RESEARCH ARTICLE


Excessive Ultrafiltration During Hemodialysis Plays a Role in Intradialytic Hypertension Through Decreased Serum Nitric Oxide (NO) Level



Yenny Kandarini*, Ketut Suwitra, Raka Widiana
Department of Internal Medicine, Division of Nephrology and Hypertension, Faculty of Medicine Udayana University Sanglah General Hospital, Denpasar, Bali, Indonesia


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© 2018 Kandarini et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Internal Medicine, Division of Nephrology and Hypertension, Faculty of Medicine Udayana University Sanglah General Hospital, Denpasar, Bali, Indonesia; Tel: +628123805344; E-mail: dr.yennykandarini@gmail.com


Abstract

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.

Keywords: Hemodialysis, Intradialytic hypertension, Ultrafiltration, NO, ADMA, ET-1.