Serum vasopressin response in patients with intradialytic hypotension: a pilot study.
OBJECTIVE
Arginine vasopressin (AVP), an endogenous hormone with vasopressor properties, may be inadequately secreted during episodes of intradialytic hypotension (IDH).


METHODS
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.
Rho
Mira
M
Yale University School of Medicine, New Haven, CT 06520, USA.
Perazella
Mark A
MA
Parikh
Chirag R
CR
Peixoto
Aldo J
AJ
Brewster
Ursula C
UC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D016022:Case-Control Studies; D003971:Diastole; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007022:Hypotension / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009481:Neurophysins / Q000097:blood*; D010865:Pilot Projects; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects*; D012107:Research Design; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D013599:Systole; D013997:Time Factors; D014667:Vasopressins / Q000097:blood*
C438657:AVP protein, human; D009481:Neurophysins; D011498:Protein Precursors; D014667:Vasopressins; D012964:Sodium