKD) or Chronic Renal Failure (CRF) [1]. Intradialytic hypertension, defined as an increase in systolic BP during HD, is a relatively common problem observed in about 5-15% of the maintenance HD population [6 - 8]. It is currently receiving attention since the occurrence of intradialytic hypertension would affect the adequacy of HD and mortality [8]. Several elements were suggested to cause intradialytic hypertension, i.e., Renin-Angiotensin-Aldosterone System (RAAS) activation due to hypovolemia, ultrafiltration (UF) duration, excess activity of sympathetic nervous system, K+ and Ca2+ variation during HD, fluid overload, Erythropoietin (EPO) therapy-induced increased of blood viscosity, rise in Cardiac Output (COP), omission of antihypertensive medications during HD and vasoconstriction due to endothelin-1 (ET-1) [1].
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