title: Pathophysiological, cardiovascular and neuroendocrine changes in hypertensive patients during the hemodialysis session.
abstract: The pathophysiological mechanisms of arterial hypertension during hemodialysis (HD) in patients with end-stage renal disease (ESRD) are still poorly understood. The aim of this study is to investigate physiological, cardiovascular and neuroendocrine changes in patients with ESRD and its correlation with changes in blood pressure (BP) during the HD session. The present study included 21 patients with ESRD undergoing chronic HD treatment. Group A (study) consisted of patients who had BP increase and group B (control) consisted of those who had BP reduction during HD session. Echocardiograms were performed during the HD session to evaluate cardiac output (CO) and systemic vascular resistance (SVR). Before and after the HD session, blood samples were collected to measure brain natriuretic peptide (BNP), catecholamines, endothelin-1 (ET-1), nitric oxide (NO), electrolytes, hematocrit, albumin and nitrogen substances. The mean age of the studied patients was 43 ± 4.9 years, and 54.6% were males. SVR significantly increased in group A (P<0.001). There were no differences in the values of BNP, NO, adrenalin, dopamin and noradrenalin, before and after dialysis, between the two groups. The mean value of ET-1, post HD, was 25.9 pg ml(-1) in group A and 13.3 pg ml(-1) in group B (P = < 0.001). Patients with ESRD showed different hemodynamic patterns during the HD session, with significant BP increase in group A, caused by an increase in SVR possibly due to endothelial dysfunction, evidenced by an increase in serum ET-1 levels.
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: O A
authors.initials: OA
authors.lastname: Gutiérrez-Adrianzén
authors.affiliation: Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: M E A
authors.initials: ME
authors.lastname: Moraes
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: A P
authors.initials: AP
authors.lastname: Almeida
authors.affiliation: Department of Statistics, State University of Ceará, Fortaleza, Brazil.
authors.forename: J W O
authors.initials: JW
authors.lastname: Lima
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: M F
authors.initials: MF
authors.lastname: Marinho
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: A L
authors.initials: AL
authors.lastname: Marques
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: J P V
authors.initials: JP
authors.lastname: Madeiro
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Nepomuceno
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: J M S
authors.initials: JM
authors.lastname: da Silva
authors.affiliation: School of Medicine, Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Brazil.
authors.forename: G B
authors.initials: GB
authors.lastname: Silva
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: E F
authors.initials: EF
authors.lastname: Daher
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: C R M
authors.initials: CR
authors.lastname: Rodrigues Sobrinho
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002302:Cardiac Output; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000097:blood; D009569:Nitric Oxide / Q000502:physiology; D006435:Renal Dialysis; D014655:Vascular Resistance
chemical_list: D019332:Endothelin-1; D018377:Neurotransmitter Agents; D009569:Nitric Oxide