Relation of changes in endothelin-1 level during dialysis with intradialytic hypertension

Abstract

Intradialytic hypertension is a major problem encountered in ESRD patients affecting 5-15% of maintenance hemodialysis patients, it is a mulifactorial condition where several mechanisms are involved. There is evidence that vasoconstriction may be a predominant mechanism for intradialytic hypertension and that ET-1 has been implicated as a causative mediator. We aimed in this work toevaluatethe role of endothelin-1 in hypertension in ESRD and relation of changes in endothelin-1 level during dialysis with intradialytic hypertension. This study was conducted in Ain Shams university hospital & Ahmed Maher Educational hospital. The protocol was in conformity to the medical ethics and informed consent was taken from each participant. We included in the study 48 ESRD on regular hemodialysis for at least 6 months before the study. Patients were divided into 2 groups: Group I: (24) ESRD patient on regular hemodialysis, with intradialytic hypertension (an increase in mean arterial blood pressure (MAP) ≥ 15 mmHg during or immediately after hemodialysis)(Inrig, 2010). Group II included (24) ESRD patients on regular hemodialysis with well controlled blood pressure. Study included patients aged between 19 and 65 years, hemodialysis sessions thrice weekly, four hours for each session using bicarbonate dialysate, low flux dialyzers and heparin as anticoagulant. Diabetic patients, patients taking ACEI or ARBs, patients who had evidence of severe infection, malignancy, or having decompensated liver cell failure were excluded from this study. All patients were subjected to the following: Full history including, clinical examination including blood pressure measurement before hemodialysis session and every half an hour throughout the session.