Stimulated Secretion of Arginine Vasopressin during Hemodialysis in Patients with Hemodialysis Hypotension

Nakayama, Masaaki; Yamada, Katsushi; Nakano, Hirofumi; Miura, Yuri; Tuchida, Hiroki; Kawaguchi, Yoshindo

doi:10.1159/000045104

Cited by 9 publications

(15 citation statements)

References 5 publications

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“…An abnormally low response would suggest that vasopressor insufficiency contributes to hypotension in these patients. One small study of 5 normotensive hemodialysis patients measured hemodynamic profiles (cardiac output, systemic vascular resistance [SVR], and BP) during a routine hemodialysis treatment (27). In this group, gradual decreases in BP were associated with increasing SVR levels.…”

Section: Discussionmentioning

confidence: 99%

Serum Vasopressin Response in Patients With Intradialytic Hypotension

Rho¹,

Perazella²,

Parikh³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and Objectives: Arginine vasopressin (AVP), an endogenous hormone with vasopressor properties, may be inadequately secreted during episodes of intradialytic hypotension (IDH).Design, Setting, Participants, and Measurements: To evaluate this, we performed a prospective, observational pilot study of 20 chronic hemodialysis patients assessing the baseline AVP level and trend of AVP with ultrafiltration in patients with a diagnosis of IDH compared with patients without IDH. Ten symptomatic IDH patients and 10 controls were enrolled and matched for age, gender, and dialysis vintage. AVP levels were obtained hourly throughout the dialysis session and during hypotensive episodes.Results: We observed that IDH patients experienced greater decreases in both systolic and diastolic blood pressure during the dialysis session despite equivalent ultrafiltration in both groups. AVP concentration did not increase in the IDH patients (5.0 ؎ 1.8) compared with controls (6.4 ؎ 6.0) (P ‫؍‬ 0.5) despite hypotensive events.Conclusions: This study suggests that symptomatic IDH patients are unable to mount an appropriate increase in AVP secretion in the setting of hypotension. These findings support the possibility of AVP as a mechanism driven therapy for patients with symptomatic IDH.

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Section: Discussionmentioning

confidence: 99%

Serum Vasopressin Response in Patients With Intradialytic Hypotension

Rho¹,

Perazella²,

Parikh³

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…Thus, besides regulating the body's water balance, AVP has the ability to increase blood pressure through systemic vasoconstriction [19,20]. The effect of AVP is normally overshadowed by other blood pressure-regulating systems like the sympathetic nervous system and renin-angiotensin system [16,29]. However, AVP becomes increasingly important in maintaining hemodynamic stability when blood pressure is endangered and/or during hypovolemia [15,20,22,30,31,32,33].…”

Section: Physiology Of Avpmentioning

confidence: 99%

“…Plasma AVP levels in patients varied widely, with some studies reporting pre-HD plasma AVP levels above the concentration regarded as the upper level of normal of 4 pg/ml [2,16,24,25,35,37,38,39,40,41,45,46,47,48,49,50,51,52,53,54], while others found pretreatment plasma AVP levels around or below 4 pg/ml [32,33,34,43,44,55,56,57] (fig. 3a).The variation in pretreatment plasma AVP levels might be due to analytical variation resulting from the use of different assays.…”

Section: Plasma Vasopressin Levels In Dialysis Patients and Healthy Imentioning

confidence: 99%

“…Twenty-six of these studies, comprising 496 patients, were eligible for the meta-analysis since these studies reported the mean and standard deviation of plasma AVP levels before and after standard HD. Several studies observed a significant increase in plasma AVP levels during HD [15,16,29,38,52,53,57], whereas the other studies did not [32,33,34,35,36,37,39,40,41,42,43,44,46,49,50,51,54,55,56,58]. Overall, plasma AVP levels showed little or no increase during standard HD (7.0 ± 4.9 and 8.8 ± 9.3 pg/ml for pre- and post-HD, respectively; p = 0.433) .…”

Section: Effect Of Dialysis On Plasma Avp Levelsmentioning

confidence: 99%

“…Although dialysis patients generally have an overactive sympathetic nervous system and renin-angiotensin system [8,9,10,11,12], the increase in peripheral resistance is insufficient to prevent intradialytic hypotension in many patients [13,14]. As a consequence, the role of the vasoconstrictor arginine vasopressin (AVP) for maintaining blood pressure may become increasingly important [15,16,17]. …”

Section: Introductionmentioning

confidence: 99%

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Dialysis Hypotension: A Role for Inadequate Increase in Arginine Vasopressin Levels? A Systematic Literature Review and Meta-Analysis

Ettema¹,

Zittema²,

Kuipers

et al. 2014

Am J Nephrol

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Background: Intradialytic hypotension is a common complication of hemodialysis (HD). Some studies have suggested that inadequate arginine vasopressin (AVP) increase could play a role in the pathogenesis of intradialytic hypotension. However, AVP levels during HD and its relation to hypotension has never been systematically studied. Summary: PubMed and Embase were searched (1970-2013, search terms ‘vasopressin' and ‘hemodialysis') for studies reporting on AVP levels during standard HD or other dialysis techniques. Observational studies reporting on AVP levels pre- and postdialysis were additionally included in a meta-analysis. Thirty-seven studies were included in the systematic literature review, of which 26 studies were eligible for meta-analysis. The main findings were that pretreatment AVP levels were higher in dialysis patients compared with healthy controls (6.4 ± 3.5 vs. 2.5 ± 1.3 pg/ml, p = 0.003) and that plasma AVP levels showed little or no increase during HD (from 7.0 ± 4.9 to 8.8 ± 9.3, p = 0.433). Significant heterogeneity was found between studies. Meta-regression analysis revealed no significant associations between AVP and patient or study characteristics. Studies on other dialysis techniques showed mixed results regarding the AVP course. The eight studies that addressed the relation between intradialytic hypotension and AVP also showed inconsistent results. Key Messages: Plasma AVP levels are higher in dialysis patients compared with healthy controls, but show little or no increase during HD. The lack of a rise in AVP levels during HD may be pathophysiologically involved in the onset of intradialytic hypotension, but firm conclusions are not possible from our review of the literature.

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Dialysis hypotension: a review of recent studies of causative factors

Kikuchi

Saitō

2001

Nephrology

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Dialysis hypotension is divided into two major categories. Intradialytic (dialysis-induced) hypotension is recognized during the dialysis session. The other recognized form is sustained or chronic hypotension continuing in the non-dialysis period.Intradialytic hypotension 1 is caused mainly by an acute change in homeostasis due to dialysis therapy. 2Rapid ultrafiltration and 3 changes in serum osmosis, electrolytes 4 and temperature 5 are considered major factors that cause intradialytic hypotension. Not only direct physical or chemical influences but also activation of humoral mediators 6 play a role in this homeostasis during the haemodialysis (HD) session.Chronic hypotension is recognized in patients after dialysis initiation. Whether long-term chronic dialysis increases the incidence of persistent hypotension is not well documented; however, long-term chronic dialysis increases the incidence of cardiovascular disease. 7,8 Pathology in the cardiovascular system, autonomic nervous system and humoral factors 9,10 derived from chronic uraemia and repeated HD stimulation are considered to influence chronic hypotension. 11Dialysis hypotension is also reported as a mortality risk in chronic HD patients.12 This paper reviews recent studies examining the factors (Table 1) that influence dialysis hypotension. BLOOD VOLUME (BV)Ultrafiltration is the main cause of changes in BV 13,14 during HD. Ultrafiltration directly causes intravascular hypovolaemia and results in plasma refilling from the extravascular into the intravascular space, at least in part owing to an increase in serum oncotic pressure.4 These balances between intra-and extravascular fluid influence the BV during the HD session.15 Furthermore, as BV decreases, compensation by way of cardiac function, 16 vascular tone and/or fluid permeability 17 has been recognized during the HD session. These reports suggest that patients with intradialytic hypotension have some dysfunction of these compensatory functions.18 Several mathematical or computerized simulations 19 of BV change during the HD session have been reported. Leypoldt et al. 13 reviewed these volume changes and the methods used to evaluate them during an HD session. In this paper, recent advances in continuous noninvasive monitoring of BV using haematocrit, 20 haemoglobin 21 or bioelectrical impedance 22,23 are discussed. Control of ultrafiltration, 24 sodium concentration 24 or dialysate temperature using these monitors in a biofeedback sense is considered to offer the most effective technical strategies for the near future. The authors have developed 25 an automatic BV-balanced ultrafiltration controller and significantly reduced the frequency of intradialytic hypotension 26 for clinically ill patients. SERUM ELECTROLYTES AND OSMOLARITYRemoval of urea and other uraemic solutes reduces serum osmolarity. Sodium and other electrolyte exchange during dialysis also influences serum osmotic pressure. Generally, serum osmolarity decreases during the dialysis session. This results in a potential shift of f...

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Stimulated Secretion of Arginine Vasopressin during Hemodialysis in Patients with Hemodialysis Hypotension

Cited by 9 publications

References 5 publications

Serum Vasopressin Response in Patients With Intradialytic Hypotension

Serum Vasopressin Response in Patients With Intradialytic Hypotension

Dialysis Hypotension: A Role for Inadequate Increase in Arginine Vasopressin Levels? A Systematic Literature Review and Meta-Analysis

Dialysis hypotension: a review of recent studies of causative factors

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