Inappropriately elevated endothelin‐1 plays a role in the pathogenesis of intradialytic hypertension

Abstract

The aim of this study is to investigate the effects of endogenous vasoactive substances on the occurrence of intradialytic hypertension (IDH) in patients during maintenance hemodialysis. Thirty-four maintenance hemodialysis patients were enrolled in this trial, and 17 of them were diagnosed with IDH (defined as an increase in blood pressure of at least 10 mmHg during or immediately after a hemodialysis session), while 17 age-matched and sex-matched controls without IDH were selected for a retrospective comparison. We collected patients' blood samples before and after a dialysis session and measured the plasma levels of N-terminal fragment brain natriuretic peptide, renin, angiotensin-II, aldosterone (ALD), angiotensin-converting enzyme (ACE), endothelin-1 (ET-1), nitric oxide (NO), norepinephrine (NOR), and adrenomedullin. The post-dialysis serum ET-1 concentrations were significantly higher (4.09 ± 2.06 vs. 2.75 ± 1.34 pg/mL, P < 0.05), while the post-dialysis ratio of NO to ET-1 was lower (17.79 ± 5.65 vs. 24.78 ± 12.04, P < 0.05) in IDH patients compared with the control group. Post-dialysis ALD and NOR values were significantly lower (P < 0.01) and ACE levels were significantly higher (P < 0.01) than the pre-dialysis concentrations only in the control and not in the IDH group. All other measured factors did not differ significantly between the groups and between pre-dialysis and post-dialysis determinations. Compared with blood angiotensin-II, ALD, ACE, NOR, adrenomedullin, N-terminal fragment brain natriuretic peptide, and NO status, inappropriately elevated ET-1 plasma concentrations may play a predominant role in the pathogenesis of IDH.

Effects of respiratory muscle training on endothelium and oxidative stress biomarkers in hemodialysis patients: A randomized clinical trial

“…Another important finding in the present study is the considerable reduction in blood pressure after RMT. To better investigate this point, we analyzed serum levels of endothelin-1, a potent vasoconstrictor that is increased in hemodialysis patients [35]. Here, we demonstrated a near 50% reduction of endothelin-1 in the training group.…”

New Insights into the Pathogenesis of Intradialytic Hypertension

“…In the current study, pre dialysis ET-1 levels were higher in the IH group and increased further in post dialysis. Similarly, other studies showed higher post-dialysis levels of ET-1 in hypertensive patients [16,17,30,31]. An inappropriate increase in ET-1 combined with a decrease in NO could play an important role in the pathogenesis of IH.…”

Different Effect of Hemodialysis on Function of Human Arterial and Venous Endothelial Cells

“…A significant rise of the EDN1 blood level was observed in patients at the end of the hemodialysis session [15]. Increased release of EDN1 from the endothelial cells may predispose patients to episodes of intradialytic hypertension [16] and in the longer term may accelerate atherosclerosis in the arterial system [17].…”