Key result
Intradialytic hypertension in hemodialysis patients is associated with impaired vascular endothelial nitric oxide regulation, characterized by lower L-citrulline and ACE II, and higher collectrin and VEGF-C levels.
Why the study?
Intradialytic hypertension independently predicts adverse clinical outcomes in hemodialysis patients, but little is known about its pathophysiological mechanisms.
Does the endothelial microenvironment and monocytic VEGF-C expression differ in hemodialysis patients with intradialytic hypertension compared to those with normal blood pressure?
Observational (n=62)
No
Does the endothelial microenvironment and monocytic VEGF-C expression differ in hemodialysis patients with intradialytic hypertension compared to those with normal blood pressure?
Intradialytic hypertension is associated with impaired vascular endothelial nitric oxide regulation and increased monocytic VEGF-C expression, suggesting endothelial dysfunction plays a key role in its pathogenesis.
Endothelial changes in intradialytic hypertension are hypothesis-generating; prospective trials needed before any clinical translation in hemodialysis.
Background: Intradialytic hypertension is identified as an independent predictor of adverse clinical outcome in hemodialysis patients. Little is known about its pathophysiological mechanism. Objective: The aim of this study is to provide new insights into the mechanisms underlying this arterial pressure dysregulation. Methods: 62 subjects on chronic hemodialysis were included in this study. Blood pressure was monitored before, during and following each dialysis session for a 3-month period. Pre- and post-dialysis blood samples were drawn from all the subjects to perform immunoassays, monocyte extractions and western blot analyses. Results: Blood pressure values separated the subjects with in two groups: normal blood pressure (n=53) and intradialytic hypertension (n=9) groups. Renin, angiotensin converting enzyme I and aldosterone plasma concentrations significantly diverged between the groups. Vascular endothelial nitric oxide assessment revealed significantly lower plasma L-citrulline and angiotensin-converting enzyme II in post-dialysis intradialytic hypertensive patients, along with high endothelin I and asymmetric dimethylarginine concentrations. Plasma collectrin levels were significantly higher in pre and post-dialysis intradialytic hypertensive group compared to a normal blood pressure group. Post-dialysis interleukin 6 was significantly higher in intradialytic hypertensive group compared to normal blood pressure group. Finally, pre-dialysis intradialytic hypertension was associated with significantly higher circulating vascular endothelial growth factor C with monocytic up-regulation of vascular endothelial growth factor C/tonicity-responsive enhancer binding protein expression. Conclusion: Impairment of vascular endothelial nitric oxide key regulatory elements, as well as monocytic vascular endothelial growth factor C seems to be more prevalent in intradialytic hypertension. These clues could pinpoint novel therapeutic interventions in intradialytic hypertension management.
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Hajal et al. (2018) conducted an observational in End-stage renal disease on chronic hemodialysis (n=62). Intradialytic hypertension vs. Normal blood pressure during hemodialysis was evaluated on Endothelial and inflammatory biomarker levels. Intradialytic hypertension in hemodialysis patients is associated with impaired vascular endothelial nitric oxide regulation, characterized by lower L-citrulline and ACE II, and higher collectrin and VEGF-C levels.
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