Is there a role for endothelin-1 in the hemodynamic changes during hemodialysis?
BACKGROUND
The etiology of hemodialysis (HD)-induced hypotension and hypertension remains speculative. There is mounting evidence that endothelin-1 (ET-1) may play a vital role in these hemodynamic changes. We examined the possible role of intradialytic changes of ET-1 in the pathogenesis of hypotension and rebound hypertension during HD.


METHODS
The present study included 45 patients with end-stage renal disease (ESRD) on regular HD. They were divided according to their hemodynamic status during HD into three groups (group I had stable intradialytic hemodynamics, group II had dialysis-induced hypotension, and group III had rebound hypertension during HD). In addition, 15 healthy volunteers were included as a control group. Pulse and blood pressure were monitored before, during (every half hour), and after HD session. ET-1 level was measured at the beginning, middle, and end of HD. ET-1 was measured in the control group for comparison.


RESULTS
Pre-dialysis levels of ET-1 were significantly higher in dialysis patients compared to the controls (P < 0.001); however, they were comparable in the three HD groups. The post-dialysis ET-1 level was not changed significantly in group I compared with predialysis values (14.49 +/- 2.04 vs. 14.33 +/- 2.23 pg/ml; P = NS), while the ET-1 concentration decreased significantly in group II and increased in group III in comparison to predialysis values (8.56 +/- 1.44 vs. 11.75 +/- 2.51; 16.39 +/- 3.12 vs. 11.93 +/- 2.11 pg/ml, respectively; P < 0.001).


CONCLUSIONS
Altered ET-1 levels may be involved in the pathogenesis of rebound hypertension and hypotension during HD.
El-Shafey
E M
EM
Department of Internal Medicine, Nephrology, Faculty of Medicine, Tanta University, Tanta, Egypt. shafey70@yahoo.com.
El-Nagar
G F
GF
Department of Internal Medicine, Nephrology, Faculty of Medicine, Tanta University, Tanta, Egypt.
Selim
M F
MF
Department of Internal Medicine, Nephrology, Faculty of Medicine, Tanta University, Tanta, Egypt.
El-Sorogy
H A
HA
Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt.
Sabry
A A
AA
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D004534:Egypt; D019332:Endothelin-1 / Q000097:blood / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology*; D007022:Hypotension / Q000209:etiology* / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis
D019332:Endothelin-1