TY - JOUR
T1 - Extracellular Volume Overload and Increased Vasoconstriction in Patients with Recurrent Intradialytic Hypertension
AU - Van Buren, Peter Noel
AU - Zhou, Yunyun
AU - Neyra, Javier A.
AU - Xiao, Guanghua
AU - Vongpatanasin, Wanpen
AU - Inrig, Jula
AU - Toto, Robert
N1 - Funding Information:
This study comes from NIH 1K23DK096007-01A1 Patient Oriented Career Development Award (PVB) and institutional support as the Dedman Family Scholar in Clinical Care (PVB). JAN has been supported by the Ben J. Lipps Research Fellowship Program of the American Society of Nephrology Foundation for Kidney Research and the Truelson Fellowship Fund at UT Southwestern Charles and Jane Pak Center of Mineral Metabolism and Clinical Research. Research in this study was further supported by the National Center for Advancing Translational Sciences of the National Institute of Health under award number UL1TR001105 and the University of Texas Southwestern O'Brien Kidney Research Core (National Institutes of Health [NIH] grant P30DK079328). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background/Aims: Intradialytic hypertension (IH) occurs frequently in some hemodialysis patients and increases mortality risk. We simultaneously compared pre-dialysis, post-dialysis and changes in extracellular volume and hemodynamics in recurrent IH patients and controls. Methods: We performed a case-control study among prevalent hemodialysis patients with recurrent IH and hypertensive hemodialysis controls. We used bioimpedance spectroscopy and impedance cardiography to compare pre-dialysis, post-dialysis, and intradialytic change in total body water (TBW) and extracellular water (ECW), as well as cardiac index (CI) and total peripheral resistance index (TPRI). Results: The ECW/TBW was 0.453 (0.05) pre-dialysis and 0.427 (0.04) post-dialysis in controls vs. 0.478 (0.03) and 0.461 (0.03) in IH patients (p=0.01 post-dialysis). The ECW/TBW change was -0.027 (0.03) in controls and -0.013 (0.02) in IH patients (p=0.1). In controls, pre- and post-dialysis TPRI were 3254 (994) and 2469 (529) dynes/sec/cm2/m2 vs. 2983 (747) and 3408 (980) dynes/sec/cm2/m2 in IH patients (p=0.002 post-dialysis). There were between-group differences in TPRI change (0=0.0001), but not CI (p=0.09). Conclusions: Recurrent intradialytic hypertension is associated with higher post-dialysis extracellular volume and TPRI. Intradialytic TPRI surges account for the vasoconstrictive state post-dialysis, but intradialytic fluid shifts may contribute to post-hemodialysis volume expansion.
AB - Background/Aims: Intradialytic hypertension (IH) occurs frequently in some hemodialysis patients and increases mortality risk. We simultaneously compared pre-dialysis, post-dialysis and changes in extracellular volume and hemodynamics in recurrent IH patients and controls. Methods: We performed a case-control study among prevalent hemodialysis patients with recurrent IH and hypertensive hemodialysis controls. We used bioimpedance spectroscopy and impedance cardiography to compare pre-dialysis, post-dialysis, and intradialytic change in total body water (TBW) and extracellular water (ECW), as well as cardiac index (CI) and total peripheral resistance index (TPRI). Results: The ECW/TBW was 0.453 (0.05) pre-dialysis and 0.427 (0.04) post-dialysis in controls vs. 0.478 (0.03) and 0.461 (0.03) in IH patients (p=0.01 post-dialysis). The ECW/TBW change was -0.027 (0.03) in controls and -0.013 (0.02) in IH patients (p=0.1). In controls, pre- and post-dialysis TPRI were 3254 (994) and 2469 (529) dynes/sec/cm2/m2 vs. 2983 (747) and 3408 (980) dynes/sec/cm2/m2 in IH patients (p=0.002 post-dialysis). There were between-group differences in TPRI change (0=0.0001), but not CI (p=0.09). Conclusions: Recurrent intradialytic hypertension is associated with higher post-dialysis extracellular volume and TPRI. Intradialytic TPRI surges account for the vasoconstrictive state post-dialysis, but intradialytic fluid shifts may contribute to post-hemodialysis volume expansion.
KW - Bioimpedance Spectroscopy
KW - Endothelin-1
KW - Extracellular Volume
KW - Hemodialysis
KW - Intradialytic Hypertension
KW - Peripheral Resistance
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U2 - 10.1159/000450565
DO - 10.1159/000450565
M3 - Article
C2 - 27832647
AN - SCOPUS:84995792948
VL - 41
SP - 802
EP - 814
JO - Kidney and Blood Pressure Research
JF - Kidney and Blood Pressure Research
SN - 1420-4096
IS - 6
ER -