title: Dialysis hypotension: a role for inadequate increase in arginine vasopressin levels? A systematic literature review and meta-analysis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors: Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors: Esmée M
authors: EM
authors: Ettema
authors: Debbie
authors: D
authors: Zittema
authors: Johanna
authors: J
authors: Kuipers
authors: Ron T
authors: RT
authors: Gansevoort
authors: Priya
authors: P
authors: Vart
authors: Paul E
authors: PE
authors: de Jong
authors: Ralf
authors: R
authors: Westerhuis
authors: Casper F M
authors: CF
authors: Franssen
mesh_terms: D001127:Arginine Vasopressin / Q000097:blood*; D006801:Humans; D007022:Hypotension / Q000097:blood* / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D001127:Arginine Vasopressin