Key result
Higher ultrafiltration volume during hemodialysis was significantly associated with an increased risk of intradialytic hypertension (adjusted OR 5.17 per 1 liter increase), an effect mediated by decreased serum nitric oxide levels.
Why the study?
Does excessive ultrafiltration during hemodialysis increase the risk of intradialytic hypertension in patients on maintenance hemodialysis?
Case-Control (n=112)
No
Does excessive ultrafiltration during hemodialysis increase the risk of intradialytic hypertension in patients on maintenance hemodialysis?
Odds Ratio: 5.17 (95% CI 2.64–10.11)
p-value: p=0.001
Excessive ultrafiltration during hemodialysis is significantly associated with intradialytic hypertension, a relationship that appears to be mediated by decreased serum nitric oxide levels.
May warrant caution with ultrafiltration volumes in hemodialysis; leaves open causal nitric oxide role and need for prospective trials.
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.
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Kandarini et al. (2018) conducted a case-control in End-stage renal disease on maintenance hemodialysis (n=112). Ultrafiltration volume during hemodialysis vs. Lower ultrafiltration volume was evaluated on Intradialytic hypertension (increase in systolic BP after HD ≥10 mmHg compared with pre-HD, at least 4 times out of 6 sessions) (adjusted OR 5.17, 95% CI 2.64-10.11, p=0.001). Higher ultrafiltration volume during hemodialysis was significantly associated with an increased risk of intradialytic hypertension (adjusted OR 5.17 per 1 liter increase), an effect mediated by decreased serum nitric oxide levels.
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