Vasopressin and Prevention of Hypotension during Hemodialysis

Abstract

Context:The occurrence of intradialytic hypotension (IDH) during hemodialysis (HD) continues to be a main problem in patients with ESRD (end-stage kidney disease). It also negatively affects health-related quality of life. We aimed to determine vasopressin effect in decreasing IDH.Evidence Acquisition:We reviewed clinical and experimental literature in a variety of sources, including PubMed, Current Content, Scopus, Embase, and Iranmedex regarding the possible effect of vasopressin administration in prevention of hypotension during HD to clarify its mechanism, efficacy, and safety.Results:Although arginine vasopressin is widely recognized for its anti-diuretic properties, it is also a well-recognized vasoconstrictor. It has been shown that the vasopressin release (as it would normally be expected) does not increase in the majority of HD patients with recurrent dialysis hypotension. In addition, it has also been reported that vasopressin secretion (due to the osmotic stimulation) is the most important mechanism in blood pressure control in ESRD patients receiving hypertonic solution for IDH. Therefore, it is suggested that vasopressin administration may improve hemodynamic stability among ESRD patients during HD. There are few clinical trials about this issue, suggesting that administration of exogenous vasopressin may be significantly associated with a decreased incidence of IDH as well as cardiovascular stability in ESRD patients in need of volume removal during HD.Conclusions:Vasopressin insufficiency may have an important role in the pathogenesis of hemodynamic instability during HD and administration of exogenous vasopressin is significantly associated with a lower incidence of IDH.

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…Nonmedication strategies for treating intradialytic hypotension, such as cardiovascular status optimization, UF rate minimization, and target-weight reassessment, should be prioritized. Medication options include midodrine, 71 arginine-vasopressin, [72][73][74][75][76] sertraline, 77,78 droxidopa, amezinium metilsulfate, 79 fludrocortisone, and carnitine. 71 In general, the evidence base for these strategies is relatively weak, with most studies being small and of short duration.…”

Impact of drugs on intradialytic hypotension: Antihypertensives and vasoconstrictors

“…However, the hypertonic saline did increase serum osmolality, leading to increased endogenous AVP secretion and an increase in BP; a similar increase in BP was observed with direct exogenous AVP infusion in that study as well . Two other studies examined the administration of exogenous intranasal AVP analogs vs placebo administered just prior to the dialysis procedure in patients prone to IDH . Both studies showed that patients in the AVP group had fewer episodes of IDH and higher nadir BP compared with placebo.…”

Screen of Uremic Patients for Toxoplasmosis Before Kidney Transplantation

“…Toxoplasmosis is an opportunistic pathogen among immunocompromised patients including solid organ transplant recipients and it has been recognized as a potential donor-to-host transmission infection after transplantation (2-5). It can contribute in increment of morbidity and mortality in these patients (6)(7)(8)(9)(10)(11)(12)(13).…”