Key result
High sensitivity C-reactive protein levels ≥3 mg/L (OR 5.06) and nitric oxide levels <25 μmol/L (OR 17.14) were significantly associated with elevated systolic blood pressure ≥20 mmHg during hemodialysis.
Why the study?
Endothelial dysfunction is thought to contribute to intradialytic hypertension, but the association of hs-CRP and nitric oxide with elevated blood pressure during hemodialysis required investigation.
Are hs-CRP and NO levels associated with elevated systolic blood pressure in ESRD patients with intradialytic hypertension?
Cross-Sectional (n=40)
No
Are hs-CRP and NO levels associated with elevated systolic blood pressure in ESRD patients with intradialytic hypertension?
Answers are grounded in this paper and cite their sources.
Elevated hs-CRP and decreased nitric oxide levels are significantly associated with a greater increase in systolic blood pressure during hemodialysis in patients with intradialytic hypertension.
BACKGROUND: Hemodialysis (HD) is a procedure to replace part of kidney function in patients with end-stage kidney disease. Hemodynamic disturbances during HD may include elevated blood pressure (BP). It is reported that about 5–15% of patients undergoing regular HD have increased BP during HD. This condition is called intradialytic hypertension (IDH). Increased high sensitivity C-reactive protein (hs-CRP) levels are associated with decreased endothelial dilatation response of blood vessels. Nitric Oxide (NO) is one of the mediators that act as a vasodilator to regulate vascular pressure. Endothelial dysfunction is one of the factors thought to contribute to the incidence of IDH. AIM: This study aimed to determine the association of hs-CRP and NO with elevated BP in IDH. METHODS: This observational cross-sectional study was conducted at Prof. Dr. R.D. Kandou General Hospital, Manado, from November 2021 to April 2022. Participants were selected through consecutive sampling methods. The levels of hs-CRP and NO were examined in all patients. The correlation between hs-CRP and NO was performed using the Spearman test, while the association of hs-CRP and NO with elevated BP was performed using the Fisher- exact test or Chi-square test. RESULTS: Forty patients were included in this study. The median hs-CRP, NO, and systolic BP (SBP) of the patients were 6.55 mg/dL (0.50–43.5), 27.77 mg/dL (3.65–72.19), and 20 mmHg (10–30), respectively. The correlation analysis showed that there was a strong significant negative correlation between hs-CRP levels and NO (r = −0.680, p = 0.000). Based on the Chi-Square or Fisher Exact test, there was a significant association between hs-CRP levels and elevated SBP (OR = 5.06; 95% CI = 1.095–23.44; p = 0.040), as well as between NO levels and elevated SBP (OR = 17.14; 95% CI = 3.063–95.938; p = 0.000). CONCLUSION: There was a significant association between hs-CRP and NO levels with elevated SBP in end-stage renal disease (ESRD) patients with IDH. ESRD on hemodialysis (ESRD on R-HD) patients with hs-CRP ≤3 mg/dL or NO levels <25 mg/dL tends to have increased SBP ≥20 mmHg after HD compared to ESRD patients with low hs-CRP or high NO levels.
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Palar et al. (2023) conducted a cross-sectional in Intradialytic hypertension in end-stage renal disease (n=40). High sensitivity C-reactive protein ≥3 mg/L vs. High sensitivity C-reactive protein <3 mg/L was evaluated on Elevated systolic blood pressure ≥20 mmHg after hemodialysis (OR 5.06, 95% CI 1.095-23.44, p=0.040). High sensitivity C-reactive protein levels ≥3 mg/L (OR 5.06) and nitric oxide levels <25 μmol/L (OR 17.14) were significantly associated with elevated systolic blood pressure ≥20 mmHg during hemodialysis.
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