SUN-250 INDIVIDUALISED COOL DIALYSIS ALTERS THE ET-1/NO RATIO AND IMPROVES INTRADIALYTIC HYPERTENSION

Abstract

While hemodialysis lowers blood pressure in most hypertensive end-stage renal disease (ESRD) patients, some patients exhibit a paradoxical increase in blood pressure during hemodialysis. This adversely increases morbidity and mortality of hemodialysis patients. Aims: To study the effect of individualised cool dialysis [iCoolHD] on intradialytic hypertension [IDH]. To find if this is mediated by temperature mediated change in Endothelin-1[ET-1] and Nitric Oxide [NO] ratio. Objectives: To evaluate the incidence of intradialytic hypertension in patients on maintenance hemodialysis at 37°C[sHD] and iCoolHD. To evaluate the correlation between ET-1/NO ratio during sHD vs iCoolHD. Methods: All 48 dialysis patients had IDH. Each were dialysed at sHD and iCoolHD (i.e., dialysate temperature was adjusted to their basal body temperature as measured by Tympanic thermometer). For iCoolHD, the temperature of the dialysis was adjusted to the patients prevailing body temperature. The mean between group variation of 0.1-0.6°C was maintained throughout dialysis (fig1). The mean systolic blood pressure was 170.1±7 mmHg in sHD vs 166.8±6.6 mmHg in iCoolHD (fig2). Thirty four (71%) of the patients had mean systolic blood pressure higher during sHD (37C) in comparison to patients when dialyzed by iCoolHD. The difference was statistically significant in 18(37.5%) of patients. Only 2(4.1%) patients had higher mean systolic blood pressure at iCoolHD than sHD (fig3). The SN ratio of systolic blood pressure in sHD (variation in SN ratio of 11mmHg) and iCoolHD (variation in SN ratio of 4 mmHg) demonstrated better blood pressure stability during iCoolHD (fig4). During iCoolHD, all the patients had the ET-1/NO ratio < 1.0, whereas 36(75% ) of patients had ratio >0.92 (fig5). For the first time we show that individualised cool dialysis has a definite role in reducing the incidence of intra-dialytic hypertension. iCoolHD improved IDH in 38% of our cohort. ET1/NO ratio is affected by temperature modulation during dialysis. ET1/NO ratio is significantly reduced only at iCoolHD.