Vasopressin release is enhanced by the Hemocontrol biofeedback system and could contribute to better haemodynamic stability during haemodialysis.
BACKGROUND
Haemodialysis with the Hemocontrol biofeedback system (HHD) is associated with improved haemodynamic stability compared with standard haemodialysis (HD) (SHD). Although the beneficial effect of HHD on haemodynamic stability is generally explained by its effect on blood volume, we questioned whether additional factors could play a role. Since HHD is associated with higher initial dialysate sodium concentrations and ultrafiltration (UF) rate, we studied whether the beneficial effect of HHD on haemodynamic stability may be explained by an increased release of the vasoconstrictor arginine vasopressin (AVP).


METHODS
Fifteen chronic dialysis patients underwent SHD and HHD in random order. All other treatment factors were identical and patients served as their own control. Plasma levels of AVP were measured pre-dialysis, at 30 and 60 min intra-dialysis and, next, hourly until completion of the dialysis session.


RESULTS
Plasma AVP levels did not change significantly during SHD, whereas AVP levels rose significantly within 30 min after the start of HHD (P < 0.01). AVP levels were significantly higher at 30 and 60 min of HHD in comparison with SHD (P < 0.05). Dialysis hypotension occurred significantly less frequent during HHD than during SHD (P < 0.05).


CONCLUSIONS
HHD is associated with higher initial AVP levels compared with SHD. The enhanced release of the vasoconstrictor AVP with HHD could contribute to the lower frequency of dialysis hypotension by facilitating fluid removal during the first part of the dialysis session, permitting lower UF rates during the second half of the dialysis session.
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.
Esmée M
EM
Ettema
Johanna
J
Kuipers
Henk
H
Groen
Ido P
IP
Kema
Ralf
R
Westerhuis
Paul E
PE
de Jong
Casper F M
CF
Franssen
D000328:Adult; D000368:Aged; D001127:Arginine Vasopressin / Q000097:blood / Q000378:metabolism*; D001676:Biofeedback, Psychology / Q000379:methods*; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012964:Sodium / Q000097:blood; D013997:Time Factors; D014661:Vasoconstriction / Q000502:physiology
D001127:Arginine Vasopressin; D012964:Sodium